Suicidal intoxication with mercury chloride.

PURPOSE: Poisoning with elemental metals and metallic compounds was much more frequent in the past, and was related, among other things, to lifestyle and the lack of appropriate toxicological diagnostics. One example is mercury, which is being gradually eliminated but still has many different applications as a pure metal or in the form of various compounds. The paper presents a case of suicidal poisoning with mercury chloride (corrosive sublimate). METHODS: Forensic and toxicological tests including inductively coupled plasma mass spectrometry (ICP-MS) were at the Department of Forensic Medicine, PMU in Szczecin. RESULTS: The patient before death had a range of symptoms such as epigastric pain, vomiting of the stomach contents, central cyanosis with tachycardia, tremors, severe shortness of breath with wheezing, difficulty swallowing, slurred speech, rales in the lungs, and diarrhea. The concentration of mercury measured by ICP-MS was 191 mg/L for a blood sample collected antemortem, and 147 mg/L for a blood sample collected at autopsy. Both concentrations of mercury are regarded as lethal. The post-mortem examination revealed signs of extensive thrombotic necrosis in some internal organs. CONCLUSIONS: Mercuric chloride has an estimated human fatal dose of between 1 and 4 g. It can produce a range of toxic effects, including corrosive injury, severe gastrointestinal disturbances, acute renal failure, circulatory collapse, and eventual death. The presented case of fatal poisoning with mercury chloride, due to the type of agent used, is now interesting in toxicological practice.

Dynamic Model of a Humanoid Exoskeleton of a Lower Limb with Hydraulic Actuators.

Exoskeletons are the mechanical systems whose operation is carried out in close cooperation with the human body. In this paper, the authors describe a mathematical model of the hydraulic exoskeleton of a lower limb. The coordinates of characteristic points of the exoskeleton in the sagittal plane as a function of user height are presented. The mathematical models, kinematics, and kinetics equations were determined. The masses of the actuators and their dimensions were selected based on catalog data. The force distribution in the wearable system during the squat is shown. The proposed models allowed us to determine the trajectory of individual points of the exoskeleton and to determine the forces in hydraulic cylinders that are necessary to perform a specific displacement. The simulation results show that the joint moments depend linearly on actuator forces. The dynamics equations of the wearable system are non-linear. The inertia of the system depends on the junction variables and it proves that there are dynamic couplings between the individual axes of the exoskeleton.

Fatal Intoxication with α-PVP, a Synthetic Cathinone Derivative.

This study presents the fatal case of a young man who was admitted to the ICAU due to sudden cardiac arrest. An interview revealed that the patient had taken some unspecified crystals. From the moment of admission, his condition deteriorated dramatically as a result of increasing circulatory insufficiency. After a few hours, sudden cardiac arrest occurred again and the patient was pronounced dead. In the course of a medicolegal autopsy, samples of biological material were preserved for toxicology tests and histopathological examination. The analysis of samples using the LC-MS/MS technique revealed the presence of α-PVP in the following concentrations: blood-174 ng/mL, urine-401 ng/mL, brain-292 ng/g, liver-190 ng/g, kidney-122 ng/g, gastric contents-606 ng/g. The study also presents findings from the parallel histopathological examination. Based on these findings, cardiac arrest secondary to intoxication with alpha-PVP was determined as the direct cause of the patient's death.

[Benzodiazepines' reactivity in immunoassay techniques ­ problems with interpretation].

Introduction: The progress of civilization and the development of pharmaceuticals industry have caused an increase in psychoactive substances abuse. That is why there are often cases of overdose and poisoning with these substances. Benzodiazepines are among the most commonly used drugs. They are a group of medications producing sedative, anxiolytic, hypnotic, myorelaxant and anticonvulsant effects. Benzodiazepines are a large and diversified group of compounds (over 50 different benzodiazepines are used in clinical treatment), and their metabolites are biologically active. The progress of technology allows the use of more advanced and accurate diagnostic methods. The enzyme multiplied immunoassay technique (EMIT) is a routinely used method in toxicology laboratories, and it is often employed to determine the concentration of benzodiazepines in tested material. This technique is quite easy and quick to perform. However, these advantages have different kinds of consequences, e.g. false-positive results. Therefore, it is important to confirm the results with reference methods. The aim of this study was to evaluate the reactivity of chosen benzodiazepines using the EMITRtoxTMSerum Benzodiazepines Assay. Materials and methods: The precision and accuracy of the results were calculated. Nine benzodiazepines were analyzed (chlordiazepoxide, estazolam, flurazepam, medazepam, nitrazepam, nordazepam, oxazepam, prazepam, and temazepam) using the V-Twin System with EMIT technology from Siemens. Every drug was tested 3 times using different concentrations: 300 ng/mL, 1000 ng/mL, and 2000 ng/mL. Results and conclusions: The EMIT test showed the highest precision for the quantitative determination of prazepam, and the lowest precision for the determination of nitrazepam and medazepam, whereas the test's accuracy was highest for the determination of prazepam, and lowest in the case of nitrazepam.

