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The noticeable decline in the number of autopsies performed in recent years requires investigation into the causes of the phenomenon and attempts to prevent it. One potential cause of this trend is fear of disfiguring the body. Carrying out autopsies using a minimally invasive method may reduce the decrease in the number of autopsies performed. The first work on the development of the method and its continuation gave promising results. This allows us to start a discussion on attempts to introduce the method. The solution seems especially justified when the alternative is to completely abandon post-mortem examinations using the traditional method. Laparoscopy and thoracoscopy are tools that allow for accurate imaging and analysis of organ changes. Enriching them with additional tests using endoscopic techniques may have a positive impact on the accuracy of autopsy diagnoses. The development of a clear protocol for minimally invasive post-mortem diagnosis requires further research to determine the accuracy of the method.
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Aggression, understood as intentional actions aimed at causing harm, remains in a direct relation with the phenomenon of interpersonal violence, especially its physical form. Creating an objective marker of aggression would be an important tool for preventing, protecting the victims and maintaining control over suspects. There have been attempts to link aggression with shifts in hormone levels, including those that can be measured in saliva, especially testosterone and cortisol. The systematic review aimed to assess changes in salivary hormone levels among perpetrators of violence, with particular emphasis on physical violence, as parameters pointing to perpetrators of violence. Following the inclusion and exclusion criteria, 22 studies were included. Most of the papers included in the analysis came from the USA and Europe. Studies typically included adults as well as children, while focusing mainly on men. Among the hormones, salivary testosterone levels were the ones analyzed most frequently. On the basis of the included studies, a meta-analysis was conducted on the relationship between aggressive behavior and the levels of concentration of testosterone and cortisol measured in saliva. Regardless of gender, individuals exhibiting aggressive behavior were proved to have significantly higher testosterone levels and lower cortisol concentrations in saliva measurements. The obtained results indicate the feasibility of using the examined parameters for initial detection of perpetrators of aggression-related violence. However, further research is necessary to more precisely determine the relationship between aggressive behavior and hormonal changes in order to determine the feasibility of using these parameters as an objective marker for early identification of perpetrators.
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The effectiveness of available neuropsychiatric drugs in the era of an increasing number of patients is not sufficient, and the complexity of neuropsychiatric disease entities that are difficult to diagnose and therapeutically is increasing. Also, discoveries about the pathophysiology of neuropsychiatric diseases are promising, including those initiating a new round of innovations in the role of oxidative stress in the etiology of neuropsychiatric diseases. Oxidative stress is highly related to mental disorders, in the treatment of which the most frequently used are first- and second-generation antipsychotics, mood stabilizers, and antidepressants. Literature reports on the effect of neuropsychiatric drugs on oxidative stress are divergent. They are starting with those proving their protective effect and ending with those confirming disturbances in the oxidation-reduction balance. The presented publication reviews the state of knowledge on the role of oxidative stress in the most frequently used therapies for neuropsychiatric diseases using first- and second-generation antipsychotic drugs, i.e., haloperidol, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole, mood stabilizers: lithium, carbamazepine, valproic acid, oxcarbazepine, and antidepressants: citalopram, sertraline, and venlafaxine, along with a brief pharmacological characteristic, preclinical and clinical studies effects.
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Antidepressivos , Antipsicóticos , Transtornos Mentais , Oxirredução , Estresse Oxidativo , Humanos , Oxirredução/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Antipsicóticos/uso terapêutico , Antipsicóticos/farmacologia , Antidepressivos/uso terapêutico , Antidepressivos/farmacologia , Transtornos Mentais/tratamento farmacológico , AnimaisRESUMO
In light of falling global autopsy rates, one of the causes of which is the resulting body disfigurement, it has become crucial to search for new, minimally invasive post-mortem diagnostic tools. One of these methods is videoautopsy, a minimally invasive autopsy technique using endoscopic methods. In the years 2020-2023, 15 videoautopsies were conducted at the Department of Forensic Medicine of the Poznan University of Medical Sciences in order to determine the usefulness of the method in forensic approaches. Each post-mortem examination included laparoscopy and thoracoscopy, followed by a classic autopsy to assess the effectiveness of the method. In total, the endoscopic examination allowed for determining the cause of death in 53.3% of cases, and when the cause of death was located in the abdominal cavity or chest, the percentage increased to 80%. Traumatic lesions had good recognition efficiency. In addition, it was also possible to collect material for histopathological and toxicological tests. Retroperitoneal organs were difficult to assess. The main limitation of the method is the inability to assess the inside of the skull and the structures of the central nervous system. Videoautopsy may become an important tool in post-mortem diagnostics and in forensic cases, especially when the alternative is to not perform an autopsy. Further research is necessary to standardise the examination protocol, optimise the instrumentation, and assess the potential synergistic effect with other methods of minimally and non-invasive post-mortem examination.
