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Bianchi I, Cippitelli M, Buratti E, Cerioni A, Mietti G, Focardi M, Grifoni R, Scendoni R, Froldi R, Cingolani M, Pinchi V. A pilot study on post-mortem determination of drug abuse on dental tissues. Forensic Sci Int 2024; 363:112185. [PMID: 39151241 DOI: 10.1016/j.forsciint.2024.112185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/22/2024] [Accepted: 08/04/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Post-mortem toxicology constantly deals with the research of reliable alternative matrices to be applied in case of highly damaged corpses (such us carbonized, skeletonized, human remains, etc.). Teeth represent a promising alternative matrix since dental tissues are endowed by different features, resistance and stability after death. SCOPE Since scant literature reported on the pharmacokinetics and mechanism of incorporation of xenobiotics into dental tissues, this pilot research aims to investigate whether in the pulp can be detected the same substances found in blood in drug related death cases. Secondly, the study is addressed to disclose the possible deposit of drugs in dental hard tissues (dentine and/or enamel), thus contributing to reconstruct the drug abuse history (timing, e.g.). MATERIALS AND METHODS The study experimented with a novel method to separately analyse dental enamel, dentin, and pulp, applied to 10 teeth collected during autopsies of drug-related deaths along with blood and hair samples for classic toxicological analyses. Each tooth was prepared by "pulverization technique" and then analysed by gas chromatography paired with mass spectrometry (GC-MS) and ultra high performance liquid chromatography coupled to high resolution mass spectrometry (UHPLC/HR-MS) for searching cocaine, opiates, and metabolites. The results were then compared with those obtained from blood and hair samples. RESULTS Preliminary results demonstrated that teeth differ from any other classic matrix (blood and hairs) since the qualitative correspondence of the detected substances between pulp and blood as well as dental hard tissues and hair suggests that they can be useful in post-mortem evaluation as a unique matrix for both acute and chronic assumptions of drugs. The mechanism of accumulation of substances in mineralized dental tissues emerged the most significant result, being influenced by the type of molecule and the method of assumption. The main limitation of this study is the limited availability of the sample and the absence of anamnestic information of the time, rates and method of drug assumption during life. Further research is necessary to systematically investigate the distribution of different substances within the different tissues of the tooth.
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Affiliation(s)
- Ilenia Bianchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Marta Cippitelli
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Erika Buratti
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Alice Cerioni
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Gianmario Mietti
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Martina Focardi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Rossella Grifoni
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Roberto Scendoni
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Rino Froldi
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Mariano Cingolani
- Forensic Medicine and Laboratory (For. Med. Lab), Institute of Legal Medicine, University of Macerata, Via Don Minzoni 9, Macerata 62100, Italy.
| | - Vilma Pinchi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Largo Brambilla 3, Florence 50134, Italy; Laboratory of Personal Identification and Forensic Morphology, Department of Health Sciences, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
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Olds ML, Jones AW. Preanalytical factors influencing the results of ethanol analysis in postmortem specimens. J Anal Toxicol 2024; 48:9-26. [PMID: 37804205 DOI: 10.1093/jat/bkad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023] Open
Abstract
Excessive drinking and drunkenness are underlying factors in many fatal accidents, which make the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons although the interpretation of the results is more complicated in medical examiner cases owing to various preanalytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem ingestion of ethanol from PM synthesis. One approach involves the determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid, vitreous humor and/or urine, and comparison of results with blood alcohol concentration (BAC). Another approach involves the analysis of various alcohol biomarkers, such as ethyl glucuronide, ethyl sulfate and/or phosphatidylethanol or the urinary metabolites of serotonin 5-hydroxytryptophol/5-hydroxyindoleacetic acid (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as an enzyme inhibitor, in all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 to 0.02 g% when PM blood is analyzed. During putrefaction low BACs are more often produced after death than high BACs. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.
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Affiliation(s)
- Maria L Olds
- Fort Worth Police Department, Crime Laboratory, East Lancaster Ave, Fort Worth, TX 3616, United States
| | - Alan W Jones
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, University of Linköping, Linköping 58183, Sweden
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Edvardsen HME, Aamodt C, Bogstrand ST, Krajci P, Vindenes V, Rognli EB. Concentrations of psychoactive substances in blood samples from non-fatal and fatal opioid overdoses. Br J Clin Pharmacol 2022; 88:4494-4504. [PMID: 35470456 PMCID: PMC9543683 DOI: 10.1111/bcp.15365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
Abstract
AIM The primary aim was to compare concentrations of psychoactive substances in blood in non-fatal and fatal opioid overdoses. The secondary aim was to assess the concentration levels of naloxone in blood in non-fatal overdoses and the association between naloxone findings and concomitantly detected drugs. METHOD DESIGN Case-control study. SETTING Norway. Fatal overdoses from 2017 and non-fatal overdoses from February 2018 to September 2019. CASES Thirty-one non-fatal and 160 fatal opioid overdose cases. Data from the non-fatal overdoses were collected from hospital records and blood samples, and data from the fatal overdoses were collected from autopsy reports. Concentrations of psychoactive substances (including ethanol) in blood samples were collected at the time of hospital admission for the non-fatal overdoses and during autopsy for the fatal overdoses. RESULTS The median number of different substances detected was four for fatal and five for non-fatal overdoses. The fatal overdoses had higher pooled concentrations of opioids (188 vs 57.2 ng/mL, P < .001), benzodiazepines (5467 vs 2051 ng/mL, P = .005) and amphetamines (581 vs 121 ng/mL, P < .001) than the non-fatal overdoses. A linear relationship between naloxone and concomitant pooled opioid concentrations was found (95% confidence interval = 0.002-0.135, P < .05). CONCLUSION The total load of drug concentrations was associated with the fatal outcome of an overdose, while the number of drugs used, to a lesser extent, differentiated between those who survived and those who died from an overdose. Higher opioid concentrations were associated with treatment with higher naloxone doses.
