Age Estimation Using Maxillary Central Incisor Analysis on Cone Beam Computed Tomography Human Images.

Forensic dentistry plays an important role in human identification, and dental age estimation is an important part of the process. Secondary dentin deposition throughout an individual's lifetime and consequent modification in teeth anatomy is an important parameter for age estimation procedures. The aim of the present study was to develop regression equations to determine age in adults by means of linear measurements and ratios on sagittal, coronal and axial slices of maxillary central incisors using cone bean computed tomography (CBCT). Multiplanar measurements of upper central incisors were taken for a sample of 373 CBCTs. Subsequently, one-way analysis of variance (ANOVA) and multivariate linear regressions were performed for age estimation. The equations obtained from axial linear measurements and ratios presented a standard error of the estimate (SEE) of ±10.9 years (R2 = 0.49), and a SEE of ±10.8 years (R2 = 0.50), respectively. The equation obtained for multiplanar linear measurements presented a SEE of ±10.9 years (R2 = 0.52), while the equation for multiplanar ratios presented a SEE of ±10.7 years (R2 = 0.51). Thus, CBCT measurements on upper central incisors were found to be an acceptable method for age estimation. Horizontal measurements, especially pulp measurements, improve the accuracy of age estimate equations.

Simultaneous determination of 137 drugs of abuse, new psychoactive substances, and novel synthetic opioids in meconium by UHPLC-QTOF.

New psychoactive substances (NPS) have been introduced into the market in recent years, with new analytes reported every year. The use of these substances in women can occur at any stage of life, even in the childbearing age. Drug use during pregnancy presents significant risks for the mother and the fetus, so it is important to have tools that allow to detect prenatal exposure to these substances of abuse. Therefore, an analytical method for the determination of 137 NPS and other drugs of abuse in meconium by UHPLC-QTOF was developed and validated for semi-quantitative purpose. Linearity range, limit of detection (LOD), precision, matrix effect, selectivity, and specificity were evaluated. For all analytes, the calibration curves were studied in the ranges between 2, 10, or 50 ng/g and 750 or 1000 ng/g, (depending on the analyte) and the LOD ranged between 0.04 and 2.4 ng/g. The method was applied to 30 meconium specimens from cases in which fentanyl had been administered as epidural anesthesia at the time of delivery or cases in which the maternal hair was positive to other drug of abuse. Four meconium samples tested positive for fentanyl (range concentration = 440-750 ng/g) and two samples tested positive to acetylfentanyl (range concentration = 190-1400 ng/g).

Assessment of biological matrices for the detection of in utero cannabis exposure.

Cannabis consumption has been increasing worldwide among pregnant women. Due to the negative effects of prenatal cannabis exposure, it is necessary to develop an objective, sensitive, and specific method to determine cannabinoids use during pregnancy. In this study, we compared four different biological samples, maternal hair, meconium, umbilical cord, and placenta, for the detection of in utero cannabis exposure. The biological samples were collected from 627 mother-newborn dyads. All hair and meconium samples were analyzed, and umbilical cord and placenta if hair and/or meconium were positive for cannabinoids. Meconium and hair showed to complement each other, with an agreement between hair and meconium results of 96.7% but only 34.3% if just positive results were considered. Umbilical cord and placenta results showed a better agreement with meconium (91.3% and 92.6%, respectively) than with hair (39.1% and 34.6%, respectively). The predominant metabolites in meconium were 11-nor-carboxy-THC (THCCOOH) and 8,11-dihydroxy-THC (diOHTHC), and in umbilical cord and placenta was THCCOOH-glucuronide. Cannabidiol (CBD) and cannabinol (CBN) were detected in meconium but not in any umbilical cord or placenta. For the first time, prenatal marijuana exposure was analyzed and compared in paired hair, meconium, umbilical cord, and placental samples. Hair and meconium positivity rate was similar, but a more sensitive and specific analytical method for the hair may resolve discrepancies between the matrices. Umbilical cord and placenta may be considered suitable alternative matrices to meconium through the determination of THCCOOH-glucuronide as a biomarker of cannabis exposure.

Detection of in utero cannabis exposure by umbilical cord analysis.

