Propranolol and metoprolol: Two comparable drugs with very different post-mortem toxicological profiles.

Propranolol is a widely used beta-blocker mainly prescribed for the treatment of hypertension and other cardiac conditions. This medicine is also a frequent finding in drug screens, but little is known about its post-mortem toxicological profile. Our aim was to examine all post-mortem toxicology cases positive for propranolol in a three-year period, between 2016 and 2018 in Finland, and to compare these cases to those positive for metoprolol, another beta-blocker commonly used to treat cardiac diseases. There were 179 cases positive for propranolol and 416 for metoprolol in the study period. In the majority of propranolol cases (53%), the drug concentration in the blood was above the typical therapeutic range, but among the metoprolol cases this proportion was 18%. Propranolol was significantly more common than metoprolol in fatal poisonings, suicides and in cases with a history of drug abuse. Alcohol, benzodiazepines, antipsychotics and antidepressants were significantly more often detected in propranolol cases than in metoprolol cases. The deceased positive for propranolol were significantly younger than those positive for metoprolol. Cardiovascular diseases as the underlying cause of death were significantly more common among the metoprolol cases than among the propranolol cases. Our results showed significant differences between the propranolol group and the metoprolol group in post-mortem toxicology cases. The two drugs were used by two very different groups of people, with propranolol use being associated with psychiatric conditions.

Variability associated with interpreting drugs within forensic hair analysis: A three-stage interpretation.

Hair analysis is capable of determining both an individual's long-term drug history and a single exposure to a drug, which can be particularly important for corroborating incidents of drug-facilitated crimes. As a source of forensic evidence that may be used in a court of law, it must be credible, impartial and reliable, yet the pathways of drug and metabolite entry into hair are still uncertain. Many variables may influence drug analysis results, most of which are outside of the control of an analyst. An individual's pharmacokinetic and metabolic responses, hair growth rates, drug incorporation routes, axial migration, ethnicity, age and gender, for example, all display interpersonal variability. At present there is little standardization of the analytical processes involved with hair analysis. Both false positives and negative results for drugs are frequently encountered, regardless of whether a person has consumed a drug or not. In this regard, we have categorized these variables and proposed a three-stage analytical approach to facilitate forensic toxicologists, hair analysis experts, judiciaries and service users in the analytical and interpretation process.

Bupenorphine in Wisconsin Drivers: Concerns for Impairment?

Opinions vary on whether buprenorphine can cause impairment in drivers. Relatively little information on the observed effects of buprenorphine, outside a laboratory or a controlled driving course, exist in the literature. The Wisconsin State Laboratory of Hygiene monitored the detection of buprenorphine and its pharmacologically active metabolite, norbuprenorphine (NBUP), in Wisconsin drivers over a 2-year period. A total of 204 individuals (78 females and 126 males) were driving under the influence of buprenorphine and/or NBUP. Concentrations in whole blood (ng/mL) ranged (mean) from 0.6 to 14 (2.0) and 0.5 to 20 (2.1) for buprenorphine and NBUP, respectively. Poly-substance use is extremely prevalent in Wisconsin operating while intoxicated casework, so prevalent that only four of the previously described cases had buprenorphine and/or NBUP as the only drug(s) detected. This paper summarizes and highlights the case histories and observed impairments of those four cases. Law enforcement (LE) made contact with three of the four subjects due to either a crash or poor/reckless driving. Police reports and observations made by LE, including drug recognition expert (DRE) evaluations, were collected. Physical and behavioral observations made by LE varied and included a combination of narcotic analgesic, central nervous system depressant- and stimulant-like effects. Impaired balance and lack of coordination during the administration of the Standardized Field Sobriety Tests were documented by the arresting officers and/or the DRE. While the number of buprenorphine-only cases reported here is limited, the results demonstrate the complex paradigm associated with forensic interpretation of buprenorphine in driving under the influence of drugs casework and the frequency of poly-substance administration in Wisconsin drivers.

Inter-laboratory proficiency results of blood alcohol determinations at clinical and forensic laboratories in Italy.

