Poisoning with table salt while treating drug poisoning.

Hypernatremia is an increase in serum sodium concentration above 145 mmol/L. There are many causes of elevated sodium levels in the blood serum. One is incorrect actions performed by medical staff. The symptoms of excessively high serum sodium levels depend on the severity of hypernatremia, the rate of its increase and the accompanying volume disorders. Severe symptoms include altered consciousness, increased muscle tone and reflexes, convulsions, psychomotor hyperactivity or drowsiness (up to coma), respiratory failure, and even death. We present the case of a 45-year-old man who took seven tablets of a blood pressure-lowering drug, and paramedics subsequently administered a concentrated solution of table salt to induce vomiting. However, vomiting did not occur, leading to hypernatremia. Ultimately, the man survived but developed persistent cognitive dysfunction, including disordered short-term memory and encoding and retrieval of information from long-term memory, weakening of attention function and fatigue, and disorders in abstract thinking. The patient's family went to the prosecutor's office to investigate the possibility of medical malpractice. Experts found that the paramedics' actions were incorrect. Although it has been known for many years that table salt solutions should not be used to induce vomiting, unfortunately, both laypeople and medical professionals are still using this technique. Iatrogenic salt poisoning may end not only in serious health complications but also in legal consequences.

The Influence of the Oral Microbiome on Oral Cancer: A Literature Review and a New Approach.

In our recent article (Smedra et al.: Oral form of auto-brewery syndrome. J Forensic Leg Med. 2022; 87: 102333), we showed that alcohol production can occur in the oral cavity (oral auto-brewery syndrome) due to a disruption in the microbiota (dysbiosis). An intermediate step on the path leading to the formation of alcohol is acetaldehyde. Typically, acetic aldehyde is transformed into acetate particles inside the human body via acetaldehyde dehydrogenase. Unfortunately, acetaldehyde dehydrogenase activity is low in the oral cavity, and acetaldehyde remains there for a long time. Since acetaldehyde is a recognised risk factor for squamous cell carcinoma arising from the oral cavity, we decided to analyse the relationship linking the oral microbiome, alcohol, and oral cancer using the narrative review method, based on browsing articles in the PubMed database. In conclusion, enough evidence supports the speculation that oral alcohol metabolism must be assessed as an independent carcinogenic risk. We also hypothesise that dysbiosis and the production of acetaldehyde from non-alcoholic food and drinks should be treated as a new factor for the development of cancer.

Experimental and numerical study on failure mechanisms of bone simulants subjected to projectile impact.

Analyses of the human bones failure mechanisms under projectile impact conditions can be made through performing of a large number of ballistic trials. But the amount of data that can be collected during ballistic experiments is limited due to the high dynamics of the process and its destructive character. Numerical analyses may support experimental methodologies allowing to better understand the principles of the phenomenon. Therefore, the main aim of the study was to create and to verify a numerical model of commercially available synthetic bone material-Synbone®. The model could be used in the future as a supporting tool facilitating forensic studies or designing processes of personal protection systems (helmets, bulletproof vests, etc.). Although Synbone® is commonly used in the ballistic experiments, the literature lacks reliable numerical models of this material. In order to define a numerical model of Synbone®, mechanical experiments characterizing the response of the material to the applied loads in a wide range of strains and strain rates were carried out. Based on the mechanical tests results, an appropriate material model was selected for the Synbone® composite and the values of constants in its equations were determined. Material characterization experiments were subsequently reproduced with numerical simulations and a high correlation of the results was obtained. The final validation of the material model was based on the comparison of the ballistic impact experiments and simulation results. High similarity obtained (relative error lower than 10%) demonstrates that the numerical model of Synbone® material was properly defined.

Oral form of auto-brewery syndrome.

Although previous cases of ethyl alcohol production by microorganisms present in the intestines, referred to as auto-brewery syndrome (ABS), have been reported, a recent case in our practice was characterized by the production of alcohol in the oral cavity. Our research indicates that legally significant levels of ethyl alcohol can be detected in exhaled air in cases where there has been no alcohol consumption but where the subject has oral candidiasis. In such cases, following the consumption of foods containing carbohydrates, a fermentation process occurs in the mouth, the first stage of which is glycolysis, proceeding according to the Embden-Meyerhof-Parnas pathway, which is typical in eukaryotes. The main organic substrate in this case is glucose, which is formed in the oral cavity from disaccharides (maltose, sucrose) by the activity of α-amylase. Some mutated fungal strains of the genus Candida acquire the ability to break down sucrose and produce glucoamylase. Glucose is converted into glyceraldehyde 3-phosphate and then into pyruvate. The next stage of fermentation is the decarboxylation of pyruvate into acetaldehyde, a reaction catalyzed by pyruvate decarboxylase. The final stage is the reduction of acetaldehyde to ethanol by alcohol dehydrogenase. Such endogenous production of alcohol can be confused with its consumption, which can cause not only legal, but also social and medical problems.