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Affiliation(s)
| | - Carl Aamodt
- Department of Substance Use Disorder TreatmentOslo University HospitalOsloNorway
| | - Stig Tore Bogstrand
- Department of Forensic SciencesOslo University HospitalOsloNorway
- Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
| | - Peter Krajci
- Department of Substance Use Disorder TreatmentOslo University HospitalOsloNorway
| | - Vigdis Vindenes
- Department of Forensic SciencesOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
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Goncalves R, Pelletier R, Couette A, Gicquel T, Le Daré B. Suitability of high-resolution mass spectrometry in analytical toxicology: Focus on drugs of abuse. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Distribution of tetrahydrocannabinol and cannabidiol in several different postmortem matrices. Forensic Sci Int 2021; 329:111082. [PMID: 34775328 DOI: 10.1016/j.forsciint.2021.111082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022]
Abstract
Cannabis is the most widely used illicit substance worldwide. A limited number of studies have investigated whether tetrahydrocannabinol (THC) and cannabidiol (CBD) can be detected in other postmortem matrices than blood and urine. The aim of this study was to investigate the distribution of THC and CBD in several different postmortem matrices. Concentrations in peripheral blood were compared to those in cardiac blood, pericardial fluid, psoas muscle, vastus lateralis muscle, and vitreous humor. A total of 39 postmortem forensic autopsy cases were included. THC and CBD were analyzed using gas chromatography-mass spectrometry. We were able to detect both THC and CBD in most of the analyzed matrices. For vitreous humor, however, only approximately 50% of the cases were available for analysis, and only two were found to be positive. Median concentrations in peripheral blood were 0.0040 (0.00042-0.056) mg/L for THC and 0.0013 (0-0.023) mg/L for CBD. The concentration ratios between pericardial fluid and cardiac blood compared to peripheral blood were< 1 for both THC and CBD for the majority of the cases. For THC, a median ratio of 0.60 (0.063-7.2) and 0.65 (0.068-4.8) were found for pericardial fluid and cardiac blood, respectively, compared to peripheral blood, whereas for CBD the corresponding median ratios were 0.40 (0.010-1.9) and 0.80 (0.017-2.4). The THC concentrations in psoas muscle and vastus lateralis muscle were high compared to those in peripheral blood in several cases, and large variations in the muscles to peripheral blood concentration ratios were seen. This was also the case for CBD. Our study shows that THC and CBD can be detected in postmortem matrices other than peripheral blood, and results from other matrices might provide important information in forensic cases where peripheral blood is not available. However, vitreous humor was not suitable for detecting neither THC nor CBD.
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Lefrancois E, Reymond N, Thomas A, Lardi C, Fracasso T, Augsburger M. Summary statistics for drugs and alcohol concentration recovered in post-mortem femoral blood in Western Switzerland. Forensic Sci Int 2021; 325:110883. [PMID: 34229141 DOI: 10.1016/j.forsciint.2021.110883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
In post-mortem investigations of fatal intoxication, it is challenging to determine which drug(s) were responsible for the death, and which drugs did not. This study aims to provide post-mortem femoral blood drug levels in lethal intoxication and in post-mortem control cases, where the cause of death was other than intoxication. The reference values could assist in the interpretation of toxicological results in the routine casework. To this end, all post-mortem toxicological results in femoral blood from 2011 to 2017 in Western Switzerland were considered. A full autopsy with systematic toxicological analysis (STA) was conducted in all cases. Results take into account the cause of death classified into one of four categories (as published by Druid and colleagues): I) certified intoxication by one substance alone, IIa) certified intoxication by more than one substance, IIb) certified other causes of death with incapacitation due to drugs, and III) certified other causes of death without incapacitation due to drugs. This study includes 1 990 post-mortem cases where femoral blood was analysed. The material comprised 619 women (31%) and 1 371 men (69%) with a median age of 50 years. The concentrations of the 32 most frequently recorded substances as well as alcohol are discussed. These include 6 opioids and opiates, 3 antidepressants, 6 neuroleptics and hypnotics, 1 barbiturate, 11 benzodiazepines (and related drugs), 2 amphetamine-type stimulants, cocaine, paracetamol, and tetrahydrocannabinol (THC). The most common substances that caused intoxication alone were morphine, methadone, ethanol, tramadol, and cocaine. The post-mortem concentration ranges for all substance are categorized as I, IIa, IIb, or III. Statistical post-mortem reference concentrations for drugs are discussed and compared with previously published concentrations. This study shows that recording and classifying cases is time-consuming, but it is rewarding in a long-term perspective to achieve a more reliable information about fatal and non-fatal blood concentrations.
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Affiliation(s)
- Elodie Lefrancois
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland; University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Naomi Reymond
- School of criminal justice, Faculty of Law, Criminal Justice and Public Administration, University of Lausanne, Switzerland
| | - Aurélien Thomas
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Christelle Lardi
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Tony Fracasso
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
| | - Marc Augsburger
- University Centre of Legal Medicine (CURML), Lausanne, Geneva, Switzerland
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8
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Su H, Li Y, Wu M, Sun T, Niu W, Jia J, Wei Z, Yun K. Dynamic Distribution and Postmortem Redistribution of Tramadol in Poisoned Rats. J Anal Toxicol 2021; 45:203-210. [PMID: 32451554 DOI: 10.1093/jat/bkaa035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 11/12/2022] Open
Abstract
In the past dozen years, the cases of tramadol intoxication have become frequent in many countries. Most previous studies focused on tramadol's pharmacology, such as pharmacokinetics, pharmacodynamics and pharmacogenetics. However, the dynamic distribution and postmortem redistribution (PMR) of tramadol remain unclear. Our study aimed to investigate these two issues systematically in various specimens of 216 poisoned male rats. A validated gas chromatography-mass spectrometry method was used in this study to measure the concentrations of tramadol. In the first part, 66 tramadol poisoned rats were sacrificed at 11 different time points and their organs were collected separately for the study of tramadol's dynamic distribution, which made it feasible to investigate its PMR later on. The results of this part showed that tramadol's concentrations varied according to the organ and time, and peaked 2 h after intragastric administration in the specimens of liver, kidney, spleen, lung, brain and heart-blood (except stomach and heart). Based on the results of the first part, the concentration of tramadol peaked 2 h in most tissues. Therefore, this time point was used for the study of tramadol's PMR. In the second part, the remaining 150 rats were sacrificed 2 h after intragastric administration of tramadol, and the carcasses were stored under three different conditions (-20, 4 and 20°C). The autopsy was carried out at eight different time points and their organs were collected separately. The results of this part showed that under storage temperatures of -20 and 4°C, the concentrations of tramadol in individual organs showed no significant changes at different time points whereas under a storage temperature of 20°C, the concentrations in certain organs (liver, kidney, spleen, lung, brain and heart-blood) increased significantly at the last few time points. PMR of tramadol was therefore confirmed. The process of PMR of tramadol could be slowed or stopped at lower storage temperatures (-20 or 4°C), which is significant in cases of suspected tramadol poisoning.