BACKGROUND: Inter-laboratory proficiency schemes are widely used to control the performance of clinical and forensic toxicology laboratories. In 2016 the Laboratory of Environmental Hygiene and Forensic Toxicology - Venice (Italy) initiated an inter-laboratory proficiency test of blood-alcohol analysis. The number of participating laboratories gradually increased from 26 to 36. Furthermore, a few clinical laboratories were included if gas chromatographic (GC) methods were used for blood alcohol analysis. PROCEDURE: Whole blood was obtained from the Blood Transfusion Centre of the Venice Hospital and a mixture of sodium fluoride and potassium oxalate was added as a preservative and anticoagulant, respectively. Aliquots of the blood were spiked with certified pure ethanol to obtain target blood-alcohol concentrations (BACs) ranging from 0 to 5.0g/L. Two blood samples (4mL each) were included in each shipment to the participating laboratories. The laboratories were asked to provide information about number of replicate BAC determinations they made, the types of ethanol reference standards used, and inherent measurement uncertainty. The aim of the testing was to obtain a mean consensus value for the target BAC and to assess inter-laboratory imprecision. All procedures for registration and submission of results were done on-line. A confidential report and statistical evaluations were returned to the participants one week later. ANALYTICAL METHODS: All participants used head-space GC (HS-GC) for the analysis of ethanol in blood. More than 85% of participants used HS-GC with flame-ionization detection, whereas the others used mass spectrometry (MS) as a detector. More than 40% of the participating laboratories kept the blood samples frozen (-20°C) prior to analysis, whereas the others used refrigeration (+4°C). The preliminary validation tests showed that there were no statistically significant differences between BAC in frozen or refrigerated samples for a period of 20 days. RESULTS AND CONCLUSION: The statistical evaluation of results was done using an iterative procedure known as Algorithm A (ISO 13528:2015, C.3.1). This provides robust estimates for mean and standard deviation between laboratories and these were used as consensus values. More than 85% of participants provided satisfactory results (z-score <1) and 94% of laboratories were within z-score <2, based on five control samples. When a blood sample without any alcohol (blank) was sent for analysis, laboratories reported this as zero, 0.00g/L, below limit of detection (LOD) or not detected. Some type of consensus should be reached for reporting blank samples.

Bibliometrics Analysis of Forensic Toxicology Literature of Mainland Chinese Scholars in SCIE Journals.

ABSTRACT: Objective To conduct bibliometrics analysis of forensic toxicology literature of mainland Chinese scholars published in SCIE journals between 1998 and 2018. Methods Gephi 0.9.2 software was used for bibliometrics analysis. The status of forensic toxicology research in mainland China was network visualized through data analysis of institutional cooperation, author collaboration, fund support, keywords co-occurrence as well as literature interpretation. Results The total number of papers published in SCIE journals in the past twenty years by mainland Chinese scholars was 242, and increased year by year. Thematic studies, such as analysis and evaluation of toxins in hair, identification of new psychoactive substances, optical enantiomer analysis of amphetamines, analysis of toxic animal and plant components, etc, reached the international advanced level. Conclusion The forensic toxicology discipline in our country has developed rapidly in recent years. The opening and development of forensic science in colleges and universities, the constant emerging of new research teams, especially the funding of major special projects of National Natural Science Foundation of China and the Ministry of Science and Technology, have promoted high level research output and academic status of Chinese forensic toxicology on the international stage.

Bibliometrics Analysis of Forensic Toxicology Literature of Mainland Chinese Scholars in SCIE Journals / 法医学杂志

Objective To conduct bibliometrics analysis of forensic toxicology literature of mainland Chinese scholars published in SCIE journals between 1998 and 2018. Methods Gephi 0.9.2 software was used for bibliometrics analysis. The status of forensic toxicology research in mainland China was network visualized through data analysis of institutional cooperation, author collaboration, fund support, keywords co-occurrence as well as literature interpretation. Results The total number of papers published in SCIE journals in the past twenty years by mainland Chinese scholars was 242, and increased year by year. Thematic studies, such as analysis and evaluation of toxins in hair, identification of new psychoactive substances, optical enantiomer analysis of amphetamines, analysis of toxic animal and plant components, etc, reached the international advanced level. Conclusion The forensic toxicology discipline in our country has developed rapidly in recent years. The opening and development of forensic science in colleges and universities, the constant emerging of new research teams, especially the funding of major special projects of National Natural Science Foundation of China and the Ministry of Science and Technology, have promoted high level research output and academic status of Chinese forensic toxicology on the international stage.

