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postmortem toxicology

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https://www.readbyqxmd.com/read/28340233/increase-in-drug-overdose-deaths-involving-fentanyl-rhode-island-january-2012-march-2014
#1
Melissa C Mercado, Steven A Sumner, M Bridget Spelke, Michele K Bohm, David E Sugerman, Christina Stanley
Objective.:  This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl. Methods.:  This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases...
March 6, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28315148/a-case-of-cardiac-tamponade-due-to-an-isolated-abscess-in-the-ascending-aorta-of-a-pregnant-woman-with-a-history-of-intravenous-substance-abuse
#2
Brandy Shattuck, John Livingstone
We describe the case of a 23-year-old white female, 10-12 weeks pregnant, with a history of intravenous drug use and a recently diagnosed pneumonia, who was found deceased in her bed after a night of sleep. Although postmortem serum toxicology tested positive for alprazolam, tetrahydrocannabinol, and morphine, the ultimate cause of death was determined to be cardiac tamponade secondary to an isolated abscess in the ascending aorta. The patient had several risk factors for aortic rupture and cardiac tamponade including intravenous drug use, pneumonia, and pregnancy...
March 17, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28261784/fatal-folic-acid-toxicity-in-humans
#3
Gerard Pradeep Devnath, Senthil Kumaran, R Rajiv, Kusa Kumar Shaha, Ashok Nagaraj
Folic acid is B-9 vitamin. Folic acid is prescribed commonly for pregnant women to prevent neural tube defects in the fetus, patients under chemotherapy, pernicious anemia and to reduce the risk of stroke and cardiovascular disease. Acute or chronic ingestion of a large dose of folic acid generally manifests as neurological complications, which are reversible. In this present case, a 23-year-old pregnant woman committed suicide by consuming folic acid tablets and succumbed to death within 36 h. Postmortem toxicological analysis detected folic acid in viscera...
March 6, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28240418/analysis-of-drugs-of-abuse-in-cerumen-correlation-of-postmortem-analysis-results-with-those-for-blood-urine-and-hair
#4
Sylvia I Meier, Sarah C Koelzer, Manfred Schubert-Zsilavecz, Stefan W Toennes
The evaluation of drug and alcohol abuse is a major subject of forensic toxicology. Assessment of drug abstinence currently requires the analysis of urine or hair. In the present study cerumen, a mixture of sebum and sweat, was tested as an alternative. Postmortem samples (blood, urine, hair and cerumen from 38 corpses) were analyzed using liquid chromatography and gas chromatography, each coupled to mass spectrometry (LC-MS, GC-MS). The results were compared. In all cases of recent drug use (i.e. detection of opiates, amphetamine and derivatives, cocaine, methadone and diazepam or their metabolites in blood) the corresponding cerumen was positive...
February 27, 2017: Drug Testing and Analysis
https://www.readbyqxmd.com/read/28237441/toxicological-results-in-a-fatal-and-two-non-fatal-cases-of-scopolamine-facilitated-robberies
#5
K J Lusthof, I J Bosman, B Kubat, M J Vincenten-van Maanen
The use of scopolamine as an incapacitating drug, in sexual crimes and robberies, has been known for many decades. However, blood concentrations and doses of scopolamine in those cases are largely unknown. Here we present the toxicological results of one fatal and two non-fatal cases in a series of scopolamine-facilitated robberies. In the fatal case, the concentration of scopolamine in heart blood was 0.30mg/L, about 3000 times higher than the average therapeutic level of 0.0001mg/L (for one dermal patch)...
February 4, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28133719/the-toxicology-of-methadone-related-death-in-infants-under-1-year-three-case-series-and-review-of-the-literature
#6
Anthea B Mahesan Paul, Lary Simms, Arnold M Mahesan
Methadone-related fatalities occur rarely in infants under 1 year, with five confirmed cases in the literature. The interpretation of pediatric postmortem toxicology relies on adult data; however, infants have crucial physiological differences that may impact interpretation of results. Retrospective case review included scene investigation, interviews, autopsy, and NIH/CDC Sudden Unexplained Infant Death Investigation Reporting Form. Methadone levels were confirmed by liquid chromatography/tandem mass spectrometry (LC-MS/MS)...
January 30, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28114865/sudden-death-in-racehorses
#7
Santiago S Diab, Robert Poppenga, Francisco A Uzal
In racehorses, sudden death (SD) associated with exercise poses a serious risk to jockeys and adversely affects racehorse welfare and the public perception of horse racing. In a majority of cases of exercise-associated sudden death (EASD), there are no gross lesions to explain the cause of death, and an examination of the cardiovascular system and a toxicologic screen are warranted. Cases of EASD without gross lesions are often presumed to be sudden cardiac deaths (SCD). We describe an equine SD autopsy protocol, with emphasis on histologic examination of the heart ("cardiac histology protocol") and a description of the toxicologic screen performed in racehorses in California...
