Analysis of seroconversion following COVID-19 vaccination among multiple sclerosis patients treated with disease-modifying therapies in Poland.

CLINICAL RATIONALE FOR THE STUDY: The rapid spread of SARS-CoV-2 throughout the world has highlighted the importance of vaccinations to control the pandemic and to protect people at risk for severe disease courses. Disease-modifying therapies (DMT) in multiple sclerosis (MS), whether immunomodulatory or immunosuppressive, may affect the immune response. Therefore, the question arose as to whether these vaccinations would be effective. AIM OF THE STUDY: We planned a study to assess the immune response to SARS-CoV-2 vaccines by type of therapy. MATERIAL AND METHODS: Participants were recruited from 14 Polish MS centres. The data was obtained by neurologists using a questionnaire. We collected data on 353 MS patients (269 females, 84 males) who received complete primary SARS-CoV-2 vaccination. All persons with MS (PwMS) were treated with disease-modifying therapies. RESULTS: 305 out of 353 PwMS (86.4%) were positive for IgG Abs against SARS-CoV-2 S domain S1 Ag after vaccination. A strong immune response was noted in 129 PwMS (36.5%). The rate of seroconversion after SARS-CoV-2 vaccination in PwMS who received immunomodulatory DMTs (interferon beta, glatiramer acetate, teriflunomide, dimethyl fumarate, natalizumab) was 91.5%, in PwMS receiving immune reconstruction therapy (alemtuzumab, cladribine) was 92%, and in immunosuppressive DMTs (fingolimod, ocrelizumab), the seroconversion rate was 59%. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study shows that, in PwMS receiving immunomodulatory therapy, the immune response to vaccination is generally excellent. Even in immunosuppressive patients, seroconversion is satisfactory.

Antibodies against SARS-CoV-2 S and N proteins in relapsing-remitting multiple sclerosis patients treated with disease-modifying therapies.

CLINICAL RATIONALE FOR THE STUDY: The course of COVID-19 in people with multiple sclerosis (PwMS) has been described, while the serological status after SARS-CoV-2 infection or vaccination, especially in patients treated with disease-modifying therapies (DMT), is still under investigation. This is a significant clinical problem, as certain DMTs may predispose to a severe course of viral infections. AIM OF THE STUDY: We analyzed the presence of antibodies against spike (S) and nucleocapsid (N) proteins of SARS-CoV-2 in relapsing-remitting PwMS treated with DMT, especially dimethyl fumarate, interferon beta, and glatiramer acetate, in a single multiple sclerosis (MS) centre in north-eastern Poland (the Department of Neurology, Medical University of Bialystok). MATERIAL AND METHODS: The presence of antibodies against S and N proteins in PwMS was assessed twice: on visit one (between May and June 2020) (n = 186) and on visit two (between May and June 2021) (n = 88). Samples were taken from 68 individuals on both visits. Demographic and clinical data was collected: duration of MS, Expanded Disability Status Scale Score (EDSS), type of DMT, history of COVID-19 (positive PCR or antigen test in the past), vaccination status, and the type of vaccine. RESULTS: It was shown that on visit one: 3.7% (n = 7) PwMS were positive for IgA against S protein (IgA-S), 3.2% (n = 6) for IgG against S (IgG-S) protein, and none of those examined was positive for IgG against N protein (IgG-N). On visit two, the most common detected antibodies were IgG-S (71.3%; n = 62), then IgA-S (65.1%; n = 55), and the least common was IgG-N (18.2%; n = 16). On visit two: 20.45% of PwMS had a history of a positive SARS-CoV-2 PCR or antigen test during the last year. By the time of visit two, 42.05% (n = 37) of patients who participated in visit two had been full-course vaccinated against COVID-19. It was demonstrated that vaccination against SARS-CoV-2 significantly induces the production of IgG-S and IgA-S (p < 0.0001), while no difference between vaccinated and unvaccinated patients was shown in the detection of IgG-N. There was no correlation between COVID-19 infection and antibodies against proteins S and N in the study group. Moreover, the presented study did not show any relationship between the ability to produce antibodies against the S protein with any of the used DMTs. CONCLUSIONS AND CLINICAL IMPLICATIONS: According to our study, PwMS treated with dimethyl fumarate, interferon beta, or glatiramer acetate can efficiently produce antibodies against SARS-CoV-2 both after infection and after vaccination.