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Pregnancy is a period which is especially sensitive to physical violence and its aftermath. Subjecting a pregnant woman to violence can have negative effects on both the mother as well as the child. In Poland, there are programs, such as the Blue Card, aimed at protection against violence, however the phenomenon is underestimated. Documentation covering forensic examinations carried out at the request of the police or privately at the Department of Forensic Medicine in Poznan in the years 2015-2020 was analyzed. Out of 7,689 cases, 22 were concluded to meet the criteria of violence against pregnant women. The cases were then further analyzed, consideration of the victim's age, professional status, relations with the perpetrator, form of physical violence, and medical assistance. The average age of the women at the time of the incident was 31.1 years. In 90.1% of the cases, the perpetrator was a known man, usually a current or former partner. The most common injuries were abrasions and bruises, while the most common locations of injuries were the head, neck, and arms. The most common forms of violence were grappling, kicking, and hitting with an open hand. Over 72% of the women sought medical attention after the incident. There is a need for educational programs concerning the effects of violence during pregnancy and ways to help. Gynecologists and midwives play an especially important role, by having direct contact with the patient, thus being able to quickly identify victims of violence and take actions to secure safe environment for the woman and the child.
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In recent years, the administration of fentanyl (FNTL) implicitly in transdermal drug delivery systems (TDDS) has vastly increased in chronic pain treatment. Non-medical and uncontrolled use of FNTL in TFDS (transdermal fentanyl delivery systems) may reveal toxic effects by the route of exposure, dermal or alternative, by ingestion of patches, and drug release in the stomach. The purpose of this study was to present three different cases of FNTL poisonings, two of which resulted in death due to TFDS abuse. The first case is a 66-year-old woman treated for accidental FTNL poisoning resulting in acute respiratory distress syndrome. Two remaining cases are a 31-year-old woman and a 25-year-old man who died as a result of FNTL overdose after on-skin and ingestion application of the drug patches. During the hospitalization of the 66-year-old patient, in blood samples, FNTL was confirmed at a concentration of 10.0 ng/mL. Tests run on blood taken from the corpses of 25- and 31-year-old patients exhibited FNTL presence in concentrations of 29.1 ng/mL and 38.7 ng/mL, respectively. The various routes of administration and ultimately toxic effects are important to present because, in TDDS, fentanyl can be a reason for severe to fatal poisoning, as shown by the three cases above.
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Unconventional (alternative, natural) medicine in Poland and worldwide includes hundreds of non-scientifically verified "treatment" modalities. Among the most popular are biological therapies using chemical or natural compounds administered with injection or drip infusion. The latter has found the most excellent use in treating rheumatological and dermatological diseases and certain types of cancer. Vitamin infusions, curcumin, glutathione, perhydrol and dimethylsulphoxide (DMSO) have gained popularity among clients of natural medicine clinics. The present study aims to analyse the case of a 37-year-old woman who was administered infusions containing perhydrol and DMSO (0.5 mL 0.04% hydrogen peroxide/0.5 mL p.d.a DMSO in saline) due to a MTHFR A1298C mutation. After having the next infusion, the woman complained of nausea and then became unconscious. Subsequently, she suffered respiratory and cardiac arrest. Adequate resuscitation was undertaken. After being taken to the hospital, the patient was in critical condition and died due to increasing multiple-organ failure. Initially, there was suspected DMSO poisoning as it was the only compound to have been administered as an intravenous infusion. However, it was not until the analysis of the secured evidence that it became clear that the patient had also been given an intravenous solution of hydrogen peroxide, H2O2, and that there had been a mistake in preparing the intravenous perhydrol solution. The autopsy concluded that the immediate cause of death was an acute cardiopulmonary failure due to the toxic effects of intravenously administered hydrogen peroxide. This conclusion was established after the toxicological testing of the evidence and biological material secured during the patient's treatment and autopsy. Products containing DMSO and perhydrol are not included in the lists of medicinal/therapeutical forms and preparations and thus are not authorised for marketing in Poland. In the case of perhydrol, apart from the topical use of diluted preparations for washing and cleansing wounds, no data on therapeutic use exist in the available scientific literature. Furthermore, "DMSO and perhydrol therapy" cannot even be considered a placebo effect, as both are toxic compounds which could, at most, cause poisoning symptoms rather than improve health.
