Toxicological Analysis Of Blood Research Articles

Detection of thiocyanate in postmortem blood of a fatal potassium thiocyanate-poisoning patient using gas chromatography-mass spectrometry.

Thiocyanate is an inorganic compound used in industrial applications. Here, we report a case of suicidal death due to acute thiocyanate overdose. A 44-year-old man who consumed an unknown amount of thiocyanate solution was transferred to the emergency room and died two hours after admission. An autopsy was performed two days after death. General toxicological analysis of blood using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry found no drug or alcohol. Quantification using GC-MS post-derivatization with pentafluorobenzyl bromide revealed 2,290 and 1,920 mg/L of thiocyanate in the heart and femoral blood samples, respectively. Thus, the cause of death was attributed to thiocyanate overdose. This study provides useful information for the interpretation of thiocyanate-related fatalities.

The Spectrum of Toxicological Analysis in a Tertiary Care Setting-Pakistan

Objective: To determine the frequency of opiate, cannabinoid, amphetamine, benzodiazepine, barbiturate, organophosphate, alcohol and related drugs of abuse poisonings in the tertiary care setting.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Toxicology & Therapeutic Drug Monitoring, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2014 to Mar 2019.
 Methodology: Random sampling was done, and specimens of blood in an EDTA bottle, urine in a plain container and gastric lavage in a syringe were collected for drugs of abuse (Opiate, Cannabinoid, Amphetamine, Benzodiazepine, Barbiturate, Organophosphate) and alcohol. The screening was done on fluorescence immunoassay and Microarray Technology, while confirmation was done on Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS) for all drugs of abuse except alcohols and Gas Chromatography (GC-Head space) for alcohols.
 Results: 146,601 toxicological tests were divided into two categories according to request forms; clinical toxicological cases 92,333 (63 %) and forensic toxicology 54,268 (37%). The maximum no of cases were routine toxicological analysis of blood, urine, and gastric lavage, 89,169 (60.8%) tests, and emergency toxicology cases were only 1,708 (1.2%) tests in clinical toxicology. Forensic toxicology included a maximum of no cases of routine workplace testing (two drug panel testscannabinoid and opiate) 43,850 (29.9%), and post mortem toxicology cases were only 6912 (4.7%). The frequency of benzodiazepine poisoning was maximum 1390 (28.5%) than cannabinoid and opiate poisoning, i.e., 180 (3.7%) and 210 (4.3%) respectively, in clinical toxicology cases. The frequency of benzodiazepine poisoning was still maximum 501 (22.2%) than Cannabinoid, Amphetamine and opiate poisoning, which were....

Випадок нетравматичної субдуральної гематоми

The risk for the development of subacute or chronic subdural hematoma is associated with the widespread use of anticoagulant therapy for both prophylactic and therapeutic purposes. Therefore, the purpose of the study was to carry out clinical and morphological analysis of the case of chronic subdural hematoma associated with the use of antithrombotic therapy to substantiate the pathogenetic links of their relationship. Materials and methods. The case report. The body of a woman with signs of bodily injuries was found in the apartment at the place of residence. The autopsy along the entire length of the vertebral canal revealed a draining thin-layer subdural hemorrhage in the form of layers of liquid dark red blood, which effortlessly filled all the free spaces between the dura mater and arachnoid mater. The bones of the vault, the base and the frontal skeleton of the skull were intact. The dura mater was moderately tense, grayish in color, with the bones of the skull tightly fused in all parts of the skull. On the convex and basal surfaces of both hemispheres of the brain with spread between the hemispheres of the brain, around the cerebellum and trunk with penetration into the large occipital foramen, subdural hemorrhage in the form of layers of thick dark red blood was found. Forensic histological examination of pieces of internal organs revealed hemorrhage under the dura mater of the brain and spinal cord with reactive inflammatory changes, deposition of hemosiderin granules. Forensic toxicological analysis of blood, urine, stomach and small intestine contents, liver and gallbladder and kidneys revealed diclofenac and an unknown substance that might be an anticoagulant; however, it could not be identified by the approved methods due to the limited number of comparison samples. Examination of the corpse in the apartment revealed blisters and ampoules of various drugs in the largest amount of diclofenac, warfarin. Results and discussion. The analysis of the data obtained on the scene, as well as from the medical history, records in the available medical documentation, morphological characteristics of detected hemorrhages, results of forensic toxicological and forensic histological studies have established that hemorrhages might have occurred due to uncontrolled use of diclofenac and warfarin. Conclusion. Subdural hematomas are currently the topical medical and social issue due to the significant growing rate of its incidence. Based on this case, it can be stated that the development of chronic subdural hematoma is caused by the combination of mild trauma and inflammatory response in the damaged dura mater with potentiation of hematoma formation through the use of antithrombotic drugs

