Fatal intoxication with new synthetic cannabinoids 5F-MDMB-PICA and 4F-MDMB-BINACA-parent compounds and metabolite identification in blood, urine and cerebrospinal fluid.

Synthetic cannabinoids (SCs) remain one of the largest groups of new psychoactive substances. Recently, new synthetic cannabinoids 5F-MDMB-PICA and 4F-MDMB-BINACA are increasing in popularity. A 33-year-old man lost consciousness after smoking an unknown substance. A glass pipe and two lumps of substance that turned out to contain 5F-MDMB-PICA and 4F-MDMB-BINACA were found at the scene. Blood, urine and cerebrospinal fluid were collected during the examination of the body. The synthetic cannabinoids were isolated from autopsy materials by precipitation with acetonitrile and extraction with ethyl acetate. The screening and quantitative analyses were performed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The liquid chromatography-quadrupole/time of flight mass spectrometry (LC-Q/TOF) technique was used for metabolite identification. 5F-MDMB-PICA was detected and quantified in all analysed materials, whereas 4F-MDMB-BINACA was found only in cerebrospinal fluid. The determined concentrations of 5F-MDMB-PICA were 0.9 (blood), 0.1 (urine) and 3.2 ng/mL (cerebrospinal fluid). The concentration of 4F-MDMB-BINACA in cerebrospinal fluid was 0.1 ng/mL. The main metabolites of both compounds (hydrolysis and oxidative defluorination) were found in all analysed body fluids. Cerebrospinal fluid may be important alternative material in autopsy cases. Rapid elimination of 5F-MDMB-PICA and 4F-MDMB-BINACA compounds also means that the metabolite analysis can be crucial for the investigation. Laboratories must be made aware of their presence and incorporate these SCs and their metabolites into workflows for detection and confirmation. Ester hydrolysis and oxidative defluorination products can be found in blood, urine and cerebrospinal fluid making them useful biomarkers of intake.

A case of intoxication with a new cathinone derivative α-PiHP - A presentation of concentrations in biological specimens.

INTRODUCTION: Cathinones are currently the second largest and the second most frequently seized group of new psychoactive substances (NPS). One of the most recent synthetic cathinones that has appeared on the 'legal highs' market is alpha-pyrrolidinoisohexanophenone (α-PiHP). CASE HISTORY: An 18-year-old man was found dead in an apartment. The autopsy materials were collected for toxicological analyses. METHODS: The quantitative analyses were carried out by LC-MS/MS. RESULTS: α-PiHP was detected and quantified in all post-mortem materials except the hair. The determined concentrations of the compound in the blood, urine and bile were 69 ng/mL, 2072 ng/mL, and 341 ng/mL respectively. The concentrations of α-PiHP in solid tissues were in the range of 7-478 ng/g. 4-Chloromethcathinone (4-CMC), N-ethylhexedrone, benzoylecgonine and 3,4-methylenedioxymethamphetamine (MDMA) were also detected in some materials. DISCUSSION: No cases presenting concentrations of α-PiHP in biological materials have been reported so far. Due to the similarity of structures and the reported dosages, an attempt to compare the concentrations of α-PVP and α-PHP has been made. In the described case, functional death through intoxication of α-PiHP was accepted as the final cause of death. The other detected substances did not contribute to death due to their very likely distant administration. CONCLUSION: α-PiHP is another new synthetic cathinone that is a danger to the life of users. The described fatal intoxication case presents the concentrations of α-PiHP in post-mortem materials. This data could be valuable for further interpretation of other results from toxicological analyses in cases where the use of α-PiHP is suspected.

Penetration Depth of Projectiles Fired from a Replica of Colt Navy of 1851 in 20% Gelatin Blocks Correlated with Fatal Injuries Assessed in an Autopsy of a 78-Year-Old Man.