The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis-A Literature Review.

SARS-CoV-2/Coronavirus 2019 (COVID-19) is responsible for the pandemic, which started in December 2019. In addition to the typical respiratory symptoms, this virus also causes other severe complications, including neurological ones. In diagnostics, serological and polymerase chain reaction tests are useful not only in detecting past infections but can also predict the response to vaccination. It is now believed that an immune mechanism rather than direct viral neuroinvasion is responsible for neurological symptoms. For this reason, it is important to assess the presence of antibodies not only in the serum but also in the cerebrospinal fluid (CSF), especially in the case of neuro-COVID. A particular group of patients are people with multiple sclerosis (MS) whose disease-modifying drugs weaken the immune system and lead to an unpredictable serological response to SARS-CoV-2 infection. Based on available data, the article summarizes the current serological information concerning COVID-19 in CSF in patients with severe neurological complications and in those with MS.

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies - the Polish experience.

INTRODUCTION: The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited. MATERIALS AND METHODS: This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health. RESULTS: There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used. CONCLUSIONS AND CLINICAL IMPLICATIONS: Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Evaluation of the usefulness of the immunoradiometric method for post-mortem measurement of insulin concentration in the intraocular fluid: preliminary results.

INTRODUCTION: In medicolegal practice, rare cases associated with suicidal, criminal or accidental overdose of insulin are both analytically and forensically challenging. The determination of insulin in post-mortem blood has limited diagnostic value, mainly on account of post-mortem chemical degradation processes (particularly hemolysis), and hence is not useful in medicolegal practice. AIM OF THE STUDY: The aims of the study were: 1) to assess the usefulness of the immunoradiometric method, used in clinical practice, for post-mortem measurement of insulin concentration in the intraocular fluid, 2) to preliminarily evaluate the usefulness of the obtained results for toxicological and medicolegal assessment, and 3) to verify on the basis of our own material the validity of the cited literature data on the effect of hemolysis on the result of insulin level determination in post-mortem blood. MATERIAL AND METHODS: The study material consisted of 93 samples of intraocular fluid collected during consecutive medicolegal autopsies performed in the Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice. In addition, 10 samples of peripheral blood taken from living people (5 women and 5 men) for clinical and diagnostic purposes were analyzed. Insulin(e) IRMA KIT from IMMUNOTECH was used for the analyses. RESULTS: In 86 (92.5%) samples, the insulin concentration was below the analytical sensitivity of the method (less than 0.5 µIU/ml), while in 7 cases it was in the range of 1.42-24.42 µIU/ml. CONCLUSIONS: Determination of the insulin level in the intraocular fluid by the immunoradiometric method provides an opportunity for objective verification of poisoning, however this claim requires further research.

New challenges in toxicology of new psychoactive substances exemplified by fatal cases after UR-144 and UR-144 with pentedrone administration determined by LC-ESI-MS-MS in blood samples.