Simultaneous fatal poisoning of two victims with 4F-MDMB-BINACA and ethanol

PurposeMethyl-2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate (4F-MDMB-BINACA) is a newly emerging synthetic cannabinoid receptor agonists (SCRA) first described in 2018 in both Europe and the United States. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.MethodsThe victims were brothers who were both found deceased after consuming 4F-MDMB-BINACA and ethanol. Post-mortem toxicological analyses of blood and urine were carried out by supercritical fluid chromatography tandem mass spectrometry (SFC–MS/MS) and headspace gas chromatography with flame ionization detection (HS-GC–FID).ResultsThe concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively.ConclusionAccording to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The threshold SCRA concentration for fatal overdose can be estimated ng/mL level (0.37–4.1 ng/mL according to the reported cases) in cases in which 1.5–2.5 g/L of ethanol is present in the blood.

Determination of Aldicarb, Carbofuran and Methamidophos in Blood Derived from Forensic Cases through Liquid Chromatography with Electrospray Ionization and Tandem Mass Spectrometry (LC--ESI-MS-MS).

The presence and use of carbamate and organophosphate pesticides with agricultural and urban purposes in Colombia has been justified for pest control. However, these substances pose a national problem because of their toxic nature, which is associated with accidental poisoning or even with homicides or suicides related to acute fatal poisoning. This study aims to develop and to validate an analytical methodology for the determination of the aldicarb, carbofuran and methamidophos pesticides in blood through liquid chromatography--tandem mass spectrometry (LC-MS-MS). To this end, the method for extracting pesticides from the blood was developed, the conditions of LC were defined, the instrumental system MS-MS was optimized and the bioanalytical methodology was validated. This methodology proved to be selective, precise, accurate and linear in the concentration range from 0.10 to 5.0 µg/mL, with a limit of detection of 0.020 µg/mL for aldicarb and carbofuran and 0.050 µg/mL for methamidophos, recovery between 90% and 102%, and stability at room temperature and in the autosampler between 80% and120%. The analytical methodology was applied to 34 forensic cases. Carbofuran was found at a concentration ranging from 0.020 to >5.0 µg/mL, aldicarb was found at a concentration ranging from 0.10 to 2.5µg/mL and methamidophos was found at a concentration >5.0 µg/mL. In 62% of the cases, the pesticides under study were used to commit suicide. Necropsy findings of pesticide poisoning are non-specific. Therefore, toxicological blood analysis provides significant information at the forensic level, and the analytical method validated represents a sensitive, fast and reliable analysis with little solvent consumption of a small sample amount, so it is suitable for routine application in fatal pesticide poisonings.

New Psychoactive Substance 5-MeO-MiPT In vivo Acute Toxicity and Hystotoxicological Study.