January 1, 2017: Journal of Veterinary Diagnostic Investigation
https://www.readbyqxmd.com/read/28108144/postmortem-in-vitro-ethanol-production-it-could-be-more-common-than-we-think
#8
Maria José Quintas, Pedro Costa, Paula Melo, André Castro, João Miguel Franco, Helena M Teixeira
The blood alcohol concentration (BAC) is the most frequent determination in a Forensic Toxicology Laboratory. Despite its apparent simplicity, the results interpretation can be complex and always have relevant social and legal implications, particularly in postmortem analysis. In the present report we describe the case of a 55-year-old male with an apparent natural death by myocardial infarction, whose initial BAC was 0.18g/L but, in repeated determinations prompted by discrepancies observed in the first two, it rapidly increased to 0...
January 5, 2017: Forensic Science International
https://www.readbyqxmd.com/read/28096302/postmortem-and-toxicological-findings-in-a-series-of-furanylfentanyl-related-deaths
#9
Davide Guerrieri, Emma Rapp, Markus Roman, Henrik Druid, Robert Kronstrand
Over the course of 4 months in 2015 and 2016, a cluster of seven fatal intoxications involving the opioid-analogue furanylfentanyl occurred in Sweden; toxicological analysis showed presence of furanylfentanyl either as the only drug or in combination with other illicit substances. Previous publications have only reported non-lethal furanylfentanyl intoxications. In the cases presented here, furanylfentanyl intoxication-alone or in combination with other drugs-was determined to be the cause of death by the responsible pathologist...
January 17, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28012128/death-of-a-seven-month-old-child-in-a-washing-machine-a-case-report
#10
Antonio Osculati, Silvia Damiana Visonà, Laura Re, Marta Sozzi, Francesca Castelli, Luisa Andrello, Claudia Vignali
The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby's mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema...
December 24, 2016: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/27999095/a-case-report-of-fatal-desmethyl-carbodenafil-toxicity
#11
Erica L Bakota, Anna T Kelly, Jeffrey P Walterscheid, Darshan R Phatak
We present the case report of a 34-year-old Hispanic male who was found unresponsive in the carport of his residence. Surveillance video footage from a security camera showed that he collapsed as he was walking to his vehicle. The decedent had no medical history and no history of illicit drug use. Initial toxicology testing revealed no alcohol or illicit drugs. Autopsy findings indicated a need for additional toxicological analysis due to a lack of trauma and the paucity of pathophysiologically significant natural disease...
December 19, 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27992785/identification-of-novel-psychoactive-substances-25b-nbome-and-4-cmc-in-biological-material-using-hplc-q-tof-ms-and-their-quantification-in-blood-using-uplc-ms-ms-in-case-of-severe-intoxications
#12
Marek Wiergowski, Justyna Aszyk, Michał Kaliszan, Kamila Wilczewska, Jacek Sein Anand, Agata Kot-Wasik, Zbigniew Jankowski
This paper describes cases of poisoning caused by new psychoactive substances such as: 25B-NBOMe (2-(4-bromo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine) and 4-CMC (1-(4-chlorophenyl)-2-(methylamino)-1-propanone). The analytical procedure includes rapid and selective method for the extraction and determination of 4-CMC and 25B-NBOMe in blood samples using UPLC-MS/MS technique. To the best of our knowledge, this is the first report, that involves a fully validated method for quantification of new-designer drug - 4-CMC in postmortem blood samples...
January 15, 2017: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
https://www.readbyqxmd.com/read/27932047/disturbances-of-glucose-metabolism-associated-with-the-use-of-psychotropic-drugs-a-post-mortem-evaluation
#13
Cristian Palmiere, Marc Augsburger, Vincent Varlet
Treatment with atypical antipsychotic agents and tetracyclic antidepressants has been associated with impaired glycemic control. Reported complications have included new-onset diabetes mellitus, life-threatening diabetic ketoacidosis and, rarely, death. The study presented herein focuses on biochemical investigations of glucose metabolism in a series of medico-legal cases that revealed the presence of atypical antipsychotic agents (clozapine, olanzapine, quetiapine and risperidone) or mirtazapine at toxicology...
December 5, 2016: Forensic Science International
https://www.readbyqxmd.com/read/27915431/time-dependent-postmortem-redistribution-of-morphine-and-its-metabolites-in-blood-and-alternative-matrices-application-of-ct-guided-biopsy-sampling
#14
Sandra N Staeheli, Dominic Gascho, Lars C Ebert, Thomas Kraemer, Andrea E Steuer
Interpretation of postmortem morphine concentrations in forensic toxicology provides several pitfalls such as missing information on tolerance, analyte stability, or postmortem redistribution (PMR). Recently, it had been shown that computed tomography (CT)-guided collection of biopsies using a robotic arm (virtobot) provides a valuable strategy for systematic studies on time-dependent PMR. Using this technique, time-dependent PMR of morphine and its metabolites was investigated in 12 cases. At admission to the institute (t1), femoral and heart blood (right ventricle) as well as biopsies from the right lung, the right kidney, liver, spleen, and muscle tissue were collected...