[Amanitine determination as an example of peptide analysis in the biological samples with HPLC-MS technique].

Introduction: Routine toxicological analysis is mostly focused on the identification of non-organic and organic, chemically different compounds, but generally with low mass, usually not greater than 500­600 Da. Peptide compounds with atomic mass higher than 900 Da are a specific analytical group. Several dozen of them are highly-toxic substances well known in toxicological practice, for example mushroom toxin and animal venoms. In the paper the authors present an example of alpha-amanitin to explain the analytical problems and different original solutions in identifying peptides in urine samples with the use of the universal LC MS/MS procedure. Materials and methods: The analyzed material was urine samples collected from patients with potential mushroom intoxication, routinely diagnosed for amanitin determination. Ultra filtration with centrifuge filter tubes (limited mass cutoff 3 kDa) was used. Filtrate fluid was directly injected on the chromatographic column and analyzed with a mass detector (MS/MS). Results: The separation of peptides as organic, amphoteric compounds from biological material with the use of the SPE technique is well known but requires dedicated, specific columns. The presented paper proved that with the fast and simple ultra filtration technique amanitin can be effectively isolated from urine, and the procedure offers satisfactory sensitivity of detection and eliminates the influence of the biological matrix on analytical results. Another problem which had to be solved was the non-characteristic fragmentation of peptides in the MS/MS procedure providing non-selective chromatograms. It is possible to use higher collision energies in the analytical procedure, which results in more characteristic mass spectres, although it offers lower sensitivity. Conclusions: The ultra filtration technique as a procedure of sample preparation is effective for the isolation of amanitin from the biological matrix. The monitoring of selected mass corresponding to transition with the loss of water molecule offers satisfactory sensitivity of determination.

[A rare case of exposure to natural psychoactive substances, and difficulties with medicolegal assessment]. / Rzadki przypadek ekspozycji na naturalne srodki psychoaktywne i trudnosci w opiniowaniu sadowo-lekarskim.

An unusual case of exposure to natural psychoactive substances deriving from Datura stramonium (jimsonweed, thorn-apple) is presented in this article. It may be of interest in this case that a hallucinogenic substance was intentionally administered by a third party. An initial assessment in this criminal case was questionable, and resulted from a lack of consideration of toxicological exposure and its possible aftermath. The above-mentioned case demonstrates the necessity of considering all toxicological aspects of the case, even though initial findings seemed to indicate something else.

[Overdosing of popular medicines available without a prescription, a new trend among teenagers]. / Naduzywanie popularnych leków dostepnych bez recepty nowym trendem wsród mlodziezy.

INTRODUCTION: For last several years popularity of substances which improve concentration or/and cause hallucinations has considerably increased. There is a conviction that most frequent addictions among teenagers are cigarettes, alcohol or drugs of abuse. A very dangerous phenomenon has been ignored, becoming more common among scholars and students - usage of medicines available without doctor's prescription (over the counter drugs - OTC). Popularity and fame of these specifics comes from side effects observed especially when overdosed. MATERIAL AND METHODS: In years 2007-2012 in Clinical Toxicology Laboratory of Medical Pomeranian University 4304 toxicological analyses was conducted with specified direction on drugs analysis (39% of all analyses made in that period). In some cases, especially of young people, a doctor ordering the analysis pointed as possible cause of intoxication "recreational usage" of OTC drugs. Those suspicions were confirmed by toxicological examinations. CONCLUSIONS: It seems that dominating character feature of people who abuse psychoactive substances is emotional immaturity. Maturation process can be impaired or completely inhibited by abusing psychoactive substances. This is processes are considered which enhance immaturity of person's personality - so called defense mechanisms.