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Recently, there has been a considerable rise in the popularity and use of electric scooters. Because of this, the number of accidents involving them has also risen. Head and neck injuries are the most common. The aim of the study was to determine the most frequent craniofacial injuries resulting from accidents involving electric scooters, and to identify the risk factors directly related to their placement and severity. The study carried out a retrospective analysis of the medical records of patients of the Clinic of Maxillofacial Surgery over 2019-2022, in terms of craniofacial injuries suffered as a result of e-scooter-related accidents. In the study population (31 cases), of which 61.3% were men, the median age was 27 years. At the time of the accident, 32.3% patients were under the influence of alcohol. Accidents were most common in the 21-30 age group; more often than not, they occurred during warm months and on weekends. The study identified a total of 40 fractures in the patients. The most common craniofacial injuries were mandibular fractures (37.5%), zygomatic-orbital fractures (20%) and frontal bone fractures (10%). A multidimensional correspondence analysis was also performed, which showed that at an age of under 30, alcohol consumption and female gender were associated with a higher likelihood of mandibular fracture. Proper education on the risks associated with the use of e-scooters is essential, with particular emphasis on the impact of alcohol on the driver. It is important to develop diagnostic and therapeutic algorithms for doctors, both in ED and in specialised departments.
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BACKGROUND: Estrogens have pleiotropic mechanisms of action, and their cellular transduction pathways can modulate various proteins with differential tissue expression. Proline-, glutamic acid-, and leucine-rich protein 1 (PELP1) is one such protein whose role seems important, although little is known about this protein. However, very little is known about the expression of modulators involved in the estrogen-mediated pathways in the tissues of the male reproductive tract. METHODS: In this study, we obtained autopsy specimens of testis and epididymis from 13 men of Caucasian descent. Expression levels were analyzed for both estrogen receptors (ESR1 and ESR2) and their co-regulators, including PELP1 and kinase c-Src (SRC). RESULTS: Protein expression was confirmed with western blot and immunocytochemistry techniques. The expression of both SRC and PELP1 was significantly higher in the testis compared to the epididymis (p=0.040 and p=0.002, respectively). Furthermore, a significant, positive correlation was observed between SRC and PELP1, regardless of tissue type p<0.0001, R=0.78). In the testis, PELP1 expression positively correlated with ESR1 expression (p=0.367, R=0.6). CONCLUSIONS: Our study suggests a possible relationship between PELP1, SRC, and ESR1 in the human testis and epididymis. This study makes a valuable contribution to the field of estrogen-mediated pathways in the male reproductive tract and describes trends of analyzed genes' expression and presence. We think our results may open some new research directions of the estrogen signaling in the male reproductive system.