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Affiliation(s)
- Hongliang Su
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China.,Key Laboratory of Forensic Toxicology, Ministry of Public Security, No. 9 Qianmen East Street, Dongcheng District, Beijing, Beijing 100192, People's Republic of China
| | - Yongjun Li
- Hengyang Public Security Bureau, Criminal Science and Technology Institute, No. 28 Tianzhu Road, Huaxin Development Zone, Zhengxiang District, Hengyang, Hengyang 421001, People's Republic of China
| | - Miaomiao Wu
- The People's Procuratorate of Baoding, No. 106, Wusi West Road, Jingxiu District, Baoding, Baoding 071000, People's Republic of China
| | - Tingting Sun
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China
| | - Weifen Niu
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China.,Key Laboratory of Forensic Toxicology, Ministry of Public Security, No. 9 Qianmen East Street, Dongcheng District, Beijing, Beijing 100192, People's Republic of China
| | - Juan Jia
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China.,Key Laboratory of Forensic Toxicology, Ministry of Public Security, No. 9 Qianmen East Street, Dongcheng District, Beijing, Beijing 100192, People's Republic of China
| | - Zhiwen Wei
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China.,Key Laboratory of Forensic Toxicology, Ministry of Public Security, No. 9 Qianmen East Street, Dongcheng District, Beijing, Beijing 100192, People's Republic of China
| | - Keming Yun
- School of Forensic Medicine, Shanxi Medical University, No. 56, Xinjian South Road, Taiyuan, Taiyuan 030001, People's Republic of China.,Key Laboratory of Forensic Toxicology, Ministry of Public Security, No. 9 Qianmen East Street, Dongcheng District, Beijing, Beijing 100192, People's Republic of China
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9
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Chu M, Rago MD, Mantinieks D, Glowacki L, Woodford NW, Gerostamoulos D, Drummer OH. Time-Dependent Changes in THC Concentrations in Deceased Persons. J Anal Toxicol 2021; 45:1-7. [PMID: 32435813 DOI: 10.1093/jat/bkaa052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 11/13/2022] Open
Abstract
Changes in the concentrations of Δ9-tetrahydrocannabinol (THC) in the postmortem period were investigated in a series of cases by comparing concentrations in blood taken on receipt of the body in the mortuary (admission specimen, AD) with the concentrations obtained in blood taken at autopsy some time later and also from blood specimens taken antemortem. Overall, the median THC concentration in AD blood was 13.7 ng/mL (n = 239, range LOQ-220), while the median concentration at autopsy was 13.8 ng/mL (n = 106, range LOQ-810) and 1.9 ng/mL (n = 147, range LOQ-48) antemortem. Fourteen cases had all three specimens taken from the same decedent. The corresponding AM, AD and PM median concentrations were 4.0 (range LOQ-48), 15.5 (range 4.0-176) and 4.4 ng/mL (LOQ-56), respectively. The median elapsed times from AM to AD and AD to PM were 33 and 97.5 h, respectively. In contrast, acetaminophen showed no change in blood concentration from AM to AD (6.8 and 6.0 mg/L, respectively). These data show large increases in THC concentration in the early postmortem period, followed by a decline, although the median blood concentrations at autopsy were similar to that obtained antemortem. In contrast, when blood was taken from the femoral region, subclavian and heart ventricles sites, in the same case, the THC concentrations, while variable, showed overall no significant difference. These dynamic changes reflect complex phenomenon occurring in deceased persons and will further serve to increase the uncertainty over any interpretation of postmortem THC concentrations.
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Affiliation(s)
- Mark Chu
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Dylan Mantinieks
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Linda Glowacki
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noel W Woodford
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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10
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The importance of sample size with regard to the robustness of postmortem reference values. Forensic Sci Int 2020; 311:110292. [PMID: 32330811 DOI: 10.1016/j.forsciint.2020.110292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/22/2022]
Abstract
Evaluating postmortem toxicological results is a challenging task due to multiple factors affecting blood concentrations after death. In order to improve the diagnostic accuracy in cases of suspected fatal intoxication different compilations of postmortem reference drug concentrations are often used. However, it is not clear what constitutes a reliable postmortem reference value. The current study presents reference concentrations for 13 substances from seven substance groups according to a standardized protocol. The reference concentrations were gathered from 3767 autopsy cases and subdivided into intoxications by one substance only (Group A, n=611), multi-substance intoxications (Group B, n=1355) and postmortem controls, in which incapacitation by drugs were excluded (Group C, n=1801). In particular, this study presents statistical information about the precision and conformity change with various sample sizes. Based on the present data >10 detections are usually needed, for the substances examined, to differentiate between intoxication cases and controls. Repeated samplings show that the median of small samples (N=≤5) has a high variation (normalized interquartile range 138-75%) and that a high number of detections (N=>20) in each group are needed to reduce the variation.
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11
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Stam NC, Gerostamoulos D, Pilgrim JL, Smith K, Moran L, Parsons S, Drummer OH. An analysis of issues in the classification and reporting of heroin-related deaths. Addiction 2019; 114:504-512. [PMID: 30397976 DOI: 10.1111/add.14486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/02/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases. METHODS Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study. Heroin-related death data from the Australian Institute of Health and Welfare (AIHW) and Australian Bureau of Statistics (ABS) were then compared. Differences in the number of deaths reported as well as the classification and coding assigned to the identified heroin-related death cases were investigated by cross-referencing these data sets and examining the assigned ICD-10 codes. RESULTS A total of 243 heroin-related deaths were identified through the NCIS compared with 165 heroin-related deaths reported by the AIHW and assigned the heroin-specific ICD-10 code of T40.1. Forty per cent of all the missed heroin-related death cases resulted from either the attribution of the death to morphine toxicity or with non-specific drug toxicity certification; 30% occurred where the cases had been attributed to heroin but there were irregularities in death certification. Additional missed heroin-related death cases occurred as a result of late initial registration of these deaths to the Registry of Births, Deaths and Marriages, and where these cases were then not assessed by the ABS for classification and coding purposes. CONCLUSIONS In Victoria, Australia, in 2012 and 2013, the overall number of heroin-related deaths was under-reported by 32% compared with the number of deaths currently identified by the Australian Bureau of Statistics and reported by the Australian Institute of Health and Welfare.