According to the 2014 National Survey on Drug Use and Health, 5.3% of pregnant women smoked marijuana in the past month. This prevalence is expected to increase as a growing number of states and countries are now considering legalization. Although the umbilical cord is becoming a useful objective tool to detect in utero drug exposure, currently data about analytical methods and its utility to detect cannabis exposure are scarce. The objective of this work was to develop a method for the determination of Δ9 -tetrahydrocannabinol (THC), 11-hydroxyTHC (THC-OH), 11-nor-9-carboxy-THC (THCCOOH), 8-ß-11-dihydroxyTHC (THC-diOH), THC and THCCOOH glucuronides, and cannabidiol (CBD) in the umbilical cord by liquid chromatography-tandem mass spectrometry (LC-MS/MS) with dual ionization source. Umbilical cord samples (0.5 g) were homogenized in methanol and extracted by solid-phase extraction. Reversed-phase chromatographic separation was performed in 14 minutes, and 2 transitions per analyte were monitored in multiple reaction monitoring mode. Method validation included linearity (1-10 to 20-200 ng/g), precision (4.1%-23.4%), accuracy (87.5%-111.4%), matrix effect (-54.8% to -5.8%), extraction efficiency (25%-45.6%), limits of detection and quantification (1-10 ng/g), and endogenous (n = 5) or exogenous interferences (not detected). The method was applied to 13 authentic samples from cannabis-exposed newborns, which meconium samples had tested positive for cannabis. Twelve cord specimens tested positive for THCCOOH-glucuronide (1.6-19.1 ng/g). We developed and validated a specific and sensitive method for the simultaneous determination of THC, its metabolites, including THC and THCCOOH glucuronides, and CBD in umbilical cord samples by LC-MS/MS. The analysis of authentic samples showed the usefulness of umbilical cord to detect cannabis in utero exposure.

Bioanalysis for cocaine, opiates, methadone, and amphetamines exposure detection during pregnancy.

Drug exposure during pregnancy constitutes a major legal issue and a public health concern. Drug and metabolite determination in biological matrices from mother and newborn is an objective indication of prenatal drug exposure. However, limited data are available regarding the interpretation of these analytical results in terms of window of detection and degree of exposure. We collected paired maternal hair, meconium, placenta, and umbilical cord from 727 mother-newborn dyads. We analyzed these specimens by liquid chromatography-tandem mass spectrometry for the determination of cocaine, opioids, methadone, and amphetamines, and compared the analytical results from the four different matrices. The cases were divided in non-exposure, low, and frequent exposure, based on maternal hair concentrations and segmental analysis by trimesters. For cocaine, 62 cases tested positive in hair, 9 in meconium, 6 in placenta and 7 in umbilical cord. In the case of opioids, 14 maternal hair cases were positive, 11 meconium and umbilical cord and 9 placenta samples. For methadone, 11 cases were positive in hair, 9 in meconium and 6 in placenta and umbilical cord. For amphetamines, 18 cases were positive according to maternal hair, but all meconium, placenta, and umbilical cord tested negative. Maternal hair was the most sensitive specimen to detect drug exposure during pregnancy. Meconium, placenta, and umbilical cord tested positive if hair concentrations showed frequent drug use during the whole pregnancy, especially during the third trimester. Meconium, placenta, and umbilical cord also tested positive for morphine and metabolites, if this drug was administered during labour and delivery. Copyright © 2016 John Wiley & Sons, Ltd.

El monóxido de carbono y la neurología. Réplica / Carbon monoxide and neurology. Reply

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Síndrome neurológico tardío tras intoxicación por monóxido de carbono / Delayed neurological syndrome following carbon monoxide poisoning