The topic of this paper relates to the study of cases involving the use of new psychoactive substances (NPS) from the classes of synthetic cannabinoids and cathinones, analyzed from multiple viewpoints including clinical and medico-legal perspectives. The paper investigates three fatal cases in which UR-144 and UR-144 with pentedrone identified in the bodies of victims during post-mortem examinations were responsible for the tragic consequences and proved to be the indirect cause of death. The victims were men aged 16, 22 and 40 years who used drugs, for example they smoked marijuana or its substitutes in the form of synthetic cannabinoids. In addition, all of them had behavioural problems. On account of emotional imbalance attributable probably to the presence of UR-144 (in one case) and a mixture of UR-144 and pentedrone (in the other two cases), two men committed suicide by jumping from a height and hanging, and one man had fatal accidental poisoning with pentedrone which was used to enhance the effect of previously used UR-144. The presence of UR-144 and pentedrone in the post-mortem material was analyzed by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). The results of toxicological tests were analyzed with a focus on possible tragic side effects caused by the presence of UR-144 and UR-144 with pentedrone in the body.

Patient's death as a result of mistakenly injection of pancuronium.

Pancuronium is a typical non-depolarizing, curare-mimetic, very potent muscle relaxant. Besides application in anesthesiology and intensive care, it is used in execution as a part of lethal injection. In medico-legal practice, there are cases of using this substance in order to commit suicide or to deprive other people of their lives. Accidental pancuronium intoxications are very rare. The authors present such case ended in sudden death of hospitalized woman after mistakenly injection of the drug. 57-year-old female alcoholic was admitted to the Acute Poisoning Centre after ethylene glycol ingestion. During the fifth day of treatment the nurse by mistake, instead of furosemide, intravenously administered her pancuronium. Sudden respiratory and circulatory arrest occurred, so she was intubated and resuscitation with artificial ventilation were undertaken, however within 1 hour and 45 minutes the patient died. Due to the vague background of a sudden deterioration in the patient's condition, the case was brought for prosecution. The autopsy and histopathological studies did not reveal the cause of death, but undertaken chemico-toxicological examinations identified the presence of pancuronium in blood, liver and kidney (190 ng/ml, 70 ng/g and 125 ng/g, respectively). Chemico-toxicological analysis proved that the cause of death of the 57-year-old hospitalized woman was pancuronium intoxication due to evident medical error during drug administration. In our case the concentration of pancuronium in blood was in therapeutic range (200-600 ng/ml). However, even a therapeutic pancuronium dose administered to patient the breath of whom is not supported and monitored can be a threat to his life.

Analysis of the Presence and Levels of IgG Antibodies Directed against the S1 Protein Receptor Binding Domain and the N Protein of SARS-CoV-2 in Patients with Multiple Sclerosis Treated with Immunomodulatory Therapies.

The coronavirus 2019 disease (COVID-19) course and serological statuses of patients with relapsing-remitting multiple sclerosis (RRMS), treated with disease-modifying therapies (DMTs) are generally parallel that of the general population. Over the pandemic's course, however, a notable increase in the number of RRMS patients who received vaccination against severe acute respiratory coronavirus 2 (SARS-CoV-2) and those who had COVID-19 (symptomatic and asymptomatic) was reported. This virus and/or vaccination likely influenced DMT-treated RRMS patients' serological statuses regarding the presence of SARS-CoV-2 antibodies and their quantitative expression. This investigation assesses the presence and levels of the antibody directed against the S1 protein receptor binding domain (SRBD) and against the N protein of SARS-CoV-2 in 38 DMT-treated RRMS patients. The findings indicate that people vaccinated against SARS-CoV-2 exhibited significantly higher levels of IgG antibodies against S1-RBD at both assessment points. Patients with a prior history of COVID-19 demonstrated statistically significant increases in anti-N antibodies at visit 1, whereas such statistical significance was not observed at visit 2. DMT-treated RRMS patients generated neutralizing antibodies following vaccination and/or COVID-19 infection. Nevertheless, it is noteworthy that antibody levels more accurately reflect the serological status and exhibit a stronger correlation with vaccination than just the presence of antibodies.

Case report: Variants in the ERCC4 gene as a rare cause of cerebellar ataxia with chorea.

