Evaluation of survival time and acting capability after fatal injuries based on the type and extent of injuries

One of the tasks of the forensic specialist is to attempt to determine the interval between fatal injuries and death, and to assess whether the victim could be physically active before death and, if so, to what extent. There is ongoing research aimed at the application of additional tests (histological, immunohistochemical and others) to answer these questions. Unfortunately, currently used methods have numerous limitations and require further improvements. Moreover, they are not commonly employed in medicolegal practice in Poland. The greatest difficulty in assessing the time of survival and activity occurs when the period is relatively short (seconds-minutes-hours). Therefore, in practice, injury examination is often the only tool to assess the interval between fatal injuries and death, and the possibility of physical activity during that time. The aim of the paper is review the literature on this topic with a focus on biological methods and attempt to find a correlation between the nature of injuries and survival time, and between the nature of injuries and the capability to be physically active. An analysis of available cases has shown that unfortunately, on account of numerous limitations, the approach with the exception of specific situations, allows determining at most an approximate time interval during which the victim could be alive and active.

Methods for the initial (non-laboratory) assessment of unfitness for driving caused by psychoactive substances

The psychophysical impairment of drivers caused by psychoactive substances is still a common and important factor in road accidents. While in the case of ethyl alcohol the initial detection of drivers who have consumed alcohol is not a problem due to the widespread use of breathalyzers, other psychoactive substances are a problem. These substances are a group of numerous, variously acting and regularly growing compounds. In this publication, the authors have reviewed the methods used worldwide for the initial detection of psychoactive substances, i.e. saliva testers and elements of the medical examination grouped into test kits, which can be used as part of routine police control, and have also assessed their usefulness. New methods of detection based on the evaluation of pupils and eyeball mobility, which are still in the process of improvement, were also discussed.

Concurrent DNA Copy-Number Alterations and Mutations in Genes Related to Maintenance of Genome Stability in Uninvolved Mammary Glandular Tissue from Breast Cancer Patients.

Somatic mosaicism for DNA copy-number alterations (SMC-CNAs) is defined as gain or loss of chromosomal segments in somatic cells within a single organism. As cells harboring SMC-CNAs can undergo clonal expansion, it has been proposed that SMC-CNAs may contribute to the predisposition of these cells to genetic disease including cancer. Herein, the gross genomic alterations (>500 kbp) were characterized in uninvolved mammary glandular tissue from 59 breast cancer patients and matched samples of primary tumors and lymph node metastases. Array-based comparative genomic hybridization showed 10% (6/59) of patients harbored one to 359 large SMC-CNAs (mean: 1,328 kbp; median: 961 kbp) in a substantial portion of glandular tissue cells, distal from the primary tumor site. SMC-CNAs were partially recurrent in tumors, albeit with considerable contribution of stochastic SMC-CNAs indicating genomic destabilization. Targeted resequencing of 301 known predisposition and somatic driver loci revealed mutations and rare variants in genes related to maintenance of genomic integrity: BRCA1 (p.Gln1756Profs*74, p.Arg504Cys), BRCA2 (p.Asn3124Ile), NCOR1 (p.Pro1570Glnfs*45), PALB2 (p.Ser500Pro), and TP53 (p.Arg306*). Co-occurrence of gross SMC-CNAs along with point mutations or rare variants in genes responsible for safeguarding genomic integrity highlights the temporal and spatial neoplastic potential of uninvolved glandular tissue in breast cancer patients.

The impact of lifetime substance use on psychiatric comorbidities and treatment seeking in patients with alcohol use disorders.

It is well-recognized that individuals with alcohol-related disorders often use other psychoactive substances; however, systematic research on this topic remains limited. The primary objective was to determine the prevalence of lifetime psychoactive substance use and describe the dependence between concurrent use of alcohol and other drugs on psychiatric comorbidities in the analyzed group. The secondary aim was to try to assess the frequency of seeking psychiatric treatment between individuals declaring the concurrent use of alcohol with other drugs and those declaring the use only alcohol. The study was designed as a retrospective cross-sectional analysis based on discharge reports from psychiatric patients admitted to the Regional Psychiatric Hospital in Olsztyn, Poland. 1015 cases were included and analyzed in the study. Data for the study were collected in specially designed monitoring cards from discharge reports including data from psychiatric examinations, especially anamnesis. The percentage of people declaring lifetime use of psychoactive substances was 17.6%. 2.8% of them were diagnosed with substance-related disorders (F11-19 according to ICD-10). The most frequently declared use was cannabis, followed by amphetamine-type substances, benzodiazepines and new psychoactive substances. In the group of people declaring the lifetime use of psychoactive substances, 13.4% were additionally diagnosed with mental disorders. It was, consequently, 8% in the group of people denying the lifetime use of psychoactive substances. People declaring lifetime use of psychoactive substances were significantly more likely to seek psychiatric treatment, i.e. they were admitted significantly more often on an emergency admission than on an elective one, these people were significantly more likely to have undergone psychiatric treatment in the past and were more often hospitalized in our center during the research period. People who concurrently use alcohol with other drugs significantly more often have psychiatric comorbidity than people who deny the use of other drugs. That group also visibly more often seeks psychiatric treatment than patients who deny taking psychoactive substances.