Comparison of dispensed medications and forensic-toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013.

PURPOSE: To investigate person-level agreement between medication exposure as predicted using the PRE2DUP (a prescription-based design to estimate continuous drug use) method and postmortem toxicological findings, in the Swedish population during the years 2006 to 2013. METHODS: Using the Swedish National Board of Forensic Medicine's toxicology database and the Swedish National Board of Health and Welfare's registries on causes of death, dispensed medications, and in-patient care, forensic-toxicological findings were compared with prescription-based estimates of drug use for 27 medications. We modeled expected drug-use periods with the PRE2DUP using an algorithm of demonstrated high validity that evaluates personal drug-purchasing patterns with consideration to possible stockpiling of drugs and package information. Excluding criteria included self-inflicted death and recent in-patient care. RESULTS: In data from 18 627 performed autopsies, as well as 10 160 instances of dispensed drug use, the agreement between PRE2DUP drug-use periods and forensic toxicology was, overall, moderate (Cohen's kappa: 0.56 [95% confidence interval {CI}: 0.55-0.57]) with a positive predictive value, or predicted adherence rate, of 46.0%. The group-level predicted adherence and agreement were highest for antidepressants, at 71.0% (Cohen's kappa: 0.74 [CI: 0.73-0.76]), and lowest for cardiovascular drugs, at 21.5% (Cohen's kappa: 0.33 [CI: 0.31-0.36]). Predicted recreational use (negative predictive value) was low for all investigated drugs (0.0%-1.4%). The biological half-life explained 29% (P = 0.003) of the variability of the false-positive rate. CONCLUSIONS: Measured agreement between PRE2DUP-based drug-use estimates and forensic-toxicological findings is dependent upon a number of factors, including true continuous drug use and postmortem detectability of the investigated drugs, as well as the occurrence of unconventional dosing and true non-adherence.

Forensic Toxicology Perspectives of Methadone-associated Deaths in Tehran, Iran, a 7-year Overview.

Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.

[Alcohol-associated mortality in Russia (based on the materials for the period from 2011 till 2016)]. / Alkogol'-assotsiirovannaia smertnost' v Rossii (po materialam 2011-2016 gg.).

The objective of the present study was to evaluate the frequency of alcoholic drunkenness documented during forensic medical expertises (investigations) of the corpses carried out in this country throughout the period from 2011 till 2016. The investigations were conducted with the use of medical statistics methods by calculating the fractional difference, dynamics, and rates of detection of the cases of alcoholic intoxication depending on the cause of death. The study has demonstrated the high frequency of the cases of alcoholic drunkenness revealed during forensic medical expertises (investigations) of the corpses that amounted to 30.5% [15, 16]. The total number of the corpses examined in 2016 was 8.6% higher than in 2011. The frequency of the documented cases of alcoholic drunkenness during the same period decreased by 19.7%. The frequency of the documented cases of alcoholic drunkenness in the cases of violent death was 2.8 times that in the cases of death from various diseases (52.8 and 19.0% respectively). The enhanced frequency of alcoholic drunkenness in relation to the number of the conducted forensic medical expertises was documented in the cases of death by drowning and from hypothermia whereas the lowest frequency of alcoholic intoxication was recorded for the corpses of the people who had died from malignant tumours and diseases of the nervous system. Various regions of Russia differed in terms of the frequency of alcoholic drunkenness recorded among the recently deceased people.

Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends.

There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.

Determination of safety margins for whole blood concentrations of alcohol and nineteen drugs in driving under the influence cases.