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Epididimo , Quinases da Família src , Humanos , Masculino , Quinases da Família src/metabolismo , Epididimo/metabolismo , Testículo/metabolismo , Estrogênios , Receptores de Estrogênio/genética , Receptores de Estrogênio/metabolismo , Fatores de Transcrição , Proteínas CorrepressorasRESUMO
Forensic medical opinions serve the appropriate classification of a crime against health. Violence, a multifaceted phenomenon, requires forensic medical examination in the case of causing damage to health. Due to the effects caused by the perpetrator, the damage to health is divided into severe, medium, and light. This study analyzed 7689 incidents of violence from 2015-2020, taking place in the area subordinate to the Provincial Police Headquarters in Poznan, based on anonymized documentation of forensic medical examinations performed at the Department of Forensic Medicine in Poznan at the request of the Police and privately. The analysis took into account: units ordering the test, type of exposure, medical help, sex and age of the victim, places of the incident, classification and localization of injury, manner of impact, attitude of the perpetrator to the victim, profession of the victim, gender of the perpetrator, and remarks. In Poland, statistics on violence victims are underestimated, resulting from the low reporting of crimes committed to law enforcement authorities. There is a need for programs to educate the perpetrator of violence on methods of conflict resolution and programs to prevent violence, covering events taking place in public spaces.
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Vítimas de Crime , Abuso Físico , Cidades , Prevalência , Polônia , Medicina LegalRESUMO
(1) Background: Insertion-deletion (InDel) markers show the advantages of both short tandem repeats (STRs) and single nucleotide polymorphisms (SNPs) and are considered alternative markers in forensic genetics. (2) Methods: Allelic frequencies and corresponding forensic efficiency parameters of 30 autosomal polymorphic InDel loci included in the Investigator DIPplex kit (Qiagen) were obtained in a sample of 631 unrelated Polish individuals. Allelic frequency data were compared with those reported for selected populations (3) Results: All the loci conformed with Hardy-Weinberg equilibrium after applying a Bonferroni correction and no pair-wise significant linkage disequilibrium was detected. (4) Conclusions: DIPplex Kit differences were high among populations worldwide. The InDel markers are highly discriminating for human identification purposes in the Polish population.
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Genética Populacional , Mutação INDEL , Humanos , Polônia , Frequência do Gene/genética , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
Insulin is the most effective glycemic-lowering drug, and for people suffering from type 1 diabetes it is a life-saving drug. Its self-dosing by patients may be associated with a higher risk of overdose, both accidental and deliberate. Insulin-induced hypoglycemia causes up to 100,000 emergency department calls per year. Cases of suicide attempts using insulin have been described in the literature since its introduction into therapy, and one of the important factors in their occurrence is the very fact of chronic disease. Up to 90% of patients who go to toxicology wards overdose insulin consciously. Patients with diabetes are burdened with a 2-3 times higher risk of developing depression compared to the general population. For this reason, it is necessary to develop an effective system for detecting a predisposition to overdose, including the assessment of the first symptoms of depression in patients with diabetes. A key role is played by a risk-conscious therapeutic team, as well as education. Further post-mortem testing is also needed for material collection and storage, as well as standardization of analytical methods and interpretation of results, which would allow for more effective detection and analysis of intentional overdose-both by the patient and for criminal purposes.
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AIMS: The number of cardiovascular procedures using the coronary sinus (CS) as a gateway is constantly increasing. The present study aimed to define specific structures within CS, which could potentially complicate CS cannulation and to develop a new Thebesian valve (TV) classification system. METHODS AND RESULTS: The study was performed on 560 consecutive unfixed cadaveric hearts during routine autopsy examination (1-3 days post-mortem). Basic CS dimensions were measured and the presence and dimensions of the TV and the Vieussens valve (VV) were assessed. Thebesian valves were classified according to their morphology into six main types: remnant fold, semilunar, fenestrated, chord, fused strands, and mixed shaped. The median age of hearts was 48 years (range 16-95 years), and 38.9% were female. Thebesian valve was present in 79.5%. The most common TV type was semilunar (54%) followed by fenestrated (8.2%), remnant fold (5.5%), fused strands (4.8%), chord (4.0%), and mixed shaped (3.0%). In 1.1% of hearts, TV totally covered the coronary sinus ostium (CSO). The VV was detected in 67.9%. Potentially occlusive VV was found in 1.1% hearts and in all of which it coexisted with obstructive TV. The median CSO area was 87.9 mm2 [interquartile range (IQR): 56.5-127.1 mm2] and median CS length was 38 mm (IQR: 29.5-45 mm). The CSO area and CS length correlated with each other and with the right atrium's dimensions. CONCLUSION: We identified six types of TVs, among which only 1.1% TVs caused total occlusion of CSO. The obstructive TV co-existed with potentially occlusive VV what might hinder CS cannulation.