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Affiliation(s)
- Nathan C Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lauren Moran
- Mortality Data Centre, Health and Vital Statistics Section, Australian Bureau of Statistics, Brisbane, Australia
| | - Sarah Parsons
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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12
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Stam NC, Pilgrim JL, Drummer OH, Smith K, Gerostamoulos D. Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment. Clin Toxicol (Phila) 2018; 56:1135-1142. [DOI: 10.1080/15563650.2018.1478093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Nathan C. Stam
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
| | | | - Olaf H. Drummer
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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13
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Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases. Forensic Sci Int 2017; 281:127-133. [DOI: 10.1016/j.forsciint.2017.10.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/20/2022]
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14
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Stam NC, Gerostamoulos D, Dietze PM, Parsons S, Smith K, Lloyd B, Pilgrim JL. The attribution of a death to heroin: A model to help improve the consistent and transparent classification and reporting of heroin-related deaths. Forensic Sci Int 2017; 281:18-28. [DOI: 10.1016/j.forsciint.2017.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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15
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Ferner RE, Aronson JK. The toxicological significance of post-mortem drug concentrations in bile. Clin Toxicol (Phila) 2017; 56:7-14. [PMID: 28681613 DOI: 10.1080/15563650.2017.1339886] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Robin E. Ferner
- Institute of Clinical Science, University of Birmingham, and West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
| | - Jeffrey K. Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe infirmary, Oxford, UK
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16
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Cippitelli M, Mirtella D, Ottaviani G, Tassoni G, Froldi R, Cingolani M. Toxicological Analysis of Opiates from Alternative Matrices Collected from an Exhumed Body. J Forensic Sci 2017; 63:640-643. [DOI: 10.1111/1556-4029.13559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/04/2017] [Accepted: 04/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Marta Cippitelli
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
| | - Dora Mirtella
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
| | - Giovanni Ottaviani
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
| | - Giovanna Tassoni
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
| | - Rino Froldi
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
| | - Mariano Cingolani
- Chemistry Laboratory for Forensic Toxicology and Medicine University of Macerata via Don Minzoni 9 62100 Macerata Italy
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17
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Ferrara SD, Cecchetto G, Cecchi R, Favretto D, Grabherr S, Ishikawa T, Kondo T, Montisci M, Pfeiffer H, Bonati MR, Shokry D, Vennemann M, Bajanowski T. Back to the Future - Part 2. Post-mortem assessment and evolutionary role of the bio-medicolegal sciences. Int J Legal Med 2017; 131:1085-1101. [PMID: 28444439 DOI: 10.1007/s00414-017-1585-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023]
Abstract
Part 2 of the review "Back to the Future" is dedicated to the evolutionary role of the bio-medicolegal sciences, reporting the historical profiles, the state of the art, and prospects for future development of the main related techniques and methods of the ancillary disciplines that have risen to the role of "autonomous" sciences, namely, Genetics and Genomics, Toxicology, Radiology, and Imaging, involved in historic synergy in the "post-mortem assessment," together with the mother discipline Legal Medicine, by way of its primary fundament, universally denominated as Forensic Pathology. The evolution of the scientific research and the increased accuracy of the various disciplines will be oriented towards the elaboration of an "algorithm," able to weigh the value of "evidence" placed at the disposal of the "justice system" as real truth and proof.
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Affiliation(s)
- Santo Davide Ferrara
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy.
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Rossana Cecchi
- Department of Biomedical, Biotechnological and Translational Medicine, University of Parma, Parma, Italy
| | - Donata Favretto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne-Geneva, University of Lausanne, Lausanne, Switzerland
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Wakayama, Japan
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University-Hospital of Padova, Padua, Italy
| | - Heidi Pfeiffer
- Institute of Legal Medicine, University-Hospital Münster, Münster, Germany
| | - Maurizio Rippa Bonati
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Medical Humanities, University of Padova, Padua, Italy
| | - Dina Shokry
- Department of Forensic Medicine and Clinical Toxicology, University of Cairo, Cairo, Egypt
| | - Marielle Vennemann
- Institute of Legal Medicine, University-Hospital Münster, Münster, Germany
| | - Thomas Bajanowski
- Institute of Legal Medicine, University-Hospital Essen, Essen, Germany
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18
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Post-mortem concentrations of drugs determined in femoral blood in single-drug fatalities compared with multi-drug poisoning deaths. Forensic Sci Int 2016; 267:96-103. [DOI: 10.1016/j.forsciint.2016.08.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 11/17/2022]
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19
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Morini L, Vignali C, Tricomi P, Groppi A. Analytical Challenge in Postmortem Toxicology Applied to a Human Body Found into a Lake after Three Years Immersion. J Forensic Sci 2015; 60:1383-6. [PMID: 26258895 DOI: 10.1111/1556-4029.12815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
Abstract
The body of a 30-year-old woman was found in Como lake at a depth of about 120 meters in her own car after 3 years of immersion. The aim of this study was to evaluate psychoactive drugs as well as alcohol biomarkers in biological matrices. The following analyses were initially performed: GC-MS systematic toxicological analysis on biological fluids and tissues; GC-MS analysis of drugs of abuse on pubic hair; direct ethanol metabolite determination in pubic hair by LC-MS/MS. After 7 years, the samples, that had been stored at -20°C, were re-analyzed and submitted to an LC-MS/MS targeted screening method, using multiple reaction monitoring mode. These analyses detected citalopram (150-3000 ng/mL), desmethylcitalopram (50-2300 ng/mL), clotiapine (20-65 ng/mL), and ethyl glucuronide (97 pg/mg). The methods showed an acceptable reproducibility, and the concentrations of citalopram and desmethylcitalopram calculated through the two analytical techniques did not significantly differ in biological fluids.