The case of an abused child exposed to the direct danger of serious damage to health in the form of a permanent mental illness. / Przypadek dziecka maltretowanego jako narazenie na bezposrednie niebezpieczenstwo wystapienia ciezkiego uszczerbku na zdrowiu w postaci trwalej choroby psychicznej.

Prolonged exposure to violence in any form takes a toll on children's health. It may increase the risk of multiple mental disorders appearing in adult life. Such disorders may be of severe intensity, and in extreme cases, they can even disable normal functioning both individually and socially. The present case concerns an eight-year-old girl subjected to all forms of abuse (sexual, physical, psychological and negligence) in her biological family. The foster parents made a notification of a suspected criminal offence based on their multiple observations of behavioral disorders of the child. After analyzing the evidence, including observations of behavior in the foster family and a comprehensive medical-psychological examination of the subject, all forms of child abuse according to ICD-10 have been diagnosed, as well as a negative impact of violence on the child's psychological well-being. A thorough analysis of the whole available data led to a conclusion that the girl, functioning in her biological family, was exposed to a direct danger of severe health impairment in the form of a permanent mental illness within the meaning of art. 160 of the Polish Penal Code.

Life time use of illicit substances among adolescents and young people hospitalized in psychiatric hospital.

Adolescents are known to be particularly vulnerable, compared to children and adults, to initiation of substance use and progression to problematic use. This study aimed to examine the prevalence and type of illicit drug use in a population of adolescents and young adults who were hospitalized in a psychiatric hospital. The purpose of the study was also to find the link between age, sex, type of admission and particular mental disorders and using psychoactive substances at least once in a lifetime. A 12-month retrospective cross-sectional analysis of medical records compiled for adolescent and youth psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, between October 1, 2018, and September 30, 2019, was conducted. After analyzing the available medical records, 506 cases were included and analyzed. Data for the study were collected in an Excel spreadsheet from discharge reports, including data from psychiatric examinations, especially anamnesis. Subsequently, statistical calculations were performed. Lifetime prevalence of any illicit substance use (34.0%) was common. The most frequently used drug was Cannabis (29.2%), the next New Psychoactive Substance-NPS (14.2%) and Amphetamine (13.0%). The higher number of people declaring to take illicit substances was proportional to the increasing age. Except for the group 10-15 years, the subject group was dominated by males. The highest, statistically significant percentage of patients who declared taking illicit substances in general, was found in people with diagnoses F20-F29 (schizophrenia, schizotypal and delusional disorders) (55%), additionally, we found a statistically significant association between NPS use and these diagnoses. Only in the group of patients diagnosed with eating disorders no one declared taking psychoactive substances. However, the correlation between taking illicit drugs and the subgroups with diagnosed psychiatric diseases should be treated with caution because of the small sample size in some cases. Our findings have shown the significant prevalence of the phenomenon in this population. These data highlight the need to explore this population at high risk carefully.

Differences between unipolar and bipolar I depression in the quantitative analysis of glutamic acid decarboxylase-immunoreactive neuropil.

Alterations in GABAergic neurotransmission are assumed to play a crucial role in the pathophysiology of mood disorders. Glutamic acid decarboxylase (GAD) is the key enzyme in GABA synthesis. This study aimed to differentiate between unipolar and bipolar I depression using quantitative evaluation of GAD-immunoreactive (GAD-ir) neuropil in several brain regions known to be involved in the pathophysiology of mood disorders. Immunohistochemical staining of GAD 65/67 was performed in the orbitofrontal, anterior cingulate and dorsolateral prefrontal cortex (DLPFC), the entorhinal cortex, the hippocampal formation and the medial dorsal and lateral dorsal (LD) thalamic nuclei, with a quantitative densitometric analysis of GAD-ir neuropil. The study was performed on paraffin-embedded brains from 9 unipolar and 12 bipolar I depressed patients (8 and 6 suicidal patients, respectively) and 18 matched controls. In unipolar patients, compared with controls, only the increased relative density of GAD-ir neuropil in the right LD was different from the previous results in depressed suicides from the same cohort (Gos et al. in J Affect Disord 113:45-55, 2009). On the other hand, the left DLPFC was the only area where a significant decrease was observed, specific for bipolar I depression. Significant differences between both diagnostic groups were found in these regions. By revealing abnormalities in the relative density of GAD-ir neuropil in brain structures, our study suggests a diathesis of the GABAergic system in mood disorders, which may differentiate the pathophysiology of unipolar from that of bipolar I depression.