Death caused by addictive inhalation of nitrous oxide.

Intoxications with nitrous oxide have been, and still are, a rarity in forensic medicine. Apart from accidental overdose during hospital procedures, intoxication with this gas is the result of voluntary inhalation. We report the fatal case of a 32-year-old male who died during inhalation of nitrous oxide from whipped dairy cream cans and hint on the role of the internet in creating new behaviors among drug addicts. We rely on the autopsy report from the Department of Forensic Medicine, Pomeranian Medical University in Szczecin, on laboratory tests, and court files. Neither the autopsy nor the toxicologic and histopathologic tests disclosed the exact cause of death. However, circumstances in which the body was discovered were indicative that death resulted from cardiorespiratory failure. The present case is interesting with regard to its rarity, diagnostic difficulties and potential harm from nitrous oxide used by the food industry.

[Carbon monoxide as an external cause of fatality]. / Tlenek wegla przyczyna zewnetrzna wypadku przy pracy.

INTRODUCTION: Carbon monoxide intoxications mainly occur as a result of fires in houses and failures of heating systems. Case of fatal accident involving a charcoal factory worker is described in this paper. MATERIAL AND METHODS: Authors based on a medico-legal autopsy protocol and material collected in prosecutor files. Medico-legal autopsy of a 46 year old male was performed in the forensic medicine department. Interlocutory proceedings indicated that the immediate cause of death was a head-crush caused by a hydraulic cover. Previously self-ignition in the factory was noted. RESULTS: Autopsy revealed crushes of cervical spine involving the medulla. Where there were no sings of carbon monoxide intoxication. Due to unusual circumstances of the accident (self-ignition was detected by a carbon monoxide sensor and was treated by steam) additional toxicological test of autopsy material was performed. Twenty percent of carboxyhemoglobin was detected in blood collected from the heart cavity. In our opinion carbon monoxide may have been responsible for the accident. CONCLUSIONS: Relatively low carboxyhemoglobin concentration in the blood is known to be an important cause of central nervous system abnormalities. Exposure to carbon monoxide may also result in an impaired response to danger. Sometimes carbon monoxide exposure does not lead to fatal intoxication, but may lead to a fatal accident. Regardless of a well noted immediate cause of death, a specific toxicological test must be involved in each medico-legal procedure, if exposition to various chemical substances is suspected.

[Lawsuit experiment as an important element in expert's work regarding carbon monoxide poisoning cases]. / Eksperyment procesowy jako istotny element w opiniowaniu zatrucia tlenkiem wiegla.

INTRODUCTION: Giving an opinion in the field of carbon monoxide intoxications is still problematic. MATERIAL AND METHODS: In the paper we present a case of the sudden death of a young female in the garage. In such a situation there were serious suspicions of a violent cause of the death. According to eye-witness relation an experiment to evaluate momentary carbon monoxide concentration in the garage was conducted. The toxicokinetic and biologic effects of carbon monoxide were taken under consideration. RESULTS: It was revealed that under the given parameters it was impossible there to reach a lethal carbon monoxide concentration.

[Biochemical skin sweat-sebum profile in individual identification]. / Biochemiczny profil lojowo-potowy skóry w identyfikacji osobniczej.

INTRODUCTION: Sweat-sebum substance released by an individual, is left on the surface of different objects by direct contact (touch), which takes place in the well known mechanism of finger-print formation. Interesting from the crime detection point of view seems to be the determination of qualitative and quantitative changes in sweat-sebum biochemical profile left on objects, which may contribute to the determination of precise biochemical profiles in relation to individual identification. MATERIAL AND METHODS: Five different hand profiles of sweat-sebum were determined using gas chromatography with mass spectrometry obtaining referral material, then obtained profiles were compared to the profile left on a rough plastic surface by one individual belonging to the referral group. RESULTS: Obtained results indicate the possible application of the procedure for correlation of sweat-sebum skin profiles for identification purposes in crime detection, as indirect prove. Undoubtedly, although there is no possibility to show the uniqueness of particular profiles, like it is in a genetic examination, the short time needed to perform analysis (approximately 40 min) is very significant in the presented procedure, which may be a complementation of genetic methods in case were short time of perpetrator typing is a crucial step. CONCLUSIONS: Presented procedure may be helpful in preliminary individual identification in case were there is no possibility to collect finger-print profiles from the surface (inappropriate surface structure, smear traces).