The hallucinogenic tryptamine analog 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT) causes social problems worldwide. There are several studies on the metabolism; however, not more studies were found in the literature on acute toxicity. To report the acute toxicity of 5-MeO-MiPT in mice, followed by quantitative toxicological analysis of blood and organs, hystotoxicological and immunohistochemical analysis of tissues and cells. Animal experiment Methods: In vivo experiments were performed using CD1 adult female mice (n=26). Animals were caged in 4 groups randomly. First group was a control (n=3). Second group was vehicle control (n=3) and injected 150 μL of blank solution (50% dimethyl sulfoxide in saline /0.9% of NaCl). While for acute toxicity experiments, 5-MeO-MiPT was added to a blank solution in order to obtain a dose of 0.27 mg/kg in 150 μL injection (n=10) and the last group were injected 2.7 mg/kg 5-MeO-MiPT in a 150 μL injection (n=10). Quantitative toxicological analysis, hystotoxicological and immunohistochemical analysis were performed. In the toxicological analysis, 5-MeO-MiPT was found negative in biological samples which were control, vehicle control, and 0.27 mg/kg dose mice groups. 5-MeO-MiPT was found 2.7-13.4 ng/mL in blood, 11-29 ng/g in kidney, 15.2-108.3 ng/g in liver, and 1.5-40.6 ng/g in the brain in 2,7 mg/kg injected group. In a low dose of the 5-MeO-MiPT liver section, compared with normal tissues, the difference in staining was statistically significant (p<0.0001). In high-dose of 5-MeO-MiPT, H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p<0.05). In high-dose of 5-MeO-MiPT, intense Caspase-3 immunoreactivity was observed and the increase in the number of Caspase-3 positive cells compared to the control was statistically significant (p<0.05). In brain section, the statistics of the results obtained from the H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p=0.0183). In vehicle control liver section, there were few Caspase-8 positive cells characterized by a light brown appearance (p=0.0117). In the high-dose 5-MeO-MiPT group, the numbers of positive cells at low and high doses of 5-MeO-MiPT group were statistically significant compared to the control (p<0.05). In the high-dose 5-MeO-MiPT group, Caspase-8 immunoreactivity was detected in the glomerular structures. Compared to control, the increase in Caspase-8 immunoreactivity was found to be statistically significant (p<0.05). Low-dose 5-MeO-MiPT did not cause any serious histopathological effects on the liver, kidney, and brain. High doses induce apoptotic cell death through caspase activity.

Sudden Death of a Child due to Unidentified Chronic Myocarditis: Autopsy Findings

Objective – In this paper, we present the case of the sudden cardiac death of an apparently healthy 15-year-old adolescent, as well as the autopsy findings, with histopathology. Case report – A 15-year-old boy was found unconscious in his brother’s room. The boy had not been diagnosed with any disease and was apparently healthy. Preliminary autopsy findings indicated the predominance of cardiac pathology in relation to his death. All the cardiac cavities were dilated and enlarged. The trabeculae were more pronounced and thicker, with deepened spaces between them. In the anterior wall and almost the entire upper half of the posterior wall of the left ventricle, as well as the interventricular septum, with almost the entire thickness of the wall, the myocardial tissue was densely imbued with fibrous tissue. Microscopic analysis of cardiac sections showed large fields of hypocellular (scarring) fibrosis, as well as smaller fibrosis focuses of moderate cellularity, with fibroblasts, fibrocytes, and lymphocytes present. Toxicological analysis of blood taken from the femoral vein during autopsy was also performed, and the results showed that there were no traces of alcohol or psychoactive substances. Conclusion – Myocarditis is not uncommon in the pediatric population and has a relatively good prognosis, with most cases resulting in complete recovery. Extensive chronic inflammation with severe fibrosis in an apparently healthy boy leading to death makes our case particularly significant.

Development and Validation of a Method for the Analysis of Bisoprolol and Atenolol in Human Bone.

A method based on gas chromatography–mass spectrometry (GC–MS) is described for the determination of bisoprolol and atenolol in human bone. After the addition of lobivolol as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were centrifuged, and the supernatants were subjected to solid phase extraction. Elution was achieved by using 3 mL of 2% ammonium hydroxide in 80:20 dichloromethane:isopropanol solution. Eluted samples were evaporated and derivatized. Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.1–0.3 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries were 60% for bisoprolol and 106% for atenolol, the matrix effect was 69% for bisoprolol and 70% for atenolol and process efficiency was 41% for bisoprolol and 80% for atenolol. The intra- and inter-assay accuracy values were always better than 12%. The validated method was then applied to bone samples from two real forensic cases in which toxicological analysis in blood were positive for atenolol in the first case (0.65 µg/mL) and bisoprolol in the second case (0.06 µg/mL). Atenolol was found in bone samples from the corresponding case at the approximate concentration of 148 ng/mg and bisoprolol was found at 8 ng/mg.

Drug screening using the sweat of a fingerprint: lateral flow detection of Δ9-tetrahydrocannabinol, cocaine, opiates and amphetamine.