[Suicidal intoxication with sodium azide--a case report]. / Smiertelne samobójcze zatrucie azydkiem sodu--opis przypadku.

Sodium azide (NaN3) is an inorganic matrix compound with a very high toxicity. Mechanism of action is not clarified, and it is assumed to interfere with the processes of oxidative phosphorylation. The acute intoxications with sodium azide are extremely rare. We described a case of 19-year-old man who was found dead. In the course of prosecution the empty container, with label "NaN3, 20 g", was found near the body. There were traces of white powder detected in the container. Azide ions were determined by derivatization, i.e. they were transformed to pentafluorobenzaldehyde azide compound. Analysis of the final extract after derivatization was performed by gas chromatography coupled with mass spectrometry GC/MS. The largest concentration of azide ions were determined in the stomach content and vitreous humour, and much less one in whole blood, urine and kidney fluid.

Analytically confirmed presence of psychoactive substances, especially new psychoactive substances in a group of patients hospitalized with mental and behavioural disorders due to the use of psychoactive substances diagnosis.

OBJECTIVES: The study assessed the presence of new psychoactive substances (NPS) in comparison to "classic" drugs in the group of newly admitted patients with mental and behavioral disorders due to the use of psychoactive substances diagnosis (section F11-19 according to ICD-10). MATERIAL AND METHODS: Data from anamnesis and the blood and urine samples were collected from 116 patients diagnosed with mental and behavioral disorders due to psychoactive substance use. All of them expressed written informed consent. Analytical confirmation was obtained by highperformance liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS). Liquid-liquid extraction was used for sample preparation. RESULTS: In the sample, 108 (93%) of 116 were positive for psychoactive substances (including 96 cases where >1 substance was found), 69% of individuals were tested positive for opioids and 67% for benzodiazepines. Eleven (9%) of 116 patient samples were positive for NPS. We detected 7 different substances. Six of them were synthetic cannabinoids: PB-22, MDMB-CHMICA, MMB-CHMICA, AB-CHMINACA, MMB-FUBINACA, THJ-2201 and one synthetic cathinone 3-CMC. CONCLUSIONS: The prevalence and NPS profile (the predominance of synthetic cannabinoids) are similar in the group of people with addiction to psychoactive substances as in populations of people taking recreational drugs and the overdose patients admitted to the hospital. Int J Occup Med Environ Health. 2022;35(4):485-95.

Characteristics of psychiatric inpatients diagnosed with mental and behavioral disorders caused by psychoactive substances (F11-19 block), with a focus on NPS and psychiatric co-morbidities.

OBJECTIVES: This study analyzed the prevalence of new psychoactive substance (NPS) use in the analyzed group and compared demographic features and psychoactive substance profiles between the 2 subgroups (NPS users, non-NPS users). The secondary measure was used to determine the prevalence of psychiatric comorbidities in study group and to compare demographic features and psychoactive substance profiles between 2 subgroups (the F11-19 only diagnosed group and the F11-19 group with psychiatric comorbidities according to ICD-10). MATERIAL AND METHODS: A 12-month retrospective cross-sectional analysis of medical records compiled for adult psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, in October 1, 2016 - September 30, 2017 was conducted. After analyzing the available medical records, 157 cases were included and analyzed. Data for the study were collected in a specially designed monitoring card from discharge reports, including data from psychiatric examinations, especially anamnesis. RESULTS: The most commonly declared psychoactive substances were amphetamine (AMF) - 54% and cannabinoids - 46%. The prevalence of NPS use in the study group was 34%. Inpatients taking NPS, as compared with non-NPS users, were younger and more often admitted to hospital through the Emergency Department. It was also found that NPS users more often took AMF or cannabinoids, and less frequently benzodiazepines (BDZ) or opioids. However, the taking of AMF, cannabinoids and BDZ was also age-dependent. CONCLUSIONS: The prevalence of psychiatric comorbidities in the study group was 9%. Inpatients with psychiatric comorbidities were older and took BDZ significantly more often than AMF. In addition, NPS use affects different groups, including a specific group as the analyzed sample, which shows a similar NPS use profile as different groups described in the literature. Int J Occup Med Environ Health. 2020;33(2):125-36.