March 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/27881618/simultaneous-screening-and-quantification-of-basic-neutral-and-acidic-drugs-in-blood-using-uplc-qtof-ms
#15
Sergei Bidny, Kim Gago, Phuong Chung, Desdemona Albertyn, Daniel Pasin
An analytical method using ultra performance liquid chromatography (UPLC) quadrupole time-of-flight mass spectrometry (QTOF-MS) was developed and validated for the targeted toxicological screening and quantification of commonly used pharmaceuticals and drugs of abuse in postmortem blood using 100 µL sample. It screens for more than 185 drugs and metabolites and quantifies more than 90 drugs. The selected compounds include classes of pharmaceuticals and drugs of abuse such as: antidepressants, antipsychotics, analgesics (including narcotic analgesics), anti-inflammatory drugs, benzodiazepines, beta-blockers, amphetamines, new psychoactive substances (NPS), cocaine and metabolites...
November 22, 2016: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/27874190/the-value-of-outsourcing-selected-cases-in-a-medical-examiner-population-a-10-year-experience
#16
Brandi C McCleskey, Stephanie D Reilly, Dan Atherton
Due to increasing caseloads and inadequate staffing, the burden on Coroner/Medical Examiner Offices to comply with recommended autopsy limits for forensic pathologists (FPs) has been difficult. Since 2006, pathologists at the University of Alabama at Birmingham have performed select autopsies for the Alabama Department of Forensic Sciences. Each case was reviewed by a state FP and scene investigator to determine appropriateness for referral. All referred cases received full postmortem examination including microscopic examination and collection of toxicological samples, and toxicology was ordered by the referring FP as appropriate...
January 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/27864951/evaluation-of-the-role-of-toxicological-data-in-discriminating-between-h2-s-femoral-blood-concentration-secondary-to-lethal-poisoning-and-endogenous-h2-s-putrefactive-production
#17
Nunziata Barbera, Angelo Montana, Francesca Indorato, Nadia Arbouche, Guido Romano
Hydrogen sulfide is a colorless gas and has a strong odor of rotten eggs. It is absorbed by the upper respiratory tract mucosa, and it causes histotoxic hypoxemia and respiratory depression by exerting an inhibitory effect on cytochrome oxidase. To evaluate the role of toxicological data in distinguishing between the H2 S blood concentration secondary to lethal poisoning and the endogenous H2 S produced during putrefaction, we compared the postmortem H2 S concentrations of six fatal H2 S poisoning cases (8...
November 16, 2016: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/27864947/determining-the-toxicological-significance-of-pregabalin-in-fatalities
#18
Simon P Elliott, Timothy Burke, Christopher Smith
Pregabalin has become more widely prescribed and abused in recent years but is still not always included in laboratory analysis. An LC-MS-MS method has been developed and applied to measure pregabalin in 93 postmortem cases, including drug-related deaths, alternative causes of death, and fatalities where pregabalin was likely to have contributed to death. Other drugs or alcohol was detected, and the most common drug types (in decreasing frequency) were antidepressants, opioids, benzodiazepines, opiates, alcohol, antipsychotics, cocaine, cardiac drugs, amphetamines, cannabis, anticonvulsants, and antihistamines...
January 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/27863698/striatal-h3k27-acetylation-linked-to-glutamatergic-gene-dysregulation-in-human-heroin-abusers-holds-promise-as-therapeutic-target
#19
Gabor Egervari, Joseph Landry, James Callens, John F Fullard, Panos Roussos, Eva Keller, Yasmin L Hurd
BACKGROUND: Opiate abuse and overdose reached epidemic levels in the United States. However, despite significant advances in animal and in vitro models, little knowledge has been directly accrued regarding the neurobiology of the opiate-addicted human brain. METHODS: We used postmortem human brain specimens from a homogeneous European Caucasian population of heroin users for transcriptional and epigenetic profiling, as well as direct assessment of chromatin accessibility in the striatum, a brain region central to reward and emotion...
April 1, 2017: Biological Psychiatry
https://www.readbyqxmd.com/read/27842791/forensic-toxicology-an-introduction
#20
REVIEW
Michael P Smith, Martin H Bluth
This article presents an overview of forensic toxicology. The authors describe the three components that make up forensic toxicology: workplace drug testing, postmortem toxicology, and human performance toxicology. Also discussed are the specimens that are tested, the methods used, and how the results are interpreted in this particular discipline.
December 2016: Clinics in Laboratory Medicine
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