Legislative limits for driving under the influence of 20 non-alcohol drugs were introduced in Norway in February 2012. Per se limits corresponding to blood alcohol concentrations (BAC) of 0.2g/kg were established for 20 psychoactive drugs, and limits for graded sanctions corresponding to BACs of 0.5 and 1.2g/kg were determined for 13 of these drugs. This new legislation made it possible for the courts to make sentences based on the analytical results, similar to the situation for alcohol. To ensure that the reported concentration is as least as high as the true concentration, with a 99% safety level, safety margins had to be calculated for each of the substances. Diazepam, tetrahydrocannabinol (THC) and alcohol were used as model substances to establish a new model for estimating the safety margins. The model was compared with a previous used model established several years ago, by a similar yet much simpler model, and they were found to be in agreement. The measurement uncertainties depend on the standard batch used, the work list and the measurements' replicate. A Bayesian modelling approach was used to determine the parameters in the model, using a dataset of 4700 diazepam positive specimens and 5400 THC positive specimens. Different safety margins were considered for low and high concentration levels of diazepam (≤2µM (0.6mg/L) and >2µM) and THC (≤0.01µM (0.003mg/L) and >0.01µM). The safety margins were for diazepam 19.5% (≤2µM) and 34% (>2µM), for THC 19.5% (≤0.01µM) and 24.9% (>0.01µM). Concentration dependent safety margins for BAC were based on a dataset of 29500 alcohol positive specimens, and were in the range 10.4% (0.1g/kg) to 4.0% (4.0g/kg) at a 99% safety level. A simplified approach was used to establish safety margins for the compounds amphetamine, MDMA, methamphetamine, alprazolam, phenazepam, flunitrazepam, clonazepam, nitrazepam, oxazepam, buprenorphine, GHB, methadone, ketamine, cocaine, morphine, zolpidem and zopiclone. The safety margins for these drugs were in the range 34-41%.

A Metabolomics Study of Retrospective Forensic Data from Whole Blood Samples of Humans Exposed to 3,4-Methylenedioxymethamphetamine: A New Approach for Identifying Drug Metabolites and Changes in Metabolism Related to Drug Consumption.

The illicit drug 3,4-methylenedioxymethamphetamine (MDMA) has profound physiological cerebral, cardiac, and hepatic effects that are reflected in the blood. Screening of blood for MDMA and other narcotics are routinely performed in forensics analysis using ultra-performance liquid chromatography with high-resolution time-of-flight mass spectrometry (UPLC-HR-TOFMS). The aim of this study was to investigate whether such UPLC-HR-TOFMS data collected over a two-year period could be used for untargeted metabolomics to determine MDMA metabolites as well as endogenous changes related to drug response and toxicology. Whole blood samples from living Danish drivers' positive for MDMA in different concentrations were compared to negative control samples using various statistical methods. The untargeted identification of known MDMA metabolites was used to validate the methods. The results further revealed changes of several acylcarnitines, adenosine monophosphate, adenosine, inosine, thiomorpholine 3-carboxylate, tryptophan, S-adenosyl-l-homocysteine (SAH), and lysophospatidylcholine (lysoPC) species in response to MDMA. These endogenous metabolites could be implicated in an increased energy demand and mechanisms related to the serotonergic syndrome as well as drug induced neurotoxicity. The findings showed that it was possible to extract meaningful results from retrospective UPLC-HR-TOFMS screening data for metabolic profiling in relation to drug metabolism, endogenous physiological effects, and toxicology.

Synthetic cannabimimetics in Bulgaria 2010-2013.

BACKGROUND: The manufacturing, distribution and use of synthetic cannabimimetics (SCs) have seen dynamic changes over the last few years, and have had an unprecedented growth. Forensic toxicologists in Bulgaria faced SCs for the first time in 2010, as compounds detected in seized blends. METHODS: This is a retrospective survey on the SCs seized in Bulgaria 2010-2013. RESULTS: The number of SCs increased progressively: 17 cases in 2010, 38 in 2011, 75 in 2012, and 80 in 2013. In Bulgaria, from 2010 to 2013, there were two cases of toxicologically proved intoxications (with JWH-018). JWH-018 was the most often detected SC in Bulgaria for the whole studied period. The most popular combination detected in 2013 was: UR-144+MAM-2201 with or without STS-135. Highly potent halogenated SCs appeared in 2013. 5F-AКB-48 (nearly 3 kg) was seized in 12 cases. Published data suggest that SCs may have more severe side effects than marijuana. Parallel adaptation of Bulgarian law with adoption of analog laws tried to meet the increased forensic challenges. CONCLUSIONS: Over the last decade, the rapid growth in the number and types of SCs distributed in Europe has challenged the capacity, and sometimes the credibility, of identification, risk assessment and control systems. Forensic toxicology needs to adapt in a timely manner, providing scientific basis of legislative changes.