Here, we describe the use of a fluorescence based lateral flow competition assay for the screening of four classes of drugs, viz, Δ9-tetrahydrocannabinol (THC), cocaine (through the detection of benzoylecgonine, BZE), opiates (through the detection of morphine, MOR) and amphetamine (AMP) present in the sweat of a fingerprint. The Drug Screening Cartridge was specifically developed for fingerprint sample collection and analysis. For this study, the cut-offs were set at: 190, 90, 68 and 80 pg/fingerprint for THC, BZE, MOR and AMP, respectively. Working with three UK coroners, the Drug Screening Cartridge, together with its fluorescence reader, was applied to the detection of drugs in the sweat of a fingerprint from deceased individuals. The study shows that there was sufficient sweat present on the fingertips to enable analysis and that the Drug Screening Cartridge could detect the presence, or absence, of each drug. The presence of the drugs was confirmed using LC–MS-MS analysis of a second fingerprint sample collected simultaneously. Excellent correlation was achieved between the results obtained from the Drug Screening Cartridge and the LC–MS-MS analysis of the fingerprint samples obtained from 75 individuals. The accuracy of the results was: 99% for THC; 95% for BZE; 96% for MOR and 93% for AMP. The results obtained using the Drug Screening Cartridge were also compared to toxicological analysis of blood and urine samples with good correlation. The accuracy of the results between the Drug Screening Cartridge and blood was: 96%, 92%, 88% and 97% for THC, BZE, MOR and AMP, respectively. The comparison with urine showed an accuracy ranging between 86% and 92%. This fingerprint sample method has a collection time of just 5 s and a total analysis time of <10 mins. These results show that the lateral flow Drug Screening Cartridge is an excellent screening test to provide information on drug use from the sweat in a single fingerprint sample.

Cortical Expression of the Polysialylated Isoform of the Neural Cell Adhesion Molecule on Brain Tissue to Recognize Drug-Related Death: An Exploratory Analysis.

The polysialylated isoform of the neural cell adhesion molecule (PSA-NCAM) has been shown to be a key player in neuroplastic changes and is expressed in various disorders. We investigated the PSA-NCAM expression on brain cortical tissue in a cohort of drug-related deaths. Brains from 25 drug abusers and 10 control subjects were removed at autopsy, and 2 samples of the right parietal lobe of each case were obtained. The polysialylated isoform of NCAM was evaluated on formalin-fixed and paraffin-embedded tissues. Eleven patients were polydrug abusers; 14 used a single substance. The mechanisms of death were acute respiratory failure (n = 19), cardiorespiratory failure (n = 4), acute heart failure (n = 1), and brain injury (n = 1). Toxicological analyses of blood were available for all cases, and urine and bile analyses for 19 of 25 cases. The polysialylated isoform of NCAM immunoexpression in the neuronal soma and dendritic spines was observed in 18 (72%) of 25 drug abusers and in 2 (20%) of 10 control subjects. Drug abusers were statistically more positive for PSA-NCAM than control subjects (P = 0.0082). The expression of PSA-NCAM in the parietal cortex could be an indicator of brain damage due to drug abuse, and its availability could allow the forensic pathologists to develop rapid and low-cost additional or alternative method to improve detection of drug-related deaths.

Suicide among Young People and Adults in Ireland: Method Characteristics, Toxicological Analysis and Substance Abuse Histories Compared.

ObjectiveInformation on factors associated with suicide among young individuals in Ireland is limited. The aim of this study was to identify socio-demographic characteristics and circumstances of death associated with age among individuals who died by suicide.MethodsThe study examined 121 consecutive suicides (2007–2012) occurring in the southern eastern part of Ireland (Cork city and county). Data were obtained from coroners, family informants, and health care professionals. A comparison was made between 15-24-year-old and 25-34-year-old individuals. Socio-demographic characteristics of the deceased, methods of suicide, history of alcohol and drug abuse, and findings from toxicological analysis of blood and urine samples taken at post mortem were included. Pearson’s χ2 tests and binary logistic regression analysis were performed.ResultsAlcohol and/or drugs were detected through toxicological analysis for the majority of the total sample (79.5%), which did not differentiate between 15-24-year-old and 25-34-year-old individuals (74.1% and 86.2% respectively). Compared to 25-34-year-old individuals, 15-24-year-old individuals were more likely to engage in suicide by hanging (88.5%). Younger individuals were less likely to die by intentional drug overdose and carbon monoxide poisoning compared to older individuals. Younger individuals who died between Saturday and Monday were more likely to have had alcohol before dying. Substance abuse histories were similar in the two age groups.ConclusionBased on this research it is recommended that strategies to reduce substance abuse be applied among 25-34-year-old individuals at risk of suicide. The wide use of hanging in young people should be taken into consideration for future means restriction strategies.