Introducción. La intoxicación por monóxido de carbono es la más frecuente en nuestro medio a consecuencia de la exposición a gases tóxicos. Los efectos de la intoxicación por monóxido de carbono no se limitan a la exposición aguda porque, tras la aparente recuperación de la intoxicación, pueden aparecer alteraciones neurológicas o del comportamiento. Pacientes y métodos. Se realizó un estudio de las intoxicaciones por monóxido de carbono en un área sanitaria de 80.000 habitantes durante un período de 10 años. Posteriormente se hizo un seguimiento de estos pacientes y se valoró la aparición de síndrome neurológico tardío (SNT) y su relación con diferentes variables en la exposición inicial al monóxido de carbono, en el tratamiento administrado o en la gravedad de la intoxicación. Resultados y conclusiones. Se observó que el 9,1% de los intoxicados por monóxido de carbono detectados en el área sanitaria de Salnés desarrollan el SNT, que es más frecuente en los pacientes con criterios analíticos de gravedad y muy poco probable en los que no los tienen. Los pacientes con SNT no expresaron manifestaciones clínicas ni analíticas diferentes a los que no presentaron el síndrome; tampoco se observaron diferencias en relación con la terapia con oxígeno administrada. La tasa de SNT en el área sanitaria de Salnés entre 2002 y 2012 es de 0,84 casos por 100.000 habitantes y año (AU)

Introduction. Poisoning by carbon monoxide is the most frequent form of intoxication in our milieu as a result of exposure to poisonous gases. The effects of carbon monoxide poisoning are not limited to acute exposure, since, following apparent recovery from the acute intoxication, neurological or behavioural disorders may appear. Patients and methods. A study was conducted to examine the cases of carbon monoxide poisoning that had occurred in a healthcare area of 80,000 inhabitants over a 10-year period. These patients were then submitted to a follow-up to appraise the appearance of delayed neurological syndrome (DNS) and its relationship with different variables in the initial exposure to the carbon monoxide, in the treatment that was administered or in the severity of the intoxication. Results and conclusions. It was observed that around 9.1% of those intoxicated by carbon dioxide detected within the healthcare district of Salnés went on to develop DNS, which is more frequent in patients with severe analytical criteria and very unlikely in those who do not have them. Patients with DNS did not express any clinical or analytical manifestations that differed from those who did not have the syndrome; no differences were observed in relation to the oxygen therapy that was administered. The rate of DNS within the healthcare district of Salnés between 2002 and 2012 is 0.84 cases per 100,000 inhabitants per year. (AU)

[Delayed neurological syndrome following carbon monoxide poisoning]. / Síndrome neurológico tardío tras intoxicación por monóxido de carbon.

INTRODUCTION: Poisoning by carbon monoxide is the most frequent form of intoxication in our milieu as a result of exposure to poisonous gases. The effects of carbon monoxide poisoning are not limited to acute exposure, since, following apparent recovery from the acute intoxication, neurological or behavioural disorders may appear. PATIENTS AND METHODS: A study was conducted to examine the cases of carbon monoxide poisoning that had occurred in a healthcare area of 80,000 inhabitants over a 10-year period. These patients were then submitted to a follow-up to appraise the appearance of delayed neurological syndrome (DNS) and its relationship with different variables in the initial exposure to the carbon monoxide, in the treatment that was administered or in the severity of the intoxication. RESULTS AND CONCLUSIONS: It was observed that around 9.1% of those intoxicated by carbon dioxide detected within the healthcare district of Salnés went on to develop DNS, which is more frequent in patients with severe analytical criteria and very unlikely in those who do not have them. Patients with DNS did not express any clinical or analytical manifestations that differed from those who did not have the syndrome; no differences were observed in relation to the oxygen therapy that was administered. The rate of DNS within the healthcare district of Salnés between 2002 and 2012 is 0.84 cases per 100,000 inhabitants per year.

TITLE: Sindrome neurologico tardio tras intoxicacion por monoxido de carbono.Introduccion. La intoxicacion por monoxido de carbono es la mas frecuente en nuestro medio a consecuencia de la exposicion a gases toxicos. Los efectos de la intoxicacion por monoxido de carbono no se limitan a la exposicion aguda porque, tras la aparente recuperacion de la intoxicacion, pueden aparecer alteraciones neurologicas o del comportamiento. Pacientes y metodos. Se realizo un estudio de las intoxicaciones por monoxido de carbono en un area sanitaria de 80.000 habitantes durante un periodo de 10 años. Posteriormente se hizo un seguimiento de estos pacientes y se valoro la aparicion de sindrome neurologico tardio (SNT) y su relacion con diferentes variables en la exposicion inicial al monoxido de carbono, en el tratamiento administrado o en la gravedad de la intoxicacion. Resultados y conclusiones. Se observo que el 9,1% de los intoxicados por monoxido de carbono detectados en el area sanitaria de Salnes desarrollan el SNT, que es mas frecuente en los pacientes con criterios analiticos de gravedad y muy poco probable en los que no los tienen. Los pacientes con SNT no expresaron manifestaciones clinicas ni analiticas diferentes a los que no presentaron el sindrome; tampoco se observaron diferencias en relacion con la terapia con oxigeno administrada. La tasa de SNT en el area sanitaria de Salnes entre 2002 y 2012 es de 0,84 casos por 100.000 habitantes y año.