[Toxicological evaluation in the childhood]. / Evaluación toxicológica del menor.

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants' interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance.

Consideraciones toxicológicas sobre supuestos casos de sumisión química en delitos de índole sexual en el sur de España entre los años 2010-2012 / Toxicological considerations on alleged cases of drug facilitated sexual assault in southern Spain between 2010-2012

Introducción. La sumisión química consiste en la incapacitación de la víctima de delitos como violación o robo mediante la administración de sustancias químicas. La obtención de evidencias forenses en este tipo de delitos supone un importante reto para el toxicológo forense. Aunque en los últimos años se han publicado diversos protocolos de actuación con el objetivo de armonizar los procedimientos a seguir frente a estos delitos, se carece en general de datos que reflejen la situación real en los distintos países. Material y métodos. Este trabajo presenta los resultados obtenidos en un estudio retrospectivo realizado en los casos de agresión sexual recibidos en el Departamento de Sevilla del Instituto Nacional de Toxicología y Ciencias Forenses entre los años 2010 y 2012 en los que se sospechaba una posible sumisión química. Se realizó una investigación toxicológica encaminada a poner de manifiesto la presencia de alcohol etílico u otras sustancias psicoactivas. Se determinó también la presencia de semen. Resultados. Más de la mitad de los 73 casos estudiados presentaron resultados negativos, pudiendo considerar, a partir de la información sobre la víctima y los hechos y los resultados obtenidos, únicamente 3 como sumisión química. Conclusiones. Los resultados obtenidos están en consonancia con lo previamente publicado, si bien la evaluación de la situación de los casos de sumisión química en delitos de índole sexual depende del desarrollo y cumplimiento de protocolos de actuación adecuados (AU)

Introduction. Drug facilitated crime consists in incapacitating victims of rape or robbery by administering different chemical substances. Forensic evidence of this type of crime implies an important challenge for the forensic toxicologist. Although different guidelines with the objective of harmonizing existing procedures have been published, there is a general lack of data that could reflect the actual situation in different countries. Material and methods We present here the results obtained in cases of alleged sexual assault received at the Department of Seville of the National Institute of Toxicology and Forensic Sciences between 2010 and 2012, in which a possible drug facilitated sexual assault was suspected. A toxicological investigation designed to determine blood alcohol concentration and to establish the presence of psychoactive substances and drugs of abuse was performed. Semen presence was also determined. Results More than half of the 73 studied cases yielded negative results. From the received information and obtained results we could only classify 3 of the cases as a drug facilitated sexual assault. Conclusions. Obtained results are similar to those previously published, although the assessment of the current status of alleged cases of drug facilitated sexual assault depends on the development and implementation of appropriate protocols (AU)

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)

Criterios cuantitativos en toxicología forense / Quantitative criteria in forensic toxicology

La toxicología forense requiere resultados analíticos científicamente indiscutibles y legalmente defendibles. Disponer de datos analíticos fiables es indispensable para interpretar correctamente los resultados toxicológicos. Los criterios analíticos en toxicología forense, basados en las normativas y recomendaciones vigentes son proporcionados por prestigiosos organismos de ámbito internacional y local, y su cumplimiento es fundamental para obtener resultados toxicológicos científicamente sólidos. Este trabajo supone una continuación en la revisión y evaluación de los criterios analíticos en toxicología forense, iniciada con el anterior trabajo recientemente publicado en esta revista «Criterios cualitativos en toxicología forense». Su objetivo es contribuir a la calidad de la pericia y al avance en la unidad de criterio científico, aspectos cruciales en toxicología forense. Este trabajo revisa, evalúa y recopila los criterios para una correcta cuantificación detallándose los requisitos para validar las metodologías. Además, pretende servir a aquellos profesionales que deban evaluar resultados toxicológicos emitidos por laboratorios forenses (AU)