Pursuant to the Polish Weapons and Ammunitions Law, muzzle-loading black powder weapons, manufactured before 1885, or their replicas, as well as suitable projectiles, can be possessed legally without registration and special licenses. The aim of the study was to assess the penetration depth of projectiles fired from a black powder weapon, replica of Colt Navy of 1851, in 20% gelatin blocks and to compare the obtained results with the actual injuries found on autopsy of a 78-year-old man who had committed suicide. In the experiments, we used the black powder weapon and ammunitions, as well as gelatin blocks serving as a soft tissue model. We ascertained that solid spherical projectiles fired from black powder weapons cause extensive injuries, especially in the initial segment of the wound canal. Additionally, based on the presence and location of the wad in the wound canal, the distance from which the shot was fired can be determined.

Special Purpose Short Stop-Type Ammunitions (Hornet, Wasp, Mosquito)-Gelatin Model Investigation.

Short Stop-type .38 Mesko Special revolver ammunitions have been designed for incapacitation of humans without causing serious bodily injuries. Three types of those ammunitions differing in increasing amounts of gunpowder in the shell chamber and, consequently, increasing kinetic energy of the projectiles can be distinguished: Komar (Mosquito), Osa (Wasp), and Szerszen (Hornet), respectively.The aim of this study was to investigate the ballistic features of such projectiles in a gelatin model. Twenty percent gelatin blocks at 10°C were shot at with a caliber .38 ROSSI Special revolver from 5-, 20-, 50-, and 100-cm distances.The deepest penetration was observed in the case of Hornet-type projectiles, which penetrated into the depth of 10 cm even when shot from 100-cm distance.The results of the research demonstrate that none of the projectiles shot at humans from firearms can be regarded as "safe" because the inflicted injuries do not depend solely on the construction of the bullet, but also on the shooting distance. The use of theoretically nonpenetrating Short Stop-type ammunitions at a distance not exceeding 1 m may cause serious injuries, at times even as extensive as those caused by penetrating projectiles.

[Accidental intoxication with methotrexate--a case report]. / Przypadkowe zatrucie metotreksatem--opis przypadku.

The report presents a case of a 49-year-old man, who was accidentally intoxicated with methotrexate. The man was admitted to a nephrology ward because of generalized erythema involving the entire body, skin pruritus, face edema, fever and difficulty with breathing. On the day of admission, additional studies demonstrated a moderate degree of anemia, considerable leucopenia, thrombocytopenia and an increased level of C-reactive protein. In the course of hospitalization, doctors suspected the condition of the patient to be possibly caused by generalized infection, toxic lesion of the bone marrow or hematological bone marrow disease. Finally it was established that the cause of the patient's disease was his erroneous taking of a total of 35 mg of methotrexate (5 mg per day for seven days). Despite intensive treatment, the patient died seven days after admission. Autopsy confirmed that the man died from acute circulatory and respiratory insufficiency caused by intoxication with methotrexate.

[Symptomless aspiration of a dental bur in the lower respiratory tract--a case report]. / Bezobjawowa aspiracja wiertla stomatologicznego do dolnych dróg oddechowych--opis przypadku.

In this study, the authors review a case of a man who asymptomatically aspired a dental bur in the lower respiratory tract during dental treatment. Lack of any symptoms of foreign body aspiration erroneously suggested swallowing of the object and its passage to the stomach. This suggestion was not excluded by a control chest radiograph. Further specialist imaging examinations allowed for establishing the definite diagnosis and the patient underwent successful retrieval of the bur using left-sided thoracotomy.

Sudden death due to malignant hyperthermia during general anesthesia.

The authors present a case of malignant hyperthermia. The article discusses the death of a 4-year old boy who appeared to be perfectly healthy and underwent dental treatment under general anesthesia. The procedure went well at the beginning, but suddenly complications developed, such as cardiac rhythm disorders and increased body temperature, subsequently, muscle rigidity appeared. Such symptoms are characteristic for an inherited disease called malignant hyperthermia. Despite professionally performed resuscitation and help of an emergency unit, the patient died.