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Affiliation(s)
- Luca Morini
- Department of Public Health, Forensic and Experimental Medicine, University of Pavia, Via Forlanini 12, 27100, Pavia, Italy
| | - Claudia Vignali
- Department of Public Health, Forensic and Experimental Medicine, University of Pavia, Via Forlanini 12, 27100, Pavia, Italy
| | - Paolo Tricomi
- Anatomopathological Unit, Hospital of Lecco, via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Angelo Groppi
- Department of Public Health, Forensic and Experimental Medicine, University of Pavia, Via Forlanini 12, 27100, Pavia, Italy
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20
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Langford AM, Bolton JR, Carlin MG, Palmer R. Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality. J Forensic Leg Med 2015; 33:82-90. [DOI: 10.1016/j.jflm.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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21
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Dixon RB, Mbeunkui F, Wiegel JV. Stability study of opioids and benzodiazepines in urine samples by liquid chromatography tandem mass spectrometry. J Anal Sci Technol 2015. [DOI: 10.1186/s40543-015-0057-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Tominaga M, Michiue T, Inamori-Kawamoto O, Hishmat AM, Oritani S, Takama M, Ishikawa T, Maeda H. Efficacy of drug screening in forensic autopsy: retrospective investigation of routine toxicological findings. Leg Med (Tokyo) 2015; 17:172-6. [PMID: 25637163 DOI: 10.1016/j.legalmed.2015.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
Toxicological analysis is indispensable in forensic autopsy laboratories, but often depends on the limitations of individual institutions. The present study reviewed routine drug screening data of forensic autopsy cases (n=2996) during an 18.5-year period (January 1996-June 2014) at our institute to examine the efficacy of the procedures and findings in autopsy diagnosis and interpretation. Drug screening was performed using on-site immunoassay screening devices and gas chromatography/mass spectrometry (GC/MS) in all cases, followed by re-examination using GC/MS and liquid chromatography/tandem mass spectrometry (LC/MS/MS) at a cooperating institute in specific cases in the last 4 years. GC/MS detected drugs in 486 cases (16.2%), including amphetamines (n=160), major tranquilizers (n=72), minor tranquilizers (n=294), antidepressants (n=21), cold remedies (n=77), and other drugs (n=19). Among these cases, fatal intoxication (n=123) involved amphetamines (n=73), major tranquilizers (n=37), minor tranquilizers (n=86), antidepressants (n=3), and cold remedies (n=9); most cases involved self-administration, alleged suicide and accidental overdose, while homicide was not included. These drugs were also identified in other manners of death, including homicide (n=40/372), suicide (n=34/226), accidental falls (n=27/129), and natural death (n=72/514). In these cases, on-site immunoassay screening of drugs of abuse showed negative findings in 2440 cases (81.4% in all cases), while GC/MS detected other drugs in 218 cases (7.3% in all cases), including several antipsychotic drugs, acetaminophen and salicylic acid. Further analysis using LC/MS/MS detected low concentrations of benzodiazepines in 32 cases, and also anti-diabetic and hypertensive drugs in a case of fatal abuse. These observations indicate the efficacy of systematic routine toxicological analysis to investigate not only the cause of death but also the background of fatalities in forensic autopsy. The provision of extensive drug screening is needed for forensic and social risk management, considering the marked diversity of medical and illicit drugs.
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Affiliation(s)
- Mariko Tominaga
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Osamu Inamori-Kawamoto
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Asmaa Mohammed Hishmat
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia 61111, Egypt
| | - Shigeki Oritani
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Masashi Takama
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Division of Legal Medicine, Faculty of Medicine, Tottori University, Nishi-cho 86, Yonago, Tottori 683-8503, Japan
| | - Hitoshi Maeda
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan; Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan
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23
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Skov L, Johansen SS, Linnet K. Postmortem Femoral Blood Reference Concentrations of Aripiprazole, Chlorprothixene, and Quetiapine. J Anal Toxicol 2014; 39:41-4. [DOI: 10.1093/jat/bku121] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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The postmortem redistribution of iso-α-acids in postmortem specimens. Forensic Sci Med Pathol 2014; 10:550-6. [PMID: 25319244 DOI: 10.1007/s12024-014-9609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
Iso-α-acids (IAA) and reduced IAA can be used as beer-specific ingredient congeners to confirm beer consumption when detected in blood and other specimens using a UHPLC-MS/MS method. Recent analysis of postmortem casework demonstrated a high prevalence of beer consumption and the possibility of providing the source of alcohol in forensic casework. Research outlined in this manuscript has examined the degree to which the interval after death and quality of blood affects the concentration of IAA in postmortem cases. Postmortem whole blood and serum were analyzed in cases where natural or reduced IAA groups were detected. The trans-IAA, cis-IAA, and tetrahydro-IAA (TIAA) groups were subject to postmortem redistribution, although only weakly associated with the length of time from death to collection of specimens. Serum had threefold higher concentrations than blood for trans-IAA, cis-IAA, and TIAA. These studies confirm that although postmortem concentrations cannot be easily compared to concentrations found in living persons the presented findings do provide some understanding to assist in interpretation where the confirmation of beer consumption is required in forensic casework.
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25
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Giaginis C, Tsantili-Kakoulidou A, Theocharis S. Applying quantitative structure-activity relationship (QSAR) methodology for modeling postmortem redistribution of benzodiazepines and tricyclic antidepressants. J Anal Toxicol 2014; 38:242-8. [PMID: 24682110 DOI: 10.1093/jat/bku025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Postmortem redistribution (PMR) constitutes a multifaceted process, which complicates the interpretation of drug concentrations by forensic toxicologists. The present study aimed to apply quantitative structure-activity relationship (QSAR) analysis for modeling PMR data of structurally related drugs, 10 benzodiazepines and 10 tricyclic antidepressants. For benzodiazepines, an adequate QSAR model was obtained (R(2) = 0.98, Q(2) = 0.88, RMSEE = 0.12), in which energy, ionization and molecular size exerted significant impact. For tricyclic antidepressants, an adequate QSAR model with slightly inferior statistics (R(2) = 0.95, Q(2) = 0.87, RMSEE = 0.29) was established after exclusion of maprotiline, in which energy parameters, basicity character and lipophilicity exerted significant contribution. Thus, QSAR analysis could be used as a complementary tool to provide an informative illustration of the contributing molecular, physicochemical and structural properties in PMR process. However, the complexity, non-static and time-dependent nature of PMR endpoints raises serious concerns whether QSAR methodology could predict the degree of redistribution, highlighting the need for animal-derived PMR data.