Variants in the ERCC4 gene have been described to be associated with the following autosomal recessive diseases: xeroderma pigmentosum group F (XPF), xeroderma pigmentosum type F/Cockayne syndrome (XPF/CS), Fanconi anemia complementation group Q (FANCQ), and XFE progeroid syndrome (XFEPS). In this paper, we present a case of a 53-year-old Caucasian female patient with rare variants in the ERCC4 gene. When she was 42 years old, falls and loss of balance occurred. At the age of 48, involuntary, uncoordinated movements of the upper limbs and head, tongue stereotypes (licking and extending movements), speech problems (dysarthria), memory deterioration, and hearing loss occurred. Since childhood, she has shown hypersensitivity to UV radiation. The neurological examination revealed chorea syndrome, cerebellar ataxia, dysarthria, and bilateral hearing loss. She has numerous pigmented lesions on the skin. Brain MRI demonstrated massive cortico-subcortical atrophy. The neuropsychological examination revealed dysfunctions in the executive domain in terms of attention, working memory, organizing, and planning activities. The genetic diagnostics was performed which excluded spinocerebellar ataxia types 1, 2, 3, 6, and 17, Huntington's disease, and FMR1 premutation. In the genetic analysis of next-generation sequencing (NGS), two variants: c.2395C > T and c.1349G > A in the ERCC4 gene were identified in a heterozygote configuration. So far, a few cases of ERCC4 gene variants, which are associated with nucleotide excision repair pathways, have been described in connection with symptoms of cerebellar ataxia. In patients with ERCC4 biallelic variants, the adult neurological phenotype can sometimes be the first symptom and reason for access to genetic testing. The aforementioned case highlights the occurrence of rare genetic causes of progressive neurodegenerative diseases in adults, especially with the spectrum of autosomal recessive nucleotide excision repair pathway disorders (NERDs).

The Impact of the COVID-19 Virus Pandemic on the Incidence of First Psychotic Spectrum Disorders.

The effects of COVID-19 on the human body are not yet understood enough. Medical history provides information on cases of psychiatric symptoms during viral infections in the 20th century, such as the influenza pandemic. Currently, it is observed that there is an increasing number of new psychiatric disorders in previously healthy individuals. In addition, because of the decreased amount of reporting to health care providers, including psychiatrists, many physicians suggest that the number of neuropsychiatric disorders may be underestimated. In this paper, we review available studies on the occurrence of first-time psychotic spectrum disorder (PSD) in individuals related to SARS-CoV-2 infection. The reviewed studies suggest that first-time psychotic disorder in COVID-19 patients is statistically significantly more frequent compared to influenza, as well as to other respiratory infections. The emergence of new PSDs is explained by direct neurotropism of the virus on the one hand and by immunological mechanisms on the other. The main conclusions of this review should be treated with caution, and future research on this topic is needed. The authors recognize the particular need to develop standardized laboratory panels that include inflammatory markers (IL-6, TNF-α), cerebrospinal fluid (CSF) testing, and SARS-CoV-2 antibody assays to entirely understand the etiology of neuropsychiatric complications of SARS-CoV-2 infections and the pandemic itself. In addition, public health efforts are required to promote mental health, especially during COVID-19.

Safety of Vaccines against SARS-CoV-2 among Polish Patients with Multiple Sclerosis Treated with Disease-Modifying Therapies.