Disruption of ionic interactions between the nucleotide binding domain 1 (NBD1) and middle (M) domain in Hsp100 disaggregase unleashes toxic hyperactivity and partial independence from Hsp70.

Hsp100 chaperones cooperate with the Hsp70 chaperone system to disaggregate and reactivate heat-denatured aggregated proteins to promote cell survival after heat stress. The homology models of Hsp100 disaggregases suggest the presence of a conserved network of ionic interactions between the first nucleotide binding domain (NBD1) and the coiled-coil middle subdomain, the signature domain of disaggregating chaperones. Mutations intended to disrupt the putative ionic interactions in yeast Hsp104 and bacterial ClpB disaggregases resulted in remarkable changes of their biochemical properties. These included an increase in ATPase activity, a significant increase in the rate of in vitro substrate renaturation, and partial independence from the Hsp70 chaperone in disaggregation. Paradoxically, the increased activities resulted in serious growth impediments in yeast and bacterial cells instead of improvement of their thermotolerance. Our results suggest that this toxic activity is due to the ability of the mutated disaggregases to unfold independently from Hsp70, native folded proteins. Complementary changes that restore particular salt bridges within the suggested network suppressed the toxic effects. We propose a novel structural aspect of Hsp100 chaperones crucial for specificity and efficiency of the disaggregation reaction.

Atypical abdominal lacerated wound--differentiation from an incised wound.

In the Department of Forensic Medicine, Medical University in Lodz, there was performed an autopsy of a man with an extensive defect of the abdominal integument and perineum. The inspection of the body at the site it was found together with the deposition of the deceased man's concubine suggested the possibility of criminal degloving of the body using a sharp-edged tool with superimposed injuries inflicted by a dog. Autopsy findings combined with results of additional tests (microscopic examination of tissue sections, ethyl alcohol level determination) allowed for verification of the investigation hypothesis, exclusion of a criminal act and demonstrating dog-inflicted injuries as the cause of death.

[The risk of death following the consumption of ethanol based on forensic research material]. / Ryzyko zgonu w nastepstwie spozycia etanolu na podstawie materialu badawczego medycyny sadowej.

UNLABELLED: The number of abusers in Poland is estimated at about 2.8-3.5 million, including about 600-900 thousands dependent. In this group a variety of somatic disorders and mental health are diagnosed. Mortality among persons with alcohol dependence is several times higher than among those abstainers. Alcohol dependence increases the risk to attempt suicide. Health damage caused by alcohol depends on: the frequency and quantity of drinking of alcohol, age, gender, duration of addiction. THE AIM OF THIS STUDY was to analyze the causes of death in the aftermath of alcohol consumption based on sectional material. MATERIALS AND METHODS: We analyzed 336 autopsy protocols. In order to analyze the collected material was used a questionnaire created for this study. Deaths have been divided into two groups: violent deaths, resulting from trauma and natural deaths. RESULTS: It was observed significant relationship between alcohol consumption and the nature of death. CONCLUSIONS: Most of the deaths associated with alcohol consumption is a sudden deaths, not due to natural causes. Among the sudden deaths domination of ethyl alcohol poisoning, traffic accidents, murder, hanging and drowning.

[Hypoxic-ischemic encephalopathy as a special form of head injury complication in battered child syndrome]. / Encefalopatia niedotlenieniowo-niedokrwienna jako szczególna postac powiklania urazu glowy w zespole dziecka maltretowanego.