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Seio Coronário , Doenças Vasculares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Cateterismo , Seio Coronário/anatomia & histologia , Feminino , Valvas Cardíacas/anatomia & histologia , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
Paraoxonase 1 (PON1) is known for preventing atherosclerosis through lipid-modifying features, antioxidant activity, anti-inflammatory, anti-apoptosis, anti-thrombosis, and anti-adhesion properties. Uremic patients requiring haemodialysis (HD) are especially prone to atherosclerosis and its complications. We analysed the PON1 gene (PON1) polymorphisms and serum PON1 (paraoxonase) activity concerning dyslipidaemia and related cardiovascular diseases and mortality to show how they associate under uremic conditions modified by maintenance HD treatment. The rs662 AA + AG (OR 1.76, 95%CI 1.10-2.80, P = 0.018), rs854560 TT (OR 1.48, 95%CI 1.04-2.11, P = 0.031), and rs854560 AT + TT (OR 1.28, 95%CI 1.01-1.63, P = 0.040) contributed to the prevalence of atherogenic dyslipidaemia diagnosed by the triglyceride (TG)/HDL-cholesterol ratio ≥ 3.8. The normalized serum PON1 activity positively correlated with atherogenic dyslipidaemia (Ạ0.67 ± 0.25, P = 0.008). The PON1 rs854560 allele T was involved in the higher prevalence of ischemic cerebral stroke (OR 1.38, 1.02-1.85, P = 0.034). The PON1 rs705379 TT genotype contributed to cardiovascular (HR 1.27, 95% CI 1.03-1.57, P = 0.025) and cardiac (HR 1.34, 95% CI 1.05-1.71, P = 0.018) mortality. All P-values were obtained in multiple regression analyses, including clinical variables. Multifaceted associations of PON1 with dyslipidaemia, ischemic cerebral stroke, and cardiovascular mortality in HD patients provide arguments for the consideration of PON1 and its protein product as therapeutic targets in the prevention of atherosclerosis and its complications in uremic patients.
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Arildialquilfosfatase/genética , Doenças Cardiovasculares/etiologia , Dislipidemias/etiologia , Diálise Renal/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Arildialquilfosfatase/metabolismo , Doenças Cardiovasculares/metabolismo , Criança , Dislipidemias/metabolismo , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Polimorfismo de Nucleotídeo Único , Modelos de Riscos Proporcionais , Adulto JovemRESUMO
The article presents a case of sudden death of a 56-year-old woman at the workplace, caused by a very rare primary cardiac tumor. The patient's family reported a crime to the prosecutor's office suggesting participation of third parties in causing the death or malpractice in physical examinations before the death. A review of clinical data concerning cardiac angiosarcoma, available in electronic databases (e.g., Web of Science, PubMed), was presented, which could be useful in the practice of occupational medicine specialists. A legal analysis of potential claims to occupational medicine specialist in the case of failure to recognize primary cardiac tumors was also included in the article. Med Pr. 2020;71(6):757-64.
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Hemangiossarcoma/diagnóstico , Hemangiossarcoma/mortalidade , Imperícia/legislação & jurisprudência , Medicina do Trabalho/legislação & jurisprudência , Medicina do Trabalho/normas , Exame Físico/mortalidade , Exame Físico/normas , Local de Trabalho/legislação & jurisprudência , Feminino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/mortalidade , Neoplasias Cardíacas/fisiopatologia , Hemangiossarcoma/fisiopatologia , Humanos , Imperícia/estatística & dados numéricos , Pessoa de Meia-Idade , Polônia , Local de Trabalho/estatística & dados numéricosRESUMO
BACKGROUND: Recently the number of new psychoactive substances have significantly increased, becoming popular among experienced users of designer drugs. A significant group includes benzodiazepine derivatives, which have not been introduced as medications but are abused by people experimenting with new and classical psychoactive substances. CASE PRESENTATION: The aim of this paper was to present the case of a clonazolam ingestion by a person who was not habituated to benzodiazepines. The intake caused only prolonged coma, decreased muscle tone, and deep tendon reflexes without any other concomitant toxicity and cardio-respiratory failure. CONCLUSIONS: Clonazolam concentrations in patient's blood, measured three times were 0.077 mg/L, 0.015 mg/L, 0.009 mg/L after 4, 8 and 12 h, respectively. Clonazolam's human toxicity has not been well established, so any case of poisoning should be closely monitored.