Postmortem investigation of 88-cm-long dreadlocks for drugs of abuse: an unusual case report in the northeast of Germany

A 32-year-old male was found dead on the couch in his flat. Several pieces of paraphernalia for the use of illicit drugs were located on the table in front of his body. The occasional consumption of heroin and cannabis products was known. Toxicological analyses of blood, urine, and of his long (88 cm) dreadlocks were performed after autopsy. General, unknown screenings of femoral vein blood and urine were performed using different extractions, gas chromatography/mass spectrometry (GC/MS) or high-performance liquid chromatography-diode array detection. A possible influence by alcohol was determined by gas chromatography/flame ionisation detection and an alcohol dehydrogenase method. The dreadlocks were washed, segmented in 83 parts (each ~1 cm length) and pulverised using a pebble mill. Quantitative determination of illicit drugs was performed using GC/MS (selected ion monitoring). Investigation of the femoral vein blood resulted in the detection of morphine (71.1 µg/L), 6-acetylmorphine (7.4 µg/L), and codeine (9.8 µg/L). These substances and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol were also detected in urine. Alcohol concentrations in blood and urine were 2.31 and 3.01 ‰, respectively. Investigation of the segmental dreadlocks revealed concentration profiles for Δ9-tetrahydrocannabinol (≤0.65 µg/g), heroin (≤0.44 µg/g), morphine (≤1.02 µg/g), 6-acetylmorphine (≤1.13 µg/g), and codeine (≤0.32 µg/g). Strong correlations among morphine, 6-acetylmorphine, and codeine have been observed in the twelve most proximal hair segments. The consumption of heroin increased clearly in this time period. In summary, a discontinuous, long-term, illicit drug abuse and fatal intoxication with heroin and alcohol was verified by the analysis of these very long dreadlocks.

Zastrupitve z gama-hidroksibutiratom v Ljubljani med letoma 2000 in 2014

Background: Gamma-hydroxybutyrate (GHB) is an illicit drug causing unconsciousness and respiratory depression. The aim of this study was to evaluate the clinical presentation and treatment in patients admitted to the University Medical Centre Ljubljana (UMCL).Methods: In this study we included all retrospectively reviewed cases of GHB-poisoning admitted to the UMCL between 2000 and 2014. We collected all the data regarding the overdose circumstances, clinical presentation, treatment and toxicological analysis of blood and urine.Results: In the previous 15 years a total of 74 patients were admitted to the UMCL due to GHB-poisoning. The first case of GHB-poisoning was observed in 2002 and the numbers have largely increased since 2012. 86% of all the patients ingested the drug intentionally, 82% were male and the median age of admitted patients was 27 years. We recorded 6 mass GHB-poisonings in which 2-4 patients were admitted simultaneously. The most common presenting symptom of GHB-poisoning was diminished level of consciousness (95%), with 53% being unresponsive to pain. Vomiting (30%), bradycardia (28%), hypotension (26%), hypoventilation with respiratory insufficiency (19%) and agittation upon awakening (31%) were common as well. Concomitant alcohol and illicit drug use was recorded in 61% of cases. 80% of all the patients were treated symptomatically, 14% were mechanically ventilated.Conclusions: The incidence of GHB-poisoning has increased in recent years. GHB-poisoned patients are predominantly male, often admitted in groups, who ingest the drug intentionally at parties during weekends. The most common presenting symptom of GHB-poisoning is unconsciousness. Treatment is symptomatic.

Report of five cases of 2,5-dimethoxy-4-(n)-propylphenethylamine (2C-P) intoxication following recreational use

Summary Introduction 2,5-dimethoxy-4-(n)-propylphenethylamine-P (2C-P) is a synthetic derivative belonging to the new so-called 2C-series family of phenethylamine recreational drugs. The exact mechanism of 2C compounds is unknown, but they show affinity for the 5-HT2 serotoninergic receptors. We report on the toxicological analysis findings on five cases of exposure to 2C-P. Case-series The five cases involved five men aged from 17 to 21 years old. They ingested 2C-P (powder or liquid form) in a festive setting. Their major symptoms were mydriasis, severe agitation, confusion, visual hallucinations, sinus tachycardia and high blood pressure. The outcome was favourable for the five patients. Methods For the five patients, toxicological analyses of blood and urine samples obtained on admission were performed using both GC-MS and HPLC-DAD. Specific 2C-P assays were performed by HPLC-DAD and UPLC-MS/MS. Results Toxicological analysis identified 2C-P as the main active substance in urines of all five cases and in the plasma of only one case (20 μg/L). Conclusion Our results showed that 2C-P was active at very low levels. Clinicians should be alert to this substance and they should confirm exposure by blood and urine analysis.