The battered child syndrome is increasingly more often described in literature. Head injuries experienced by battered children are the main cause of deaths and neurological complications. A special form of damage inflicted in battered children is vessel background brain injury. The objective of the article was to characterize central nervous system injuries and their results in children who were victims of physical violence. Medical records of three patients hospitalized in Department of Neurology of the Polish Mother Health Center Institute in Lodz, in whom the battered child syndrome had been diagnosed, were analyzed. The authors discussed three cases of children with central nervous system injuries caused by physical violence. All the children were treated pharmacologically, placed on parenteral nutrition and rehabilitated. Among typical central nervous system injuries caused by head trauma, particular attention of the authors was focused on hypoxic-ischemic encephalopathy, a complication of a still unclear etiology that occurred in two cases. Battered children are usually treated in surgical departments and the causes of injuries are not always correctly diagnosed. Brain damage is the reason for permanent neurological consequences in children who experienced physical violence. In medico-legal practice, it is essential to describe precisely all the visible injuries (bruises, abrasions, wounds) especially during the initial medical examination.

[Opinionating errors in forensic medicine]. / Bledy opiniodawcze w medycynie sadowej.

The paper presents selected evident opinionating errors committed by experts in the field of forensic medicine who issued medico-legal opinions in criminal cases, aiming at determining causes of death. The authors analyze the causes of such errors and possibilities of avoiding them, as well as the impact of the said errors on the course of criminal proceedings and the legal position of the suspects or victims. The report emphasizes the potential effect of these opinions on the fate of individuals who have been found suspected or guilty based on such opinions should they be accepted by the court without verification by summoning another expert.

[Cases of myocarditis and their effect on the mechanism of death]. / Przypadki zapalenia miesnia sercowego i ich wplyw na mechanizm zgonu.

In this study, we describe two cases with autopsy findings of interstitial myocarditis. They show that supplementing the autopsy with histopathological examination, even when the cause of death is thought to be clear and obvious, is extremely important as it can contribute valuable information to the case, including the circumstances of death. In the first case, we discussed a tram accident in which its driver was killed. The family of the deceased reported that he had been suffering from consciousness disturbances for some time, and additional radiological examinations demonstrated abnormalities in his neck blood vessels. In the second case, a pregnant woman was admitted to hospital after a cardiac and respiratory arrest. A cesarean section was carried out but the fetus was already dead. The woman was declared dead shortly after the operation.

[Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma]. / Stluczenie pluc i zespól ostrych zaburzen oddechowych ARDS jako powiklania tepego urazu klatki piersiowej.

Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Lódz, an opinion was issued on a case which illustrates the clinical problem.

[Myocarditis in two cases of HIV infection]. / Zapalenie miesnia sercowego w dwóch przypadkach zakazenia wirusem HIV.

The authors present two cases of death in young persons infected with HIV virus and diagnosed with inflammatory changes of the heart muscle rarely seen in forensic medical practice. In one of the cases, only the findings revealed upon autopsy did prompt the examiner to suspect the infection, even though before death, the patient had been in several hospitals.

[Oxidative stress parameter analysis in rat brains during long-term ethanol intoxication]. / Ocena parametrów stresu oksydacyjnego w mózgach szczurów przewlekle intoksykowanych etanolem.

The aim of this research was to define the influence of long-term ethanol intoxication on the changes in end products of lipid peroxidation, reacting with thiobarbituric acid (TBA-reactive products) and free SH-groups concentrations in rat brains. The experiment was conducted on male Lewis rats. The experimental groups received a 1-molar ethanol solution and the control group received tap water. The animals were killed after 4, 8 and 12 weeks of intoxication and their brains were collected for further examination, encompassing measurement of the concentration of TBA-reactive products and free SH-groups. A statistically significant increase in the concentration of TBA-reactive products in 4th week of intoxication and decrease in the concentration of free SH-groups in 8th and 12th week of intoxication--compared to the control group--was noticed.

[Changes of the concentration of lipid peroxidation products and thiol groups in rat brains with long-term intoxication with methanol]. / Zmiany stezen produktów peroksydacji lipidów i grup tiolowych w mózgach szczurów w przebiegu przewleklej intoksykacji metanolem.