Forensic toxicology requires indisputable and legally defensible analytical results. Reliable analytical results are essential for the accurate interpretation of toxicological findings. Analytical criteria in forensic toxicology —based on the regulations and recommendations— are provided by prestigious international and local organizations, and their fulfilment is essential to achieve toxicological results based on solid scientific foundations. This work is a continuation of the review and assessment of analytical criteria in forensic toxicology, started with the recently published work in this journal «Qualitative criteria in forensic toxicology». It is aimed at contributing to the quality of the expert witness report and implementing common scientific criteria, both crucial aspects in forensic toxicology. The criteria necessary for an accurate quantification are reviewed, assessed and compiled in this work, detailing the requirements to validate methodologies. Moreover, this work is intended to serve those professionals who need to assess toxicological findings submitted by forensic laboratories (AU)

Evaluación toxicológica del menor / Toxicological evaluation in the childhood

Las intoxicaciones en la infancia requieren la atención médica urgente dentro del sistema sanitario. En nuestro país supone el 0,3% de las urgencias pediátricas. La mayoría son intoxicaciones accidentales, pero no son infrecuentes las relacionadas con el maltrato infantil o las intencionales con finalidad autolítica, especialmente en la adolescencia. Los objetivos del estudio son valorar la intoxicación en el menor en los aspectos clínicos asistenciales y medicolegales. Se valora la asistencia médica que comprende el diagnóstico clínico, el tipo de tóxicos más comunes, su frecuencia y la derivación a las unidades de trabajo social y equipos de asistencia urgente, dependientes de la Consejería de Bienestar Social y Consejería de Salud o, en su caso, la intervención directa de fiscalías y juzgados. Se discute la importancia de la correcta interpretación de los resultados toxicológicos en los casos de la detección en los menores de alcohol, drogas o medicamentos y se describen varios estudios de interpretación de resultados relativos a la detección de estos tóxicos Se valoran los aspectos legales y el dictamen médico forense. Las conclusiones se analizarán por la autoridad judicial a fin de delimitar responsabilidades o tomar decisiones que protejan los intereses del menor. En conclusión, la intoxicación de los menores puede derivar en procedimientos legales que requieran actuaciones concretas para su protección. El envío al juzgado de los partes judiciales es un requisito legal que deben cumplir los facultativos y centros sanitarios. Al mismo tiempo, esta información supone una vía de vigilancia epidemiológica de interés en salud pública (AU)

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants’ interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance (AU)

Toxicology testing in fatally injured workers: a review of five years of Iowa FACE cases.

Toxicology testing of fatally injured workers is not routinely conducted. We completed a case-series study of 2005-2009 occupational fatalities captured by Iowa's Fatality Assessment and Control Evaluation (FACE) Program. The goals of our research were to: (1) measure the proportion of FACE cases that undergo toxicology testing, and describe the factors associated with being tested, and (2) measure the rate of positive toxicology tests, the substances identified and the demographics and occupations of victims who tested positive. Case documents and toxicology laboratory reports were reviewed. There were 427 occupational deaths from 2005 to 2009. Only 69% underwent toxicology testing. Younger workers had greater odds of being tested. Among occupational groups, workers in farming, fishing and forestry had half the odds of being tested compared to other occupational groups. Of the 280 cases with toxicology tests completed, 22% (n = 61) were found to have positive toxicology testing. Commonly identified drug classes included cannabinoids and alcohols. Based on the small number of positive tests, older victims (65+ years) tested positive more frequently than younger workers. Management, business, science, arts, service and sales/office workers had proportionately more positive toxicology tests (almost 30%) compared with other workers (18-22%). These results identify an area in need of further research efforts and a potential target for injury prevention strategies.

[The overview of research on toxicological (forensic) chemistry based on the materials of the abstracts of dissertation theses. The forms and modes of information].

The authors discuss the system of information about investigations on toxicological (forensic) chemistry carried out for obtaining the scientific degree as it has formed in this country. They present a review and a list of theses and their abstracts in this discipline defended during the period from 1936 to 2010. The analysis of the themes of the studies is performed with reference to the dynamics of preparation of the theses in the Soviet and post-Soviet periods.