Hair Analysis for Long-Term Monitoring of Buprenorphine Intake in Opiate Withdrawal

Buprenorphine (BUP) is a psychoactive pharmaceutical drug largely used to treat opiate addiction. Short-term therapeutic monitoring is supported by toxicological analysis of blood and urine samples, whereas long-term monitoring by means of hair analysis is rarely used. Aim of this work was to develop and validate a highly sensitive ultrahigh-performance liquid chromatography tandem mass spectrometry method to detect BUP and norbuprenorphine (NBUP) in head hair. Interindividual correlation between oral dosage of BUP and head hair concentration was investigated. Furthermore, an intra-individual study by means of segmental analysis was performed on subjects with variable maintenance dosage. Hair samples from a population of 79 patients in treatment for opiate addiction were analyzed. The validated ultrahigh-performance liquid chromatography tandem mass spectrometry protocol allowed to obtain limits of detection and quantification at 0.6 and 2.2 pg/mg for BUP and 5.0 and 17 pg/mg for NBUP, respectively. Validation criteria were satisfied, assuring selective analyte identification, high detection capability, and precise and accurate quantification. Significant positive correlation was found between constant oral BUP dosage (1-32 mg/d) and the summed up head hair concentrations of BUP and NBUP. Nevertheless, substantial interindividual variability limits the chance to predict the oral dosage taken by each subject from the measured concentrations in head hair. In contrast, strong correlation was observed in the results of intra-individual segmental analysis, which proved reliable to detect oral dosage variations during therapy. Remarkably, all hair samples yielded BUP concentrations higher than 10 pg/mg, even when the lowest dosage was administered. Thus, these results support the selection of 10 pg/mg as a cutoff value.

Early Career in Drug Abuse with Preference for γ-Hydroxybutyrate Resulted in a Mixed Drug Overdose Death

Early Career in Drug Abuse with Preference for γ-Hydroxybutyrate Resulted in a Mixed Drug Overdose Death The recreational drug of abuse γ-hydroxybutyric acid (GHB) is a depressant of the central nervous system (CNS) and is often encountered in blood and urine analysed during forensic case-work. Here we report the results of toxicological analysis of blood or urine from a person arrested for abuse of illicit drugs on 28 occasions over 13 years. GHB was identified on 21 occasions, either in blood (6 times) or urine (15 times). Another popular drug of abuse was amphetamine, which was identified 15 times. The man died from a mixed-drug overdose at the age of 29 years and post-mortem toxicology showed GHB concentrations of 200 mg/L in femoral blood and 4700 mg/L in urine. The much higher concentration of GHB in urine indicates that the concentrations in blood (and brain) were much higher than 200 mg/L during the ante-mortem period, owing to GHB’s short plasma elimination half-life of 30-60 min. An early intervention and treatment for substance abuse might have been more beneficial than conventional sanctions and penalties for petty drug offences.

Multiple injuries in suicide simulating homicide: Report of three cases

Multiple inflicted injuries in traumatic deaths usually indicate homicide. Three cases are reported where homicide was initially suspected due to findings at the death scene and the apparent nature of the injuries however, after investigation, involvement of any other individuals in the deaths could be excluded. Case 1: A 52-year-old male was found with multiple stab wounds. At autopsy, 36 stab wounds were identified, the majority of which were superficial. Only two stab wounds had penetrated deeply. Case 2: A 19-year-old female was found with three gunshot entry wounds to the right temple and a .22 calibre automatic rifle resting across her lap. Case 3: A 47-year-old female was found with numerous haematomas and three deep head wounds in keeping with trauma from impact with a blunt object. A high level of clozapine was detected on toxicological analysis of blood and a history of schizophrenia was reported. Although multiple self-inflicted wounds are most often caused by sharp objects such as knives, on occasion multiple gunshot wounds and rarely, blunt trauma may also be encountered. Careful integration of scene and autopsy findings may be required to avoid misinterpretation of the circumstances and manner of death.