Medical error in treatment of Amanita phalloides poisoning in pre-hospital care.

BACKGROUND: Geopolitical and climate changes form the background of the current migration crisis. It has many faces. One of them are the tragic cases of poisoning of refugees due to eating wild forest mushrooms for socioeconomic reasons in the Western and Northern European countries. The most serious food poisonings in Europe, but not only, are caused by lamellar mushrooms, the most dangerous being Amanita phalloides. Its poisonous properties can be attributed to α-amanitin, an RNA polymerase II inhibitor. Unfortunately, as it is characterized by a delayed onset of symptoms, A. phalloides poisoning has a high risk of complications. CASE PRESENTATION: Our article presents a case of A. phalloides poisoning in a 28-year-old man, in which the responding medical emergency unit made errors in diagnosis and treatment. Since the correct diagnosis was made too late, the typical treatment of A. phalloides poisoning was ineffective. The patient suffered a life-threatening liver failure and needed liver transplant from a deceased donor. CONCLUSIONS: Mushroom poisoning is a particularly important problem not only in countries with a mushroom picking tradition, but also-due to the inflow of refugees-in countries where mushroom poisoning was very rare until recently. In such cases it is crucial to quickly implement the correct procedure, as this can prevent the need for liver transplant or even death. This is a particularly important consideration for the first medical professionals to contact the patient, especially in cases where the patient reports mushrooms consumption and presents alarming symptoms of the gastrointestinal tract. Such situations cannot be underestimated and ignored.

The age profile of court-appointed physicians in Poland. Status at the end of 2021. / Profil wiekowy lekarzy bieglych sadowych w Polsce. Stan na koniec 2021.

The problems with obtaining expert opinions from court-appointed physicians in Poland have been known for a long time and are well-diagnosed. The reasons for this state of affairs are: an overall insufficient number of physicians compared to the general needs, uncompetitive remuneration levels, and the difficulty of reconciling professional and court-appointed expert duties, while taking into consideration the availability expected of experts. The ongoing generational transition may further exacerbate these problems. The purpose of this study was to investigate the latter phenomenon by comparing the age profile of court-appointed physicians with that of physicians in general. Information on the age of court-appointed physicians was obtained from the presidents of regional courts and the Central Register of Physicians, while general statistics on physicians were also acquired from the latter. Research allowed us to formulate the following conclusions: only 0.8% of all physicians in Poland serve a court-appointed expert function. Almost two-thirds of court-appointed physicians belong to the Baby Boomer generation (born in 1946-1964), nearly one-third to Generation X (1965-1980), and only one-sixteenth (6.10%) to Generation Y (1981-1996), or Millennials. The results obtained, as well as data from the literature, suggest that the current bad state of affairs regarding access to the opinions of court-appointed physicians will further deteriorate in the coming years due to generational changes, i.e., the replacement of Baby Boomers and Generation X, currently dominant among court-appointed experts, by Generation Y, i.e., Millennials, with a different attitude to life.

Neuropathological Changes in the Brains of Suicide Killers.

BACKGROUND: Homicide combined with subsequent suicide of the perpetrator is a particular form of interpersonal violence and, at the same time, a manifestation of extreme aggression directed against oneself. Despite the relatively well-described individual acts of homicide and suicide, both in terms of psychopathology and law, acts of homicide and subsequent suicide committed by the same person are not well-studied phenomena. The importance of emotional factors, including the influence of mental state deviations (psychopathology), on this phenomenon, is discussed in the literature, but still there is relatively little data with which to attempt neuropathological assessments of the brains of suicide killers. This paper is dedicated to the issue based on the neuropathological studies performed. METHODS: We analyzed a group of murder-suicides using histochemical and immunohistochemical methods. RESULTS: The results of our research indicate the presence of neurodegenerative changes including multiple deposits of ß-amyloid in the form of senile/amyloid plaques and perivascular diffuse plaques. CONCLUSIONS: Neurodegenerative changes found in the analyzed brains of suicide killers may provide an interesting starting point for a number of analyses. The presence of neurodegenerative changes at such a young age in some murderers may suggest preclinical lesions that affect cognitive functions and are associated with depressed moods.

Suicide committed by a paramedic using a cocktail of drugs: Morphine, etomidate, diazepam and rocuronium. Case report and review of literature.