(1) Background: The present study aims to report the side effects of vaccination against coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) who were being treated with disease-modifying therapies (DMTs) in Poland. (2) Methods: The study included 2261 patients with MS who were being treated with DMTs, and who were vaccinated against COVID-19 in 16 Polish MS centers. The data collected were demographic information, specific MS characteristics, current DMTs, type of vaccine, side effects after vaccination, time of side-effect symptom onset and resolution, applied treatment, relapse occurrence, and incidence of COVID-19 after vaccination. The results were presented using maximum likelihood estimates of the odds ratio, t-test, Pearson's chi-squared test, Fisher's exact p, and logistic regression. The statistical analyses were performed using STATA 15 software. (3) Of the 2261 sampled patients, 1862 (82.4%) were vaccinated with nucleoside-modified messenger RNA (mRNA) vaccines. Mild symptoms after immunization, often after the first dose, were reported in 70.6% of individuals. Symptoms included arm pain (47.5% after the first dose and 38.7% after the second dose), fever/chills/flu-like symptoms (17.1% after the first dose and 20.5% after the second dose), and fatigue (10.3% after the first dose and 11.3% after the second dose). Only one individual presented with severe side effects (pro-thrombotic complications) after vaccination. None of the DMTs in the presented cohort were predisposed to the development of side effects. Nine patients (0.4%) had a SARS-CoV-2 infection confirmed despite vaccination. (4) Conclusions: Vaccination against SARS-CoV-2 is safe for people with MS who are being treated with DMTs. Most adverse events following vaccination are mild and the acute relapse incidence is low.

Analysis of Side Effects Following Vaccination Against COVID-19 Among Individuals With Multiple Sclerosis Treated With DMTs in Poland.

Background and Objectives: Since vaccination against COVID-19 is available for over a year and the population of immunized individuals with autoimmune disorders is higher than several months before, an evaluation of safety and registered adverse events can be made. We conducted a large study of side effects following the COVID-19 vaccine among patients with multiple (MS) sclerosis treated with disease-modifying therapies (DMTs) and analyzed factors predisposing for particular adverse events. Methods: We gathered data of individuals with MS treated with DMTs from 19 Polish MS Centers, who reported at least one adverse event following COVID-19 vaccination. The information was obtained by neurologists using a questionnaire. The same questionnaire was used at all MS Centers. To assess the relevance of reported adverse events, we used Fisher's exact test, t-test, and U-Menn-Whutney test. Results: A total of 1,668 patients with MS and reports of adverse events after COVID-19 vaccination were finally included in the study. Besides one case marked as "red flag", all adverse events were classified as mild. Pain at the injection site was the most common adverse event, with a greater frequency after the first dose. Pain at the injection site was significantly more frequent after the first dose among individuals with a lower disability (EDSS ≤2). The reported adverse events following immunization did not differ over sex. According to age, pain at the injection site was more common among individuals between 30 and 40 years old, only after the first vaccination dose. None of the DMTs predisposed for particular side effects. Conclusions: According to our findings, vaccination against COVID-19 among patients with MS treated with DMTs is safe. Our study can contribute to reducing hesitancy toward vaccination among patients with MS.

[Smuggling of the cocaine in the gastrointestinal tract ended in sudden death--the first case report from the Upper Silesia]. / Przemyt kokainy w przewodzie pokarmowym zakonczony naglym zgonem--opis pierwszego przypadku na Górnym Slasku.

Fifty-year old man was found dead in the bathroom of his apartment. Forensic autopsy was ordered to determine the cause and manner of death. Autopsy revealed the presence of 55 latex "balls" in the stomach and foregut. In the past the victim was suspected of drug's dealing and smuggling. The content of "balls" and biological material (blood, urine, bloody fluid from internal organs) were analysed with LC MS/MS in the Chair and Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice. The range of cocaine' concentration in the "balls" was 91.2-96.1%, whereas concentration in blood - 107.50 microg/ml, in urine - 284.60 microg/ml and in bloody fluid - 192.30 microg/ml. The cause of death was acute cocaine intoxication.

[Toxicological and medico-legal analyses of sudden deaths resulting from butane inhalation]. / Toksykologiczna i medyczno-sadowa ocena naglych zgonów w przebiegu narkotyzowania sie butanem.

Butane is known to be a suffocating gas with narcotic activity, especially at high concentrations. Within the past five years, a few cases of sudden deaths in teenage boys who had inhaled butane, a component of gas for lighters, were investigated in the Forensic Medicine Department, Medical University of Silesia, Katowice. Analyses of biological materials secured at autopsies and evidence from places of deaths was carried out using GC/FID. Butane was found in blood, lung and brain samples of the deceased. Moreover, histopathological examinations were performed. Results of autopsies and additional analyses were appraised from the point of view of their significance and usefulness in giving medico-legal opinions on the cause of death.