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Benzodiazepinas/intoxicação , Drogas Desenhadas/intoxicação , Hipnóticos e Sedativos/intoxicação , Adulto , Benzodiazepinas/sangue , Análise Química do Sangue , Coma/etiologia , Feminino , Humanos , Hipnóticos e Sedativos/sangue , Intoxicação/complicações , Intoxicação/diagnósticoRESUMO
OBJECTIVES: A rare case of a suicidal use of gases from the car exhaust system of the car petrol engine in an open space is presented. CLINICAL PRESENTATION AND INTERVENTION: To verify suicidal intent of poisoning, an experimental reconstruction of the crime scene was performed. This demonstrated that appropriately long exposure to carbon monoxide with unfavorable weather conditions can cause acute carbon monoxide poisoning in an open space. CONCLUSIONS: This case was studied to observe the pattern of fatal carbon monoxide poisoning in an open space. This might be helpful for forensic medicine, emergency medicine, and occupational medicine.
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Intoxicação por Monóxido de Carbono/diagnóstico , Suicídio , Autopsia , Medicina Legal , Humanos , Masculino , Pessoa de Meia-Idade , Veículos AutomotoresRESUMO
BACKGROUND: In fatal cases of meningococcal septicemia, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests, immunohistochemistry and polymerase chain reaction (PCR), are used to examine body fluids and tissues. CASE SUMMARY: We present the case of sudden death in a 2-year-old child. The patient died approximately 30 min after hospital admission before any routine diagnostic procedures were undertaken. Presence of whole-body rash and fulminant course of the disease raised suspicion of meningococcal septicemia. An autopsy was performed seven days after death when the body showed the signs of late postmortem decomposition. No etiological factor of septicemia could be identified based on macro- and microscopic findings. However, PCR demonstrated the presence of genetic material of group W Neisseria meningitidis in patient's cerebrospinal fluid and blood. CONCLUSION: Microbiological PCR should be conducted postmortem whenever a specific etiological factor could not be identified with conventional methods.
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A prodrug treosulfan (TREO) is currently investigated in clinical trials for conditioning prior to hematopoietic stem cell transplantation. Bioanalysis of TREO and its active derivatives, monoepoxide (S,S-EBDM) and diepoxide, in plasma and urine underlay the pharmacokinetic studies of these compounds but cannot explain an organ pharmacological action or toxicity. Recently, distribution of TREO and S,S-EBDM into brain, cerebrospinal fluid, and aqueous humor of the eye has been investigated in animal models and the obtained results presented clinical relevance. In this paper, a selective and rapid HPLC-ESI-MS/MS method was elaborated and validated for the studies of disposition of TREO and S,S-EBDM in rat plasma, liver, lungs, kidneys, muscle, and brain. The two analytes and codeine, internal standard (IS), were isolated from 50µL of plasma and 100µL of supernatants of the tissues homogenates using ultrafiltration Amicon vials. Chromatographic resolution was accomplished on C18 column with isocratic elution. The limits of quantitation of TREO and S,S-EBDM in the studied matrices ranged from 0.11 to 0.93µM. The HPLC-MS/MS method was adequately precise and accurate within and between runs. The IS-normalized matrix effect differed among the tissues and was the most pronounced in a liver homogenate supernatant (approximately 0.55 for TREO and 0.35 for S,S-EBDM). Stability of the analytes in experimental samples was also established. The validated method for the first time enabled determination of TREO and S,S-EBDM in the six life-important tissues in rats following administration of the prodrug.