The Effect of Neuropsychiatric Drugs on the Oxidation-Reduction Balance in Therapy.

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.

Peculiarities in coronary sinus anatomy: implications for successful cannulation from an autoptic study.

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.

Suicidal Carbon Monoxide Poisoning Using Motor Vehicle Exhaust in an Open Space.

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.

Analysis of human dentition from Early Bronze Age: 4000-year-old puzzle.

This paper presents the first ever paleodontological investigation of human remains from an archeological site in Central Europe dating from the Early Bronze Age and attributed to the Strzyzow Culture. It corroborates the knowledge gained from archeological, anthropological and genetical investigations. Our study aimed to assess dental status, dental morphology and dental pathologies as well as tooth wear and enamel hypoplasia based on visual inspection and stereomicroscopic investigation. The research was supported by CBCT imaging to obtain digital images and 3D reconstructions as well as 2D radiographs essential for dental age estimation. All of the 191 teeth discovered showed morphological similarity, with adult teeth showing similar color, shape and size. A maxillary molar presenting with a unique root morphology and a mandibular molar with a rare occlusal surface were found. Both permanent and deciduous dentition presented significant tooth wear. A few specimens displayed signs of dental caries, periapical pathology and antemortem tooth loss. Three individuals exhibited linear enamel hypoplasia. CBCT provided high-quality 2D images useful for dental age estimation by non-destructive methods. Estimated dental age correlated with the age estimated by other anthropological methods. In one case, this was crucial because of insufficient material for anthropological analysis. The presented studies have proved that besides the skeleton, teeth can be used as a fundamental tool in assessing the overall health and living conditions of paleopopulations. It would seem that there is potential for considerable development to be made in the research and investigation of paleodontological material using CBCT.

[Health state assessment in people sentenced to the penalty of restriction of liberty]. / Ocena stanu zdrowia skazanych na kare ograniczenia wolnosci.

BACKGROUND: Assessment of the health state of people sentenced to the penalty of restriction of liberty makes up a significant percentage of cases annually elaborated in the Department of Forensic Medicine, Poznan University of Medical Sciences. The analysis of such cases was accomplished to point out the difficulties that expert physicians could encounter in formulating their opinions. MATERIAL AND METHODS: The analysis involved 1051 medico-legal opinions issued in the years 2004-2013, considering the health state of people performing the duty of free, controlled social labor. The authors collected data on age, sex, type of diseases and the ability to control social work of convicted subjects. RESULTS: Among those sentenced to the penalty of restriction of liberty the men aged 51-60 were in the majority. Individuals able to work only in specified conditions were the most numerous group (56.3%). People able to work in all conditions were the smallest set (9.5%). Light work was the type of work most frequently recommended to the persons able to work only in specific conditions (58.4%). The largest group of diseases comprised spondylopathies and osteoarthropathies (51.4%). It was followed by the group of cardiac diseases and angiopathies, including hypertension (38.7%). CONCLUSIONS: The number of cases concerning the ability of the sentenced persons to serve the penalty of restriction of liberty annually elaborated in the Department of Forensic Medicine, Poznan University of Medical Sciences and the number of sentences imposed on the national scale indicate that medical experts may be obliged to provide opinions of this kind. Assessment of the health state of people sentenced to the penalty of restriction of liberty in some cases can be a difficult task for the expert physicians because of frequent lack of information about a specific type of work performed by the sentenced persons having only the data about their diseases. Med Pr 2016;67(6):765-775.

[Energy drinks as a cause of seizures--real or possible danger? Case report]. / Napoje energetyzujace jako przyczyna drgawek--realne czy potencjalne zagrozenie? Opis przypadku.

The consumption of energy beverages is increasing, especially among young people. The increasing consumption of these drinks increases the data of side effects. Case report: A 26-year old male was admitted to Toxicology Department suspected of intoxication due to ethyl alcohol and unknown psychoactive substances. The patient lost consciousness during a party in which he drank an unknown amount of ethyl alcohol mixed with an energy beverage ("Red Bull"). The patient and his friends strongly denied the use of psychoactive substances. On admission, the patient was stable, but unconscious (GCS 8 points), pupils wide, symmetric with weak reaction to light, respiratory rate 15/min. Neurological examination did not reveal any abnormalities. During the hospitalization, somnolence slowly disappeared and the patient became restless, with recurrent episodes of seizures not reacting to diazepam, clonazepam and midazolam infusion. The seizures finally abated after administration of barbiturates (Thiopental). This, in turn, caused respiratory insufficiency, requiring patient intubation and mechanical ventilation. The patients mental status and respiratory status slowly improved. After regaining consciousness, the patient strongly denied the use of psychoactive substances or of chronic alcohol use. He confirmed the single use of high, but not clearly defined, caffeine dosage (in the form of "Red Bull") mixed with alcohol. He mentioned that eight months earlier in similar circumstances he was admitted to the neurology department due to an episode of seizures. Ultimately the origin was not established, despite broad diagnostic testing. Thus the origin of the seizures was suggested to be of a toxicological origin. The patient was released home in good condition, without any side effects of the poisoning. The psychological examination doe not reveal any symptoms of alcohol or psychoactive substances addiction. In our case, due to the unclear nature of the history, we preformed broad diagnostic testing on admission to the hospital, which do not reveal the presence of any toxic substances except ethanol; concentration in the blood was 2,41 gil. Unfortunately, serum caffeine levels were not measured. There was no identification of any other factors that could be responsible for the observed symptoms. It appears that based on the interview, clinical manifestation, and negative toxicology laboratory testing (excluding the presence of ethanol), it is possible to connect the seizure state with the consumption of a high dose of energy drinks, rich in caffeine and taurine.