[Assessment of exposure to hydrogen cyanide in fire fatalities in the aspects of endogenous hydrogen cyanide production as a result of putrefaction processes in the deceased]. / Ocena ekspozycji na cyjanowodór u smiertelnych ofiar pozarów w aspekcie powstawania w zwlokach endogennego cyjanowodoru w procesach gnilno-rozkladowych.

On account of endogenous hydrogen cyanide (HCN) production in the deceased, it is not easy to assess exposure to HCN in people who died in fire involving closed rooms (flats, garages, cellars, etc). In the paper, the authors present the results of blood determinations of hydrogen cyanide in fatalities of explosions and fires occurring in coal-mines, as well as fires in closed rooms. It has been demonstrated that the time of exposure to a high temperature and the temperature itself hamper autolysis processes that lead to production of endogenous HCN in fire fatalities.

[Methods of carbon monoxide determination in postmortem blood--advantages and disadvantages]. / Metody oznaczania tlenku wegla we krwi sekcyjnej--zalety i ograniczenia.

With respect to epidemiology of carbon monoxide poisonings, the diagnostic management of poisonings caused by this xenobiotic is among the fundamental objectives of forensic toxicology. In forensic practice, to determine carbon monoxide, colorimetric and spectrophotometric methods, as well as gas chromatography are used. Based on literature data and their own experience, the authors discuss analytical methods universally applied in determinations of carbon monoxide in postmortem blood. The advantages and disadvantages, as well as the cause of errors resulting from the specificity of the examined material (postmortem blood) are indicated.

[State under the influence of drugs or psychotropic agents--a comparison of toxicological and medical examinations in materials of the Department of Forensic Medicine and Toxicology, Silesian University of Medicine, Katowice]. / Stan "pod wplywem substancji odurzajacych lub psychotropowych" porównanie wyników badan toksykologicznych z ocena lekarska w materialach Katedry i Zakladu Medycyny Sadowej i Toksykologii Sadowo-Lekarskiej Slaskiego Uniwersytetu Medycznego w Katowicach.

In the paper, the authors present the results of toxicological examinations of blood samples taken from drivers during road check procedures or from perpetrators of traffic road accidents, which--taking into consideration the kind of the determined agents and their concentrations--were compared with the results of medical examinations from blood sampling protocols studied in the Department of Forensic Medicine and Toxicology, Silesian University of Medicine. All the blood samples were first analyzed using an immunoenzymatic assay (ELISA). Then, the LC-MS method was used. The positive results of screening for the presence of cannabinols were verified by GC-MS. Out of 329 blood samples, 145 were positive. The presence of cannabinols, amphetamine or MDMA was the most predominant finding. Diazepam was determined in 4 cases and opiates in 1 case. Only in 31% cases did positive results of toxicological examinations correspond to deviations found during the medical examinations constituting the basis for the final diagnosis of state "under the influence". In practice, appraisal of drug influence during medical examination seems to be limited and dependent on variable reactions of the examined individuals to a psychoactive agent, time lapse between the traffic road event and the examination or concomitant symptoms associated with ethylene alcohol activity. The final diagnosis of state "under the influence of drugs" or "under the influence of psychotropic agents" given by the physician does not result from the effect of these substances observed during the medical examination, but is very often formulated based on the medical history or police findings. The analysis of the above mentioned cases where Delta9THC or/and amphetamine was detected showed no correlation between the concentration of the psychoactive agent determined in blood and symptoms triggered by its action as described by the physician.

First-Time Psychotic Symptoms in a Patient After COVID-19 Infection-A Case Report.