Correction to: Long-term vigabatrin treatment modifies pentylenetetrazole-induced seizures in mice: focused on GABA brain concentration.

The article Long-term vigabatrin treatment modifies pentylenetetrazole-induced seizures in mice: focused on GABA brain concentration.

Long-term vigabatrin treatment modifies pentylenetetrazole-induced seizures in mice: focused on GABA brain concentration.

BACKGROUND: The goal of our study was to examine the long-term effect of vigabatrin (VGB), a γ-aminobutyric acid aminotransferase (GABA-AT) inhibitor on clonazepam (CLO), ethosuximide (ETX) and valproate (VPA) anticonvulsive activity against pentylenetetrazole (PTZ)-induced seizures in mice. METHODS: VGB was administered for 3 and 7 days. Convulsions were evoked by PTZ at its CD97 (99 mg/kg). The influence of CLO, ETX and VPA alone or in combination with VGB on motor performance and long-term memory was analyzed. γ-aminobutyric acid (GABA) concentration in mice brain and plasma as well as glutamate decarboxylase (GAD) activity was measured. RESULTS: After 3 days of treatment, VGB in doses up to 500 mg/kg increased PTZ-induced seizure threshold, whereas after 7 days VGB (at the dose of 125 mg/kg) inhibited clonic seizures in experimental mice. 7 days of VGB administration did not change the protective effect of CLO, ETX and VPA against PTZ-induced seizures. 7 days of VGB treatment at a subthreshold dose of 75 mg/kg decreased TD50 of ETX and CLO in the chimney test, but did not affect TD50 value for VPA. 7 days of VGB administration in combination with AEDs did not affect long-term memory in mice. VGB after 3 days or 7 days of administration increased brain GABA concentration. GAD activity was decreased after 3 and 7 days of VGB administration. CONCLUSIONS: The presented results confirm anticonvulsive activity of VGB through GABA metabolism alteration and suggest care when combining VGB with ETX or CLO in the therapy.

Somatic mosaicism for copy number variation in differentiated human tissues.

Two major types of genetic variation are known: single nucleotide polymorphisms (SNPs), and a more recently discovered structural variation, involving changes in copy number (CNVs) of kilobase- to megabase-sized chromosomal segments. It is unknown whether CNVs arise in somatic cells, but it is, however, generally assumed that normal cells are genetically identical. We tested 34 tissue samples from three subjects and, having analyzed for each tissue < or =10(-6) of all cells expected in an adult human, we observed at least six CNVs, affecting a single organ or one or more tissues of the same subject. The CNVs ranged from 82 to 176 kb, often encompassing known genes, potentially affecting gene function. Our results indicate that humans are commonly affected by somatic mosaicism for stochastic CNVs, which occur in a substantial fraction of cells. The majority of described CNVs were previously shown to be polymorphic between unrelated subjects, suggesting that some CNVs previously reported as germline might represent somatic events, since in most studies of this kind, only one tissue is typically examined and analysis of parents for the studied subjects is not routinely performed. A considerable number of human phenotypes are a consequence of a somatic process. Thus, our conclusions will be important for the delineation of genetic factors behind these phenotypes. Consequently, biobanks should consider sampling multiple tissues to better address mosaicism in the studies of somatic disorders.

Calretinin and parvalbumin in schizophrenia and affective disorders: a mini-review, a perspective on the evolutionary role of calretinin in schizophrenia, and a preliminary post-mortem study of calretinin in the septal nuclei.

OBJECTIVE: The septal nuclei are important limbic regions that are involved in emotional behavior and connect to various brain regions such as the habenular complex. Both the septal nuclei and the habenular complex are involved in the pathology of schizophrenia and affective disorders. METHODS: We characterized the number and density of calretinin-immunoreactive neurons in the lateral, medial, and dorsal subregions of the septal nuclei in three groups of subjects: healthy control subjects (N = 6), patients with schizophrenia (N = 10), and patients with affective disorders (N = 6). RESULTS: Our mini-review of the combined role of calretinin and parvalbumin in schizophrenia and affective disorders summarizes 23 studies. We did not observe significant differences in the numbers of calretinin-immunoreactive neurons or neuronal densities in the lateral, medial, and dorsal septal nuclei of patients with schizophrenia or patients with affective disorders compared to healthy control subjects. CONCLUSIONS: Most post-mortem investigations of patients with schizophrenia have indicated significant abnormalities of parvalbumin-immunoreactive neurons in various brain regions including the hippocampus, the anterior cingulate cortex, and the prefrontal cortex in schizophrenia. This study also provides an explanation from an evolutionary perspective for why calretinin is affected in schizophrenia.