Severe Maajoun Poisoning in Two Infants, Morocco

Maajoun is a pastry mixture prepared from hemp resin and other aphrodisiacs. It is widely consumed in Morocco for addiction and its aphrodisiac effects. Its frequent and common consumption in adults expose the children and infants to serious accidental intoxication leading sometimes to death. We report two cases of severe poisoning in two infants due to an accidental ingestion of Maajoun with good outcome after a symptomatic treatment. Case 1: An infant aged 14 months accidentally ingested a piece of Maajoun and he presented coma, hypothermic, bradycardia and mydriasis. The biological test was normal. The toxicological analysis using immunological methods carried out on the urines was positive for the tetrahydrocannabinol (cannabis) and the Benzodiazepines. The evolution was favourable without any complication nor sequelae. Case 2: A 12 months healthy infant without any previous significant pathology was admitted to the emergency for apyretic seizures. The clinical exam objectified a tonico-clonic crisis of the four limbs with revulsion eyes and pupils in mydriasis. No neurological deficiency was associated. The infant was tachycardic at 180 beats / min, apyretic and normotensive. Toxicological analysis in blood and urine was negative for medication and pesticides. The appearance of fever to 38.5 justified the practice of lumbar puncture and a CT scan that came back normal excluding cerebromeningeal affection. A new oriented interrogation revealed addiction notion at the neighbours’. The toxicological research using immunochemical method “Olympus” has confirmed a high level of cannabis (150 ng/ml). The evolution was favourable after symptomatic treatment. The infant was discharged from the hospital after 24 hours of medical supervision. Conclusion: Accidental maajoun poisoning in infants can be serious and leading sometimes to death, health professionals should be aware of this fact and of the management of this type of poisoning in children.

Toxicological analysis of blood and urine samples from female victims of alleged sexual assault

Background. The toxicological analysis of blood and urine samples from victims of alleged sexual assault represents a crucial part of the forensic evidence when this crime is investigated. Material and methods. We searched a national forensic toxicology database (TOXBASE) to find cases registered as sexual assault, rape, including date-rape that the police had requested the analysis of ethanol and other drugs. Between 2008 and 2010, N = 1460 such cases met this criteria. After immunological screening of urine or blood samples, all positive results were verified by more specific analytical methods, such as gas chromatography-mass spectrometry (GC-MS) for illicit drugs. A large number of prescription drugs and their metabolites were determined by capillary GC with nitrogen-phosphorous (N-P) detector. GC with flame ionization detector (FID) was used to analyze ethanol and gamma-hydroxybutyrate (GHB) in blood at limits of quantitation (LOQ) of 0.1 g/L and 8 mg/L, respectively. Results. The average age (± standard deviation) of all victims was 24 ± 10.3 years and 72% were between 15 and 29 years. Ethanol and other drugs were not detected in 31% of cases (N = 459). Blood-ethanol was positive in N = 658 cases at mean, median and highest concentrations of 1.23 g/L, 1.22 g/L and 4.3 g/L, respectively. Ethanol plus drugs were present in N = 188 cases (13%) and one or more other drugs alone in N = 210 cases (14%). Cannabis (marijuana) and amphetamines were the major illicit drugs, whereas diazepam, alprazolam, zopiclone as well as newer antidepressants were the major prescription drugs identified. Conclusions. The mean age of victims of sexual assault in Sweden, the proportion of drug positive to drug negative cases, the predominance of ethanol positive cases as well as the types of other drugs showed a remarkably good agreement in two studies spanning a period of 8 years.

Suicidal strangulation by plastic lock tie

A case of self-strangulation with a rare kind of ligature material is reported and discussed. The merit of the case lies in the ‘self-retaining’ nature of the ligature material deployed. The case subject was a 50 year old man found dead in an open field with a unique ligature material of ‘plastic lock tie’ in-situ at neck. Forensic autopsy revealed ligature mark above the level of thyroid cartilage, evidence of bleeding through mouth and nostrils along with generalized features of congestion. Toxicological analysis of blood and viscera detected organophosphorus poison in stomach contents. Cause of death was opined as mechanical asphyxia due to compression of neck by self-strangulation. The importance of a scrupulous forensic autopsy supplemented by ancillary investigations and circumstantial evidences are highlighted. The relevance of the visit of autopsy surgeon to the scene of occurrence is emphasized.