Sumisión química en casos de presuntos delitos contra la libertad sexual analizados en el Instituto Nacional de Toxicología y Ciencias Forenses (Departamento de Madrid) durante los años 2010, 2011 y 2012 / Alleged drug-facilitated sexual assault cases analyzed at the National Institute of Toxicology and Forensic Science (Madrid Department) during the years 2010, 2011 and 2012

Introducción. La sumisión química en relación con los delitos contra la libertad sexual se puede aplicar tanto a los casos de administración subrepticia de determinadas sustancias, como a los casos oportunistas por una mayor vulnerabilidad de la víctima debido al consumo voluntario de las mismas. Material y métodos. Se ha realizado un estudio descriptivo retrospectivo de los casos de agresiones sexuales relacionados con el consumo de sustancias químicas, remitidos durante los años 2010, 2011 y 2012 al Departamento de Madrid del Instituto Nacional de Toxicología y Ciencias Forenses. Se ha recogido información en relación con el perfil de la víctima, el tipo de muestras biológicas remitidas y los resultados toxicológicos. Resultados. De los 306 casos de agresión o abuso sexual remitidos, 107 han cumplido los criterios de inclusión. El perfil de la víctima es el de una mujer española o latinoamericana joven (edad media: 25,9 años), que admite consumo de alcohol previo al episodio, y que sufre de amnesia total o parcial de los hechos. Las muestras remitidas han sido sangre (27,1%), orina (14%) o ambas (57%). El análisis toxicológico ha sido positivo en el 87,9% de los casos, y las sustancias identificadas han sido etanol (61,7%), fármacos (40,2%, fundamentalmente benzodiacepinas) y drogas ilícitas (27,1%, fundamentalmente cocaína), solas o en combinación. Conclusiones. El estudio refleja la necesidad de trabajar en prevención e información de potenciales víctimas y personal sanitario, que una temprana y adecuada toma de muestras son factores claves a la hora de confirmar el diagnóstico, y que las sustancias detectadas, lícitas e ilícitas, pertenecen a un patrón de consumo frecuente en nuestra sociedad (AU)

Introduction. Drug-facilitated sexual assault crimes can be applied in cases of covert administration of certain substances, as well as cases in which the victim voluntarily consumes these same substances. Materials and methods. This study describes retrospectively cases of sexual assault related to the consumption of chemical substances. They were reported to the Madrid Department of the National Institute of Toxicology and Forensic Sciences during 2010, 2011 and 2012. We collected information related to the victim's profile, the type of biological samples given and the results of the toxicological analysis. Results. Out of 306 cases of sexual assault or abuse referred, 107 have met the inclusion criteria. The victim's profile is of a young Spanish or Latin-American woman (mean age: 25.9 years) who admits to consuming alcohol prior to the episode and suffering from total or partial amnesia with regard to the facts. The given samples were blood (27.1%), urine (14%) or both (57%). Toxicological analysis was positive in 87.9% of cases and the substances identified were ethanol (61.7%), pharmaceuticals (40.2%, mainly benzodiazepines), and illicit drugs (27.1%, primarily cocaine) either alone or in combination. Conclusions. This study reflects the requirement to work in prevention and training of potential victims and healthcare personnel, proves that an early and adequate collection of samples are key factors to confirm the diagnosis and identifies that detected licit or illicit substances belong to a frequent consumption pattern (AU)

Alternative matrices for cocaine, heroin, and methadone in utero drug exposure detection.