Videoautopsy-A Minimally Invasive Autopsy Method Using Endoscopic Techniques in Forensic Medicine: Clinical Features.

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.

Minimally invasive autopsy - endoscopic approach to post-mortem diagnostics.

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.

Characteristics of physical violence against pregnant women - analysis of medico-legal data and literature review.

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.

The conclusive role of postmortem computed tomography (CT) of the skull and computer-assisted superimposition in identification of an unknown body.

Computed tomography is commonly used in modern medicine, and thus, it is often helpful for medicolegal purposes, especially as part of the antemortem record. The application of postmortem computed tomography and 3D reconstruction of the skull in challenging cases is reported, and its valuable contribution to positive identification is discussed. This paper presents a case in which the body of an unknown individual is identified. Positive identification had not been possible despite a multidisciplinary examination. The postmortem use of computerized tomography and 3D reconstruction of the skull followed by the comparison of individual morphological characteristics of the viscerocranium showed the concordant points between the deceased and a missing person. Finally, superimposition using a 3D-reconstructed skull instead of the skeletonized skull demonstrated an adequate degree of morphological consistency in the facial images of the analyzed individuals that lead to positive identification. It was concluded that where other methods of personal identification had failed, the use of postmortem computed tomography had proved to be instrumental in the positive identification of the deceased.

Polish population data for 17 Y-STRs and 8 Y-SNPs markers / Badania populacji Wielkopolski w zakresie 17 markerów Y-STRs oraz 8 Y-SNPs.

The aim of our study was to establish the genetic differentiation of the population of the province of Wielkopolska (Greater Poland) for 17 Y-STRs and 8 Y-SNPs and comparison of the Polish population with other selected populations. The investigations included 201 unrelated male inhabitants of the Greater Poland region We found 184 unique haplotypes for 17 Y-STR. The haplotype discrimination capacity was 0.96. The most frequent haplotype Ht-50 was found in 3 samples and 7 haplotypes observed twice. Further, the same samples were analyzed with Y-8 SNPs markers. We obtained 40 haplotypes. The haplotype discrimination capacity was 0.20. The most frequent haplotype was presented in 38 samples. A total of 4 different haplogroups were established. Haplogroup K= 19%, IJ = 7%, R1a1 = 59% and R1b = 15%. The HD value of Y-SNPs/Y-STRs was 0.9883.

Causes of problems in multidisciplinary bitemark analysis / Przyczyny trudnosci interdyscyplinarnej analizy sladów ugryzien.

Since a successful bitemark analysis depends on many factors, it is important that the phases preceding the analysis be carried out as thoroughly as possible. Interpretive errors in the analysis arise primarily from the complex nature of bitemarks, but also as a result of faulty research methodology, false assumptions or technical errors made during the identification and documentation process. The key role is played by qualifications, knowledge and experience of experts involved in the investigations. In case bitemarks are detected, it is recommended to seek consultations by forensic odontologists or members of an interdisciplinary team experienced in bitemark analysis. The thus obtained information allows for gathering evidence guaranteeing a reliable expert opinion.

PELP1 and SRC kinase as important molecules in the estrogen-mediated pathway in human testis and epididymis.

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.

Prevalence of Physical Violence in the Medical-Forensic Approach in the Years 2015-2020 in City and Neighboring Municipalities: Perspectives from Poland-Poznan Study.

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.

Characteristics of E-Scooter-Related Maxillofacial Injuries over 2019-2022-Retrospective Study from Poznan, Poland.

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.

Severe and Fatal Fentanyl Poisonings from Transdermal Systems after On-Skin and Ingestion Application.

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.

Causes of Death during the Intravenous Infusion of Dimethylsulphoxide and Hydrogen Peroxide in the Course of Alternative Medicine Therapy.

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.

[Biochemical markers for acute and chronic alcohol consumption]. / Markery biochemiczne stosowane w ocenie ostrej i przewleklej konsumpcji alkoholu etylowego.

In spite of the fact, that ethyl alcohol is a legal and socially accepted recreational drug its abuse may cause numerous problems for the individual and society. Casualties of car accidents caused by drunk drivers, aggressive behavior, family problems and effective less work are the main problems connected with alcohol abuse. The easiest and most effective way of proving recent alcohol consumption is confirming its presence in biological samples taken from the individual. However, the main disadvantage of this method is a short window detection for ethanol, because of its high speed of elimination process. Nowadays, in order to prevent and have a better control of alcohol abuse, markers that could provide a better view of short and long term ethanol consumption are in frequent use. Ethyl alcohol present in the body cause many qualitative and quantitative disturbances in biochemical metabolites that could be used as markers of its consumption. In practice markers of ethanol consumption are usually divided into acute (tests confirm single alcohol intake) and chronic (confirm long term alcohol consumption or lack of teetotalism). Markers of ethanol consumption are valuable alternative and complementation to customary examinations performed in medical practice and forensic medicine.

The Other Face of Insulin-Overdose and Its Effects.

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.