Suicide is still an important issue in developed countries. The problem affects all age groups and both sexes, although usually more commonly middle-aged men. Attempted suicides committed by taking drugs ended in death are rare (regardless of gender, age, social group) except among health professionals who have easy access to medications and the knowledge of their use. This paper describes a case of a paramedic's suicide and discusses the literature on the issue of suicides in terms of statistics. The paramedic, who is the subject of this case story suffered from depression and alcohol dependence and committed suicide at work using the medicines available in the Medical Air Rescue service: morphine, diazepam, etomidate and rocuronium. Toxicological studies revealed that the man had also been taking sertraline, a commonly used antidepressant. The reasons for suicide among healthcare professionals are the same as for the general population; however, given the extremely high work-related stress and easy availability of drugs that can be effectively used to commit suicide, a special approach to the issue is necessary.

Black powder handgun shots-Cases analysis and literature review.

Black powder weapons are rarely used in countries where access to firearms is easy. Poland has a fairly restrictive law regarding possession of firearms but under the Weapons and Munitions Act of May 21, 1999, as further amended, the possession of black powder weapons using separate loaded ammunition and manufactured before 1885, or replicas thereof, is legal without a permit. When the amendment was introduced, forensic pathologists anticipated a rush of cases involving such weapons, mainly suicides, but also accidents and homicides, but in our own practice in Lodz over the past 10 years (2010-2019) we have encountered only 7 such cases. Although the number is not particularly high, it does nevertheless account for nearly one-fifth of all gunshot deaths in the area. The aim of this paper is to present a series of deaths involving the use of black powder handguns. In analyzed cases, the victims were mostly men, they were sober, and their manner of death was suicide. As far as age was concerned, no regularity was found. All black powder handgun shots were characteristic enough in comparison with those from conventional firearms that they could be identified easily-the entrance wounds were larger than usual, there was a lot of gunpowder around them and in the wound canal, the bone fractures were extensive. Analysis of the literature and of our own material indicates that easy availability is not the only factor affecting the choice of a weapon; ease of use and reliability are also important.

The notion of grievous bodily harm and the legal obligation to notify law enforcement authorities.

The obligation of physicians and other health professionals under Art. 240 § 1 of the Criminal Code instructs them to notify the law enforcement authority responsible for prosecuting crimes (in particular the Police or public prosecutor's office) when prohibited acts are committed, attempted, or prepared. The list of such acts is enumerative, indicating the numbers of the relevant articles and paragraphs. On 13th July 2017 Art. 156 of the Criminal Code extended the list, adding grievous bodily harm as a prohibited act. Accordingly, this act introduced the legal obligation of denunciation, which outweighs medical privacy in such situations. As it can be difficult for a clinician to identify which injuries meet the criteria of grievous bodily harm, the authors of the paper have described in detail all of its forms with specific examples, since failure to comply with that obligation is punishable by up to three years of deprivation of liberty.

Helium suicide - A suffocation or a barotrauma?

Helium is a chemically inert gas present in atmospheric air that is used in various branches of industry and in medicine. In the case of its improper use, various complications may occur, affecting mainly the respiratory tract and, in extreme cases, even result in death. Helium has also been used for committing suicide. Helium suicide is a method that does not leave characteristic macro- and microscopic post-mortem changes. A large amount of information on how to commit suicide with the use of helium can be found on the internet, which contributes to the popularization of this method in the world. In the case of incompetent use of the equipment theoretically dedicated to such suicide, death may occur not because of the suffocation, which is the most common mechanism in such cases, but because of a pressure injury of the respiratory tract, resulting in rapid damage to the alveoli in the rupture mechanism, causing massive bleeding. Helium dissipates quickly in the ambient air, and usually, its presence cannot be detected either in the blood or in the tissues. Thus, even if the material for toxicological tests is handled properly, detection of the presence of helium in a relatively short period of time after death is usually impossible or very difficult. If death due to inert gas inhalation is suspected during an autopsy, samples of biological material can be collected to be tested later by gas chromatography combined with mass spectrometry (GC-MS), but the results of the investigations are usually not helpful from the point of view of a forensic pathologist.

Firearm Injury From Hunting .30 Caliber Bullet Passing Through an Intermediate Target (Binoculars): A Reconstruction of Events.