The usefulness of CBF brain SPECT in forensic medicine: the civil law code cases. A description of four cases.

BACKGROUND: The aim of this report was to assess the usefulness of cerebral blood flow (CBF) scanning utilising the SPECT technique in forensic medicine cases in the area of civil law cases. MATERIAL AND METHODS: CBF SPECT scanning was performed in four patients utilising (99m)Tc-ECD and a triple-head gammacamera. In the analysis both the asymmetry index and cerebellar normalisation were applied. Reference values were obtained by studying 30 healthy volunteers. RESULTS: In those cases CBF SPECT scanning played an important role in forensic argument. It influenced the sentence and the amount of financial compensation. CONCLUSIONS: CBF SPECT scanning may provide valuable information in forensic medicine argument in civil law cases, but only when taken together with psychometric tests and other neuroimaging methods (CT, MRI). The value of CBF SPECT scanning alone may be limited in judicial proceedings.

[Death attributed to toxic interaction of tramadol and other drugs]. / Przypadek smiertelnego zatrucia tramadolem w przebiegu interakcji z innymi lekami.

In this paper the authors presented the case of a 37-year old deceased investigated at the Department of Forensic Medicine of the Medical University of Gdansk. The subject of chemo-toxicological analysis were blood and urine samples as well as specimens collected from the liver, kidney and brain during autopsy. TLC, GC-FID, GC-MS were used as diagnostic tools. The determined tramadol concentration was 1.7 micrograms/ml in the blood and 15.5 micrograms/ml in the urine.

[Cases of hanging with bound limbs--suicide, homicide or accident]. / Przypadki powieszen ze skrepowanymi konczynami--samobójstwo, zabójstwo czy wypadek.

In the paper 6 cases of suicidal hanging and 1 case of accidental hanging were presented; in each case limbs of the victim were bound. These hangings always cause a suspicion of homicide, therefore the forensic specialist should pay particular attention to them, especially during the crime scene examination, they should also be carefully investigated by police and the public prosecutor's office.

["Alarm substances" as biological markers indicating emotional state before death]. / Substancje alarmowe jako wykladnik stanu emocjonalnego poprzedzajacego zgon.

This scientific project presents the results of preliminary examinations aimed to identify alarm pheromones secreted by mammals. Wistar male rats were used for the experiment. Animals were treated by aversive sensoric stimuli and fear conditioning procedures. The animals' behaviour was registered. Quantitative and qualitative analysis of air samples taken from their environment was conducted with the use of GC-FID and GC-MSD technics. In the rhinocephalon structures (olfactory bulb, olfactory tract) the concentration of glutamate was measured. During the progress of the experiment increasing behavioral reactions of anxiety were observed in the rats. In their atmosphere organic compounds were identified. Some of them can be considered to be alarm substances. In the examined structures of the rhinocephalon on increased concentration of glutamate in each individual was revealed.

Acute methoxetamine and amphetamine poisoning with fatal outcome: a case report.

Methoxetamine (MXE) is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdansk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED) at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C) and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 µg/ml) was within the non-toxic range, while MXE (0.32 µg/ml) was within the toxic range of concentrations. Amphetamine was also detected in the patient's hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient's blood and urine suggest the possibility of adverse interactions between them.

Ribosomal DNA transcription in the anterior cingulate cortex is decreased in unipolar but not bipolar I depression.

The anterior cingulate cortex (AC) is consistently implicated in the pathophysiology of depression. However, it is not clear whether unipolar and bipolar depression display distinct neuropathological features. Therefore, the objective of this post-mortem study was to re-evaluate this important issue. Brains from 9 patients with major depressive disorder (MDD) and 11 patients with bipolar disorder (BD) subtype I depression as well as 24 matched controls were analysed. The argyrophilic nucleolar organiser region (AgNOR) silver-staining method was applied on paraffin-embedded brain sections in order to assess the transcriptional activity of ribosomal DNA (rDNA) in layer III and V pyramidal neurons of the dorsal and ventral AC in both hemispheres. An AgNOR area decrease suggestive of a diminished transcriptional activity of rDNA was found in the MDD group both versus controls and versus the BD group. The effect was specific for the right hemisphere and dorsal AC and was restricted to layer V pyramidal neurons. The results suggest that only patients with MDD display region-specific chronic hypoactivity of these output neurons, which are critical for mood regulation. Furthermore, in our cohort, unipolar and bipolar I depression could be differentiated relative to the presumed AC hypoactivity and psychotropic medication did not counteract the observed effect.