The aim of this paper was to define the influence of long-term methanol intoxication on the changes of end products of lipid peroxidation, reacting with thiobarbituric acid (TBA-reactive products) and free SH-group concentration in rat brains. The experiment was conducted on male Lewis rats. The experimental groups received a 1-molar methanol solution and the control group received tap water. The animals were killed after 4, 8 and 12 weeks of intoxication and their brains were collected for further examination, which encompassed measurement of the concentration of TBA-reactive products and free SH-groups. The revealed changes of TBA-reactive products and free SH-group concentration were not statistically significant.

[Selected alcohols on the pro- and anti-oxidative processes in rat erythrocytes]. / Wplyw wybranych alkoholi na procesy pro- i antyoksydacyjne w krwinkach czerwonych szczurów.

In forensic medicine practice poisonings are rather frequent, and among them, those caused by fatal "substitution" of ethyl alcohol. One of the most frequently encountered "substitutes" for ethyl alcohol is methanol. The purpose of our research was to determine the concentration of malonic dialdehyde as the expression of lipid peroxidation and antioxidant enzyme activity after dosed chronic ethyl and methyl alcohol intoxication. The experiment was conducted on approx. 6 month-old male inbred Lewis rats each weighing approx. 250 g. Ethanol and methanol solution was given in the concentration 1.0 M. The control group of rats received water. Each experimental group numbered 30 rats, this number was divided into three sub-groups, which were put-down at 4, 8 and 12 weeks. The activity of superoxide dismutase (CuZu-SOD) was determined by the Misra-Fridovich method, catalase (CAT) by the Beers-Sizer method. The concentration of malonic dialdehyde (MDA) was determined using the method of Placer et al. by assessing the concentration of TBARS compounds. Results are expressed as a mean +/- SD. The paired Student's test for small groups were used. Superoxide dismutase SOD1 activity decreased compared with the control group throughout the duration of the experiment from 2212 U/gHb to 1676 U/gHb for ethanol and from 2212 U/gHb to 945 U/gHb for methanol. Catalase activity for methanol decreased from 9.1 U/gHb to 5.1 U/gHb, for ethanol to 7.4 U/gHb. In the 4th week of the experiment increase of malonyl dialdehyde concentration for methanol group was observed--from 0.14 umol/gHb to 0.34 umol/Hb; after 8th weeks it decreased to 0.2 umol/gHb and in the 12th week increased to 0.23 umol/gHb. For ethanol these changes was less visible and reached the level of 0.24 umol/l. The statistical processing of the results was performed on the basis of parametric tests (the t-Student test for small experiments) and computer software Statistica. The statistical significance was set for p<0.05.

[Long-term realistically life-threatening disease]. / Dlugotrwala choroba realnie zagrazajqca zyciu.

In this paper the authors discuss a legal code description of a wrongly included (as a result of a legislative error) "long-term really life-threatening disease" (dlugotrwala choroba realnie zagrazajaca zyciu) in the Criminal Code. This category of disease impossible to apply in practice since its terms "long-term" and "realistically life-threatening" are mutually exclusive--is nonetheless applicable to crimes committed from Sept. 1, 1998 to Dec. 8, 2003. In effect this causes a change in the qualification of certain acts in Art. 156 of the Criminal Code, to include those in Art. 157, Paragraph 1, and in some cases, even extending to acts named in Art. 157, Paragraph 2 of the Criminal Code.

[Myocardial infarction as a work accident in Polish Supreme Court decisions. Part I. Excessive stress at work]. / Zawal serca jako wypadek przy pracy w orzecznictwie sadu najwyzszego. Czesc I. Nadmierne obciazenie wykonywana praca.

This paper deals with Polish Supreme Court opinions on the acceptance of myocardial infarction as work accident. From them the principle emerges that excessive physical or mental work stress can be accepted as the external cause of myocardial infarction in an employee, whereby the excess strain should be judged in each case individually and with reference to the individual situation.