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Affiliation(s)
- Constantinos Giaginis
- 1Department of Food Science and Nutrition, School of Environment, University of the Aegean, Mitropoliti Ioakeim 2 Street, Myrina, Lemnos GR 81400, Greece
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26
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Alvear E, von Baer D, Mardones C, Hitschfeld A. Determination of cocaine and its major metabolite benzoylecgonine in several matrices obtained from deceased individuals with presumed drug consumption prior to death. J Forensic Leg Med 2014; 23:37-43. [PMID: 24661704 DOI: 10.1016/j.jflm.2014.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/05/2013] [Accepted: 01/19/2014] [Indexed: 12/12/2022]
Abstract
In the field of forensic toxicology, femoral blood is the most useful sample for the determination and quantification of drugs; however, cases in which blood is unavailable are common. In such cases, validated methodologies for drug determination in alternative matrices can be decisive in the investigation of a case. In particular, when femoral blood is unavailable for analysis for the presence of systemic exposure to cocaine and its principal metabolite, benzoylecgonine, validated methodologies from matrices other than blood that can be obtained in the autopsy room would be useful to the forensic toxicologist in the evaluation of a specific forensic case. To address this issue, we implemented and compared in our study the systematic evaluation of extraction, chromatographic separation, and quantification of cocaine and benzoylecgonine in different biological matrices (right and left cardiac blood, femoral arterial and venous blood, urine, vitreous humor, cerebrospinal fluid, brain accumbens nucleus, brain ventral tegmental area, and liver). The studied matrices were those most likely to be obtained from different autopsy rooms at the time of forensic testing in deceased individuals who are presumed of antemortem drug consumption. Solid phase extraction of analytes from the different matrices was performed using C-8/SCX mixed-phase columns, and gas chromatographic mass spectrometry separation was performed using detection in single-ion monitoring mode. The methodological validation was performed for all the studied matrices, and the results showed similar sensitivity and recoveries without statistical differences between the studied matrices. The methods were applied to evaluate a thanatological case using all the study matrices, showing unequal postmortem distribution of cocaine and benzoylecgonine throughout the different matrices tested. The present work opens the option of applying appropriate methodologies in the analysis of matrices, other than the usual blood, to obtain reliable results that may help clarify a forensic case. In addition, we present findings from different studies. This work affirms not only the potentiality of obtaining reliable data but also reaffirms the challenge of applying these data and taking into account the complexity of interpreting results in matrices other than blood.
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Affiliation(s)
- Eduardo Alvear
- Servicio Médico Legal de Concepción, Laboratorio, Camino a Penco 4018, Concepción, Chile
| | - Dietrich von Baer
- Universidad de Concepción, Facultad de Farmacia - Depto de Análisis Instrumental, Barrio Universitario s/n, Concepción, Chile.
| | - Claudia Mardones
- Universidad de Concepción, Facultad de Farmacia - Depto de Análisis Instrumental, Barrio Universitario s/n, Concepción, Chile
| | - Antonieta Hitschfeld
- Universidad de Concepción, Facultad de Farmacia - Depto de Análisis Instrumental, Barrio Universitario s/n, Concepción, Chile
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28
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Palmiere C, Mangin P, Werner D. Preliminary results on the postmortem measurement of 3-beta-hydroxybutyrate in liver homogenates. Int J Legal Med 2013; 127:943-9. [DOI: 10.1007/s00414-013-0870-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/06/2013] [Indexed: 11/29/2022]
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29
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Karlsson L, Green H, Zackrisson AL, Bengtsson F, Jakobsen Falk I, Carlsson B, Ahlner J, Kugelberg FC. ABCB1 gene polymorphisms are associated with fatal intoxications involving venlafaxine but not citalopram. Int J Legal Med 2013; 127:579-86. [PMID: 23515680 DOI: 10.1007/s00414-013-0849-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 03/06/2013] [Indexed: 01/11/2023]
Abstract
P-glycoprotein (P-gp), encoded by the ABCB1/MDR1 gene, is a drug transporter at the blood-brain barrier. Several polymorphisms in the ABCB1 gene are known to affect the activity and/or expression of P-gp, thereby influencing the treatment response and toxicity of P-gp substrates like citalopram and venlafaxine. In this study, we aimed to investigate the frequency of ABCB1 genotypes in forensic autopsy cases involving these two antidepressants. Further, the distribution of ABCB1 genotypes in deaths related to intoxication was compared to cases not associated to drug intoxication. The study included 228 forensic autopsy cases with different causes and manners of deaths. The ABCB1 single nucleotide polymorphisms (SNPs) G1199A, C1236T, C3435T and G2677T/A for these individuals were determined. The SNPs C1236T and C3435T in venlafaxine-positive cases were significantly different between the intoxication cases and non-intoxications. This was not seen for cases involving citalopram, indicating that the effect of genetic variants might be substrate specific. This novel finding should, however, be confirmed in future studies with larger number of cases.
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Affiliation(s)
- L Karlsson
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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30
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Affiliation(s)
- Roger W Byard
- Discipline of Anatomy and Pathology, Level 3 Medical School North Building, The University of Adelaide, Frome Road, Adelaide, 5005, Australia.