A 39-year-old, previously healthy, white male with no personal or family history of mental illness presented with new, first-time psychotic symptoms. The new psychotic symptoms appeared on patient admission to the hospital, occurring during a diagnosis of symptomatic SARS-CoV-2 infection. On the first day of hospitalization for worsening psychotic symptoms and the appearance of aggression toward the staff, the patient was transferred to the psychiatric hospital. After the initial treatment with antipsychotics and benzodiazepines, his mental condition improved. The patient was then transferred for further treatment of his somatic condition in the internal medicine ward, with a recommendation to continue treatment in the psychiatric ward once his somatic condition was stabilized. This is one of the few reported cases of COVID-19-related psychosis in a patient without a personal or family history; moreover, this description contains important data regarding elevated IL-6, which may prove to be a key factor in the induction of new psychotic symptoms. It indicates the important need for careful monitoring of neuropsychiatric symptoms among COVID-19 patients.

[Population genetics of 11 STR loci in the Upper Silesia population]. / Genetyka populacyjna 11 loci systemów STR w próbkach badanych na Górnym Slasku.

The report present the results of population studies of 11 STR loci: D16S5539, D7S820, D13S317, CSF1PO, TPOX, TH01, F13A01, FESFPS, VWA, F13B, LPL originating from samples examined in Laboratory of Biological traces, Chair and Department of Forensic Medicine, Silesian Medical University. The examinations were performed in the group of 455 non-consanguinated adults, men and women, from Upper Silesia. The purpose of the investigation was to study the distribution of allele frequencies of 11 short tandem repeat representative sample of the Upper Silesia (Poland) population, to show genetic balance in agreement with Hardy-Weinberg's law for the studied population and to compare homogeneity of the usefulness of 11 STR genetic markers for paternity testing and forensic identification purposes. Genomic DNA was isolated from blood samples and swabs from oral cavity by The Blood DNA Prep Plus kit (A&A Biotechnology) and EZ1 DNA tissue Kit for the use on the BioRobot EZ1. All reactions were carried out according to the manufacturer's recommendations (Silver Stain Detection, Promega). POR amplification was performed following the instructions of the GenePrint STR System kit using a GeneAmp PCR System 2700 Thermal Cykler. PCR products and Promega Ladders were separated by vertical electrophoresis on 6% denaturing polyacrilamide gel (Amresco), electrophoresis and visualized by silver staining (Promega Corporation). Allele frequencies, the values of heterozygosity (Ht), polymorphism information content (PIC), power of discrimination(PD), power of exclusion (PE), paternity index (PI), and matching probability (PM) were calculated using FatRec by Dudek's program and TFPGA of Miller. The concordance with HWE was evaluated using the chi-square test. The compared statistic parameters, which make an important component of research work and opinionating, show that 11 STR loci constitutes a very useful tool for individual identification in crime research and in putative paternity research.

[The effect of high temperature on the levels of selected endogenous compounds]. / Wplyw wysokiej temperatury na poziom wybranych zwiazków endogennych.

The authors present their research on the levels of carboxyhemoglobin, hydrogen cyanide and ethyl alcohol in the blood of 23 fatalities found in the extreme conditions (methane explosion, fire, high temperature) associated with a mining disaster. Determinations of the presence of carboxyhemoglobin, hydrogen cyanide, and ethyl alcohol were performed as soon as the blood samples were collected from the deceased. The concentration of ethyl alcohol ranged from 0.2 per thousand to 1.3 per thousand in 18 cases. Blood HbCO levels tested within the range of 11% to 83% in 17 cases. In six cases, HbCO tested negative, and the injuries found at autopsy indicated these individuals to have been killed at the moment of the explosion. Blood cyanide content tested negative in all the examined cases. The extreme conditions of the mining disaster, especially high temperature, to which the bodies were exposed, did not have any effect either on endogenous cyanide or carboxyhemoglobin, causing, however, a significant increase in the level of ethyl alcohol in the blood.