This article presents the results of research relating to the ricocheting of hunting ammunition and the application of these results to the investigation of a specific gunshot death, which occurred during a hunt for boars. The scene and autopsy findings revealed that a bullet had first struck a pair of binoculars around the victim's neck before entering his body. As the investigation proceeded, however, questions were raised as to whether the shot was a direct one or a ricochet. The case was thus referred to forensic medicine experts for their opinion. Experiments were conducted, which demonstrated that, although test ammunition could ricochet, the rebound fragments possessed insufficient kinetic energy to pierce the binoculars. On the basis of the experiments, it was determined that the victim had been killed by a direct shot and that the bullet had pierced the intermediate target of the binoculars before entering his body. The possibility of a ricochet producing the injuries found, that is, the victim being struck with a bullet or fragments rebounding from an obstacle, was considered unlikely.

Mean acceleration of the centre of gravity of the vehicle in which the injured/aggrieved party was travelling as a criterion for verifying the sequelae of whiplash injury.

Teresinski in his studies, both older ones, published in 2013 [1, 2] and the recent one from 2019 [3] as a follow-up to the earlier studies, discusses "acceleration" as a criterion of selective verification of the sequelae of whiplash injury. In principle, the approach outlined in the cited studies is correct, but it lacks an explicit definition of what precisely is meant by "acceleration". In the 2013 papers, the author failed to give any indication as to what type of "acceleration" was discussed, while in his latest publication he stated that "acceleration" referred to the "acceleration of the centre of gravity of the vehicle in which the victim was travelling", which is also an insufficiently precise definition. More detailed information on the topic can be found in the paper by Kedzierski [4], written from the perspective of an engineer and complementary to Teresinski's study [3], which was published in the same issue of Archives of Forensic Medicine and Criminology, but the aspect is not highlighted enough among the abundance of information presented there.

Aspartic acid racemization of root dentin used for dental age estimation in a Polish population sample.

Precise age determination of unidentified bodies and human remains is one of the essential tasks of forensic science. The aim of this study was to assess the applicability of using the enantiomeric composition of aspartic acid racemization in root and crown dentin for dental age estimation using a Polish population sample. Coronal and root dentin from four teeth groups from the mandible were studied using gas chromatography with mass spectrometry. The results demonstrated a very high correlation between the chronological age and enantiomeric composition in both of the dentin samples. Individual linear equations of root dentin with correlation coefficients between 0.96 and 0.98 and a standard estimation error of ±2.95-4.84 years validated the application of aspartic acid racemization as a significant practical contribution to everyday forensic medical practice. Discrepancies in methodological aspects and modifications that simplify the protocol are presented.

When genetic tests fail - an attempt to identify victims of gas explosion caused by damage to a high-pressure gas pipeline, with reference to problems related to the retrieval of ante-mortem dental records.

The paper illustrates a difficult case of personal identification of the remains of two construction workers, severely charred and calcined because of very high temperatures caused by an explosion of a high pressure gas pipeline. In both cases, genetic and odontological examinations were conducted for the purpose of victim identification. Genetic tests made it possible to identify the remains of one of the casualties. In the other case, however, identification was impossible on account of complete destruction of the victim's genetic material, which is typical of long-term exposure to extremely high temperatures (similar to cremation). Ultimately, the remains were identified on the basis of odontological examinations following the retrieval of the victim's ante-mortem dental records. The presented case shows that dental examinations can be an alternative to genetic tests and dactyloscopy. Unfortunately, the value of forensic odontology is Poland is still underestimated. The paper also addresses the issue of retrieval of ante-mortem dental records in Poland.

In search for the grave of 100 Poles executed on March 20, 1942 in Zgierz, Poland - research by SIGO (Network for Genetic Identification of Victims).

It can be reasonably assumed that remains exhumed in 2012 and 2013 during archaeological explorations conducted in the Lucmierz Forest, an important area on the map of the German Nazi terror in the region of Lodz (Poland), are in fact the remains of a hundred Poles murdered by the Nazis in Zgierz on March 20, 1942. By virtue of a decision of the Polish Institute of National Remembrance's Commission for the Prosecution of Crimes Against the Polish Nation, the verification of this research hypothesis was entrusted to SIGO (Network for Genetic Identification of Victims) Consortium appointed by virtue of an agreement of December 11, 2015. The Consortium is an extension of the PBGOT (Polish Genetic Database of Totalitarianisms Victims). So far, the researchers have retrieved 14 DNA profiles from among the examined remains, including 12 male and 2 female profiles. Furthermore, 12 DNA profiles of the victims' family members have been collected. Due to the fact that next-of-kin relatives of the victims of the Zgierz massacre are of advanced age, it is of key importance to collect genetic material as soon as possible from the other surviving family members, identified on the basis of a list of victims that has been nearly completely compiled by the Polish Institute of National Remembrance (IPN) and is presented in this paper.