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31
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Drummer OH, Kennedy B, Bugeja L, Ibrahim JE, Ozanne-Smith J. Interpretation of postmortem forensic toxicology results for injury prevention research. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Linnet K. Postmortem drug concentration intervals for the non-intoxicated state – A review. J Forensic Leg Med 2012; 19:245-9. [DOI: 10.1016/j.jflm.2012.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/16/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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33
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Gerostamoulos D, Beyer J, Staikos V, Tayler P, Woodford N, Drummer OH. The effect of the postmortem interval on the redistribution of drugs: a comparison of mortuary admission and autopsy blood specimens. Forensic Sci Med Pathol 2012; 8:373-9. [DOI: 10.1007/s12024-012-9341-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
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34
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Castro AL, Tarelho S, Silvestre A, Teixeira HM. Simultaneous analysis of some club drugs in whole blood using solid phase extraction and gas chromatography–mass spectrometry. J Forensic Leg Med 2012; 19:77-82. [DOI: 10.1016/j.jflm.2011.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/06/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
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35
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Atanasov V, Stoykova S, Runiov A, Dimitrova T, Aleksandrova D, Tsakovski S, Mitewa M. Stability of diazepam in blood samples at different storage conditions and in the presence of alcohol. Forensic Sci Int 2012; 215:159-63. [DOI: 10.1016/j.forsciint.2011.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 04/05/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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36
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The role of toxicology interpretations in prevention of sudden death. Forensic Sci Med Pathol 2012; 8:263-9. [DOI: 10.1007/s12024-011-9309-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2011] [Indexed: 11/25/2022]
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37
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Kingbäck M, Karlsson L, Zackrisson AL, Carlsson B, Josefsson M, Bengtsson F, Ahlner J, Kugelberg FC. Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood. Forensic Sci Int 2011; 214:124-34. [PMID: 21840145 DOI: 10.1016/j.forsciint.2011.07.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 07/05/2011] [Accepted: 07/18/2011] [Indexed: 11/18/2022]
Abstract
Venlafaxine (VEN) is an antidepressant drug mainly metabolized by the cytochrome P450 (CYP) enzyme CYP2D6 to the active metabolite O-desmethylvenlafaxine (ODV). VEN is also metabolized to N-desmetylvenlafaxine (NDV) via CYP3A4. ODV and NDV are further metabolized to N,O-didesmethylvenlafaxine (DDV). VEN is a racemic mixture of the S- and R-enantiomers and these have in vitro displayed different degrees of serotonin and noradrenaline reuptake inhibition. The aim of the study was to investigate if an enantioselective analysis of VEN and its metabolites, in combination with genotyping for CYP2D6, could assist in the interpretation of forensic toxicological results in cases with different causes of deaths. Concentrations of the enantiomers of VEN and metabolites were determined in femoral blood obtained from 56 autopsy cases with different causes of death. The drug analysis was done by liquid chromatography tandem mass spectrometry (LC/MS/MS) and the CYP2D6 genotyping by PCR and pyrosequencing. The mean (median) enantiomeric S/R ratios of VEN, ODV, NDV and DDV were 0.99 (0.91), 2.17 (0.93), 0.92 (0.86) and 1.08 (1.03), respectively. However, a substantial variation in the relationship between the S- and R-enantiomers of VEN and metabolites was evident (S/R ratios ranging from 0.23 to 17.6). In six cases, a low S/R VEN ratio (mean 0.5) was associated with a high S/R ODV ratio (mean 11.9). Genotyping showed that these individuals carried two inactive CYP2D6 genes indicating a poor metabolizer phenotype. From these data we conclude that enantioselective analysis of VEN and ODV can predict if a person is a poor metabolizer genotype/phenotype for CYP2D6. Knowledge of the relationship between the S- and R-enantiomers of this antidepressant drug and its active metabolite is also important since the enantiomers display different pharmacodynamic profiles.
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Affiliation(s)
- Maria Kingbäck
- Division of Drug Research, Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Wyman JF, Dean DE, Yinger R, Simmons A, Brobst D, Bissell M, Silveira F, Kelly N, Shott R, Ohr J, Howard R, Lewis B. The Temporal Fate of Drugs in Decomposing Porcine Tissue*. J Forensic Sci 2011; 56:694-9. [DOI: 10.1111/j.1556-4029.2011.01725.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deaths involving contraindicated and inappropriate combinations of serotonergic drugs. Int J Legal Med 2010; 125:803-15. [PMID: 21120513 DOI: 10.1007/s00414-010-0536-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/18/2010] [Indexed: 12/23/2022]
Abstract
In the Australian state of Victoria, all fatalities that were recorded from 2002 through to 2008 involving the use of certain serotonin active drugs (tramadol, venlafaxine, fluoxetine, sertraline, citalopram and paroxetine), were reviewed to assess the incidence of contraindicated or ill advised drug combinations. More than 1,000 were identified of which 326 cases formed the basis of this study. These cases involved contraindicated or inappropriate drug combinations that can lead to adverse drug reactions (ADRs) and subsequent fatal toxicity. Of these, 46% were drug-related, 35% were a result of natural disease and 13% were classified as external injury cases. The remaining cases were those where the cause of death (COD) was unascertained. Tramadol was the most common drug, usually detected alongside a serotonergic antidepressant (in 20% of cases). Twenty-five (8%) cases involved contraindicated drug combinations while the remainder (301 cases, 92%) involved drug combinations that are associated with adverse interactions ranging from minor to major severity. Of these 326 cases, the Coroner determined 166 cases (51%) to be acts of intentional self-harm or drug misuse, with the remainder unascertained or attributed to natural disease. Very few post-mortem reports and Coroners' findings made mention of possible ADRs when such combinations were actually present. The majority of cases comprising contraindicated drug combinations involved the combined use of five drugs (24%) at the time of death. A combination of three to five drugs was most common in cases involving inadvisable drug combinations. Combined drug toxicity was the most common COD, with heart disease the most common co-morbidity.
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Dinis-Oliveira RJ, Carvalho F, Duarte JA, Remião F, Marques A, Santos A, Magalhães T. Collection of biological samples in forensic toxicology. Toxicol Mech Methods 2010; 20:363-414. [PMID: 20615091 DOI: 10.3109/15376516.2010.497976] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Forensic toxicology is the study and practice of the application of toxicology to the purposes of the law. The relevance of any finding is determined, in the first instance, by the nature and integrity of the specimen(s) submitted for analysis. This means that there are several specific challenges to select and collect specimens for ante-mortem and post-mortem toxicology investigation. Post-mortem specimens may be numerous and can endow some special difficulties compared to clinical specimens, namely those resulting from autolytic and putrefactive changes. Storage stability is also an important issue to be considered during the pre-analytic phase, since its consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample. The knowledge on degradation mechanisms and methods to increase storage stability may enable the forensic toxicologist to circumvent possible difficulties. Therefore, advantages and limitations of specimen preservation procedures are thoroughfully discussed in this review. Presently, harmonized protocols for sampling in suspected intoxications would have obvious utility. In the present article an overview is given on sampling procedures for routinely collected specimens as well as on alternative specimens that may provide additional information on the route and timing of exposure to a specific xenobiotic. Last, but not least, a discussion on possible bias that can influence the interpretation of toxicological results is provided. This comprehensive review article is intented as a significant help for forensic toxicologists to accomplish their frequently overwhelming mission.