INTRODUCTION: Drug determination in biological matrices from the mother and the newborn is an objective measure of maternal and fetal drug exposure. The aim of this study was to compare maternal hair, meconium, umbilical cord, and placenta for detecting in utero drug exposure to cocaine, opiates, methadone, and amphetamines. METHOD: Maternal hair, meconium, umbilical cord, and placenta were collected from 175 mother-newborn dyads. Maternal hair (segmented in trimesters) and meconium specimens were analyzed for cocaine, opiates, methadone, and amphetamines. If either maternal hair or meconium tested positive, umbilical cord and placenta were analyzed. Analyses were performed by liquid chromatography tandem mass spectrometry. RESULTS: In hair, 24 participants tested positive; 21 for cocaine [cocaine 20-50,605, benzoylecgonine (BE) 17-46,668 pg/mg], 7 for methadone (76-26,845 pg/mg), 2 for opiates (morphine 298-2398 pg/mg, codeine 65-914 pg/mg, 6-acetylmorphine 1635-15,657 pg/mg), and 1 for amphetamines (amphetamine 1990 pg/mg, 3,4-methylenedioxyamphetamine 30 pg/mg, 3,4-methylenedioxymethamphetamine 294 pg/mg). In meconium, 6 were positive; 5 for methadone [methadone 88-3752, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) 642-25,179 ng/g], 3 for cocaine (cocaine 7, BE 79, hydroxybenzoylecgonine 5-135, ecgonine-methyl ester 2-56 ng/g), and 2 for opiates (morphine 152-1025, morphine-3-glucuronide 22-23, codeine 4-34 ng/g). Placenta and umbilical cord were positive in 5 and 6 cases, respectively; 5 for methadone in placenta (methadone 7-543, EDDP 10-51 ng/g) and cord (methadone 3-183, EDDP 2-109 ng/g); 1 for cocaine in placenta (cocaine 7, BE 2 ng/g) and cord (BE 6 ng/g); and 1 for opiates in placenta (morphine 6, morphine-3-glucuronide 48 ng/g), and 2 in cord (morphine 2, morphine-3-glucuronide 15-38, morphine-6-glucuronide 5 ng/g). Meconium, placenta, and umbilical cord only tested positive if hair concentrations were greater than Society of Hair Testing cutoffs. CONCLUSIONS: Maternal hair is the most sensitive specimen to detect drug consumption during pregnancy. Placenta and umbilical cord could be alternatives to meconium for detecting high in utero drug exposure.

Dental age estimation in Spanish and Venezuelan children. Comparison of Demirjian and Chaillet's scores.

Orthopantomographs taken from 308 Spanish Caucasian and 200 Venezuelan Amerindian children, aged between 2 and 18 years, were analysed following the Demirjian's method. The aims of this study were to test the applicability of the Demirjian's method to two different sample populations, and to develop age prediction models for both populations using the original French Canadian scores described by Demirjian (1976) and the new multi-ethnic dental scores proposed by Chaillet et al. (2005) when the ethnic origin is unknown. Results showed that despite the good correlation between dental and chronological age, Demirjian's method overestimates the age in the Spanish Caucasian sample using both scores, the mean overestimation being higher when the Demirjian's scores were used than when the Chaillet's scale was applied. In the Venezuelan Amerindian sample, the opposite was found: Demirjian's method underestimates the age using both scores, the underestimation being higher when the Chaillet's scale was applied than when Demirjian's scale was used. New graphs were produced to convert the maturity scores to dental age for Spanish and Venezuelan children. With these graphs, the Demirjian's scores showed to be inadequate after the age of 12 in both populations, while Chaillet's scores offered useful information until 14 years of age.

[Chemical submission, epidemiology and some clues for the diagnosis]. / Sumisión química: epidemiología y claves para su diagnóstico.

The use of chemical substances to control people is not a new event. Indeed, it has been done for centuries. This practice has recenttly acquired a new dimension because of its association with sexual assaults and other type of crimes. The frequency of the association of the use of chemical substances with sexual assaults is behind the term SQ (drug facilitated sexual assauit). The Spaniish term foir this practice, Sumisión Química, comes from the French one, Soumissión Chimique, and has a wide meaning. In this review, the epidemiology of SQ is revised and an analysis of its main involved elements, namely the chemical, the victim and the assailant, is done. Chief clinical signs and clues for the toxicological doiagnosis are also appproached.

Sumisión química: epidemiología y claves para su diagnóstico / Chemical submission, epidemiology and some clues for the diagnosis

El uso de sustancias químicas con el fin de manipular la voluntadde las personas no es reciente, pero en los últimos años ha cobradoun mayor protagonismo por su asociación con agresiones sexuales,robos y otras prácticas delictivas. Precisamente la frecuencia conque se asocia a los delitos sexuales le ha valido el acrónimo anglosajónde DFSA (drug facilitated sexual assault). El término «sumisiónquímica», acuñado recientemente en nuestro idioma, derivadel francés «soumission chimique» e incluye todas las figuras delictivasasociadas a esta práctica. En este trabajo se revisa la epidemiologíade este tipo de cuadros y se hace un análisis de las principalescaracterísticas de las sustancias químicas empleadas, lavíctima y el agresor. Se abordan además los principales signos desospecha diagnóstica y las claves para el diagnóstico toxicológico,en caso de que ésta exista

The use of chemical substances to control people is not a new event.Indeed, it has been done for centuries. This practice has recenttly acquireda new dimension because of its association with sexual assaultsand other type of crimes. The frequency of the association ofthe use of chemical substances with sexual assaults is behind theterm SQ (drug facilitated sexual assauit). The Spaniish term foir thispractice, Sumisión Química, comes from the French one, SoumissiónChimique, and has a wide meaning. In this review, the epidemiologyof SQ is revised and an analysis of its main involved elements, namelythe chemical, the victim and the assailant, is done. Chief clinicalsigns and clues for the toxicological doiagnosis are also appproached

Drogas y teratogenia / Drug of abuse and teratogenicity

Las drogas más usadas en el embarazo siguen siendo el tabaco y el alcohol, dentro de las legales, y el cannabis, seguido de la cocaína dentro de las ilegales. Aunque se ha asociado el consumo de drogas con un amplio abanico de malformaciones estructurales, las drogas de abuso tienen un escaso potencial teratogénico, entendido en el sentido estricto de malformación física, con la excepción del alcohol, que se asocia al síndrome alcohol fetal. Sin embargo, sí se está encontrando asociación entre la exposición prenatal a las drogas de abuso y alteraciones específicas del comportamiento, habitualmente muy sutiles, pero que no deben pasar desapercibidas, y que entran en el concepto actual de teratogénesis. La exposición intraútero a las drogas es un factor de riesgo para la gestación, con frecuencia asociado a otros factores de riesgo concomitantes, como la desnutrición, las enfermedades maternas y la pobreza, y cuyos efectos se solapan, se potencian y se confunden con frecuencia. En este trabajo se abordan de modo resumido los aspectos generales que regulan la teratogénesis (factores que determinan que una determinada exposición pueda ser considerada o no de riesgo, el papel de la placenta, etc), la epidemiología del consumo de drogas durante el embarazo y los factores que dificultan el estudio de estos efectos para estas sustancias. También se hace un análisis de los principales efectos teratogénicos relacionados con las drogas

The problem of the malformed children has concerned the humanity for ever, and this also includes the prenatal exposure to drugs of abuse. Tobacco and alcohol are the most common legal drugs used in pregnancy, and cannabis and cocaine, the most common illegal drugs. The use of drugs has been associated with a wide range of structural malformations, but with the exception of the alcohol and the fetal alcohol syndrome, drugs of abuse seem to have a weak teratogenic potential, in the classical structural malformation conception. Nevertheless, there has been found association between the prenatal exposure to these drugs and specific behavioural alterations, usually very subtle but that should not be ignored. This kind of alterations are now included in the conception of teratogenesis. So, drug use during pregnancy is a risk factor, usually associated to other concomitant risk factors like nutrition deficits, maternal illness and poverty, and these effects are overlapped, potentiated and very often confounded. In this review the main variables involved in the development of teratogenesis (factors that should be take into account in a specific exposition to evaluate the potential risk, the roll of the placenta, etc) are analysed. The epidemiology of the drug abuse in pregnancy and the concomitant factors that make difficult this evaluation are also studied. Finally a review of the main teratogenic effects related to the most common abused drugs was done