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Affiliation(s)
- R J Dinis-Oliveira
- Institute of Legal Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
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Abstract
Propofol is a potent intravenous anesthetic agent that rapidly induces sedation and unconsciousness. The potential for propofol dependency, recreational use, and abuse has only recently been recognized, and several cases of accidental overdose and suicide have emerged. In addition, the first documented case of murder using propofol was reported a few months ago, and a high profile case of suspected homicide with propofol is currently under investigation. A number of analytical methods have been employed to detect and quantify propofol concentrations in biological specimens. The reported propofol-related deaths and postmortem blood and tissue levels are reviewed. Importantly, limitations of propofol detection are discussed, and future considerations are presented. Because propofol has the potential for diversion with lethal consequences, the forensic scientist must have a basic understanding of its clinical indications and uses, pharmacologic properties, and detection methods. In addition, medical institutions should develop systems to prevent and detect diversion of this potential drug of abuse.
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Affiliation(s)
- Richard J Levy
- Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010.
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Abstract
Large inter-individual variability in drug response and toxicity, as well as in drug concentrations after application of the same dosage, can be of genetic, physiological, pathophysiological, or environmental origin. Absorption, distribution and metabolism of a drug and interactions with its target often are determined by genetic differences. Pharmacokinetic and pharmacodynamic variations can appear at the level of drug metabolizing enzymes (e.g., the cytochrome P450 system), drug transporters, drug targets or other biomarker genes. Pharmacogenetics or toxicogenetics can therefore be relevant in forensic toxicology. This review presents relevant aspects together with some examples from daily routines.
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Jones AW, Kugelberg FC, Holmgren A, Ahlner J. Drug poisoning deaths in Sweden show a predominance of ethanol in mono-intoxications, adverse drug-alcohol interactions and poly-drug use. Forensic Sci Int 2010; 206:43-51. [PMID: 20630671 DOI: 10.1016/j.forsciint.2010.06.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/10/2010] [Accepted: 06/13/2010] [Indexed: 11/30/2022]
Abstract
Over a 10-year period (1998-2007) all deaths in Sweden classified by forensic pathologists as fatal drug poisonings (N = 6894) were retrieved from a toxicology database (TOXBASE) belonging to the National Board of Forensic Medicine. The deaths were further classified as suicides N = 2288 (33%), undetermined N = 2260 (33%) and accidental N = 2346 (34%). The average age (± SD) of all victims was 49.1 ± 15.9 years and men 47.4 ± 15.6 years were 5-year younger than women 52.2 ± 15.8 years (p < 0.01). Most of the deceased (78%) were poly-drug users although a single drug (mono-intoxications) was found in 22% of all poisoning deaths (p < 0.001). The number of drugs in blood samples varied from 1 to 12 with a median of 3-4 per case. Mono-intoxication deaths were mostly ethanol-related (N = 976) and the mean and median blood-alcohol concentration (BAC) was 3.06 g/L and 3.10 g/L, respectively. The BAC decreased as the number of additional drugs in blood increased from 2.15 g/L with one drug to 1.25 g/L with 6 or more drugs. The mean (median) concentrations of non-alcohol drugs in mono-intoxication deaths were morphine (N = 93) 0.5mg/L (0.2mg/L), amphetamine (N = 39) 2.0mg/L (1.2mg/L), dextropropoxyphene (N = 33) 3.9 mg/L (2.9 mg/L), dihydro-propiomazine (N = 32) 1.6 mg/L (1.0mg/L) and 7-amino-flunitrazepam (N = 28), 0.4 mg/L (0.3mg/L). Elevated blood morphine in these poisoning deaths mostly reflected abuse of heroin as verified by finding 6-monoacetyl morphine (6-MAM) in the blood samples. When investigating drug poisoning deaths a comprehensive toxicological analysis is essential although the results do not reveal the extent of prior exposure to drugs or the development of pharmacological tolerance. The concentrations of drugs determined in post-mortem blood are one element in the case. The autopsy report, the police investigation, the findings at the scene and eye-witness statements should all be carefully considered when the cause and manner of death are determined.
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Affiliation(s)
- A W Jones
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 587 58 Linköping, Sweden.
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Tropane alkaloid analysis by chromatographic and electrophoretic techniques: An update. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:1391-406. [DOI: 10.1016/j.jchromb.2010.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 02/27/2010] [Accepted: 03/05/2010] [Indexed: 12/29/2022]
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45
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Butzbach DM. The influence of putrefaction and sample storage on post-mortem toxicology results. Forensic Sci Med Pathol 2009; 6:35-45. [PMID: 19946767 DOI: 10.1007/s12024-009-9130-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2009] [Indexed: 11/30/2022]
Abstract
There are numerous biochemical and biological processes that occur after death that may have a significant influence on post-mortem drug concentrations. These processes may render the quantification of particular drugs unreliable, or even result in drugs being undetectable in some instances, despite the use of several methods. Problems may occur with changes in the drug concentration via bacterial degradation, residual tissue enzymatic activity, or via post-mortem redistribution from tissues of a higher to a lower concentration. Many analytical techniques can suffer from interferences due to co-extracted putrefactive compounds that mask or alter the way a drug is detected, depending on the analytical technique utilised. The following paper reviews problems associated with post-mortem drug concentration changes, and the significance of microbial influences during the post-mortem interval and sample storage.
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Affiliation(s)
- Danielle M Butzbach
- Department of Chemistry, Physics and Earth Sciences, Flinders University, Bedford Park, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Giaginis C, Tsantili-Kakoulidou A, Theocharis S. Quantitative structure–activity relationship (QSAR) methodology in forensic toxicology: Modeling postmortem redistribution of structurally diverse drugs using multivariate statistics. Forensic Sci Int 2009; 190:9-15. [DOI: 10.1016/j.forsciint.2009.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/27/2009] [Accepted: 05/06/2009] [Indexed: 12/31/2022]
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Doxepin and nordoxepin concentrations in body fluids and tissues in doxepin associated deaths. Forensic Sci Int 2009; 190:74-9. [DOI: 10.1016/j.forsciint.2009.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/17/2009] [Accepted: 05/20/2009] [Indexed: 11/18/2022]
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Pilgrim JL, Gerostamoulos D, Drummer OH, Bollmann M. Involvement of Amphetamines in Sudden and Unexpected Death. J Forensic Sci 2009; 54:478-85. [DOI: 10.1111/j.1556-4029.2008.00949.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of 'lethal concentrations' are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.
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Affiliation(s)
- R E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital and Department of Clinical Pharmacology, The Medical School, University of Birmingham, Birmingham, UK.
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50
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Interpretation of postmortem toxicology: more complicated than it might seem ??? Part 1. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/fad.0b013e32830ceaea] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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