Postmortem data related to drug and toxic substance use in the Federal District, Brazil, from 2006 to 2008

A validated dilute-and-shoot LC-MS-MS urine screening for the analysis of 95 illicit drugs and medicines: Insights from clinical and forensic Brazilian cases

Urine toxicological analysis is a relevant tool in both clinical and forensic scenarios, enabling the diagnosis of acute poisonings, elucidation of deaths, verification of substance use in the workplace and identification of drug-facilitated crimes. For these analyses, the dilute-and-shoot technique associated with liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) is a promising alternative since it has demonstrated satisfactory results and broad applicability. This study developed and validated a comprehensive LC-MS-MS screening method to analyze 95 illicit drugs and medicines in urine samples and application to clinical and forensic Brazilian cases. The dilute-and-shoot protocol was defined through multivariate optimization studies and was set using 100 µL of sample and 300 µL of solvent. The total chromatographic run time was 7.5 min. The method was validated following the recommendations of the ANSI/ASB Standard 036 Guideline. The lower limits of quantification varied from 20 to 100 ng/mL. Within-run and between-run precision coefficient of variations% were <20%, and bias was within ± 20%. Only 4 of the 95 analytes presented significant ionization suppression or enhancement (>25%). As proof of applicability, 839 urine samples from in vivo and postmortem cases were analyzed. In total, 90.9% of the analyzed samples were positive for at least one substance, and 78 of the 95 analytes were detected. The most prevalent substances were lidocaine (40.2%), acetaminophen (38.0%) and benzoylecgonine (31.5%). The developed method proved to be an efficient and simplified alternative for analyzing 95 therapeutic and illicit drugs in urine samples. Additionally, the results obtained from sample analysis are essential for understanding the profile of Brazilian substance use, serving as a valuable database for the promotion of health and safety public policies.

Autopsy study of alcohol-associated unnatural deaths in Thailand, 2007-2019

BACKGROUND

To date, there have been no major studies of alcohol-associated unnatural deaths in Thailand or South East Asia. Thailand leads South East Asia in per capita alcohol consumption. The objectives of this study were to determine the incidence of alcohol-associated unnatural deaths in Thailand and their relation to post-mortem blood alcohol concentration (BAC); to investigate correlations between BAC and selected demographic variables; and to evaluate the incidence of co-use of alcohol and illicit substances.

METHODS

We conducted a retrospective register-based study of alcohol-investigated unnatural deaths in Thailand for the period 2007-2019. The core study sample (n = 77,006) was derived from a Thai government computerized database of unnatural-death autopsies.

RESULTS

Of the total autopsy sample 32.49% was alcohol positive (BAC ≥0.20 g/L). The rate at which male autopsy cases were alcohol positive (35.52%) was approximately twice that of female autopsy cases (16.62%), with males having significantly higher median BAC levels, 1.64 and 1.31 g/L, respectively. The incidence of female alcohol-positive cases with extremely high BACs (≥3.50 g/L) was comparable to that of male alcohol-positive autopsies. The rates at which victims of accidents, homicides, and suicides were alcohol positive were 42.44%, 38.81%, and 33.25%, respectively. Drowning fatalities had the highest rate of alcohol detection (49.12%) and the highest median BAC (2.47 g/L). The next highest rate (48.47%) was among road traffic fatalities (RTFs, BAC 1.92 g/L), which accounted for about one-half of all RTFs and one-third of all alcohol-positive autopsies. Of the total alcohol-positive population, 8.33% tested positive for illicit substances, most commonly methamphetamine/amphetamine.

CONCLUSIONS

BAC results for the majority of male and female alcohol-positive victims exceeded the generally accepted threshold for Heavy Episodic Drinking (0.8 g/L) and provided a rare BAC-documented (≥3.50 g/L) example of gender parity in the incidence of heavy alcohol consumption. The median BAC value for alcohol-positive RTFs (1.92 g/L) was about 10% higher than in studies in most other countries and about four times greater the Thai legal limit for motor-vehicle operation (0.50 g/L).

Retrospective analysis of forensic toxicology data from 2021 to identify patterns of various forensic cases

PURPOSE

Knowing and analyzing the characteristics and trends of forensic toxicology cases in a certain area is particularly important for a local government to establish an effective prevention and control system. The purpose of this work was to summarize data from forensic toxicology cases received by the Academy of Forensic Sciences (AFS) in 2021.

METHODS

As requested by the police or according to the details of cases, samples were systematically screened or analyzed by various methods. Liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry were used to identify medicinal drugs, drugs of abuse, pesticides, poison gases, etc. RESULTS: AFS received a total of 17,758 cases in 2021, of which 314 cases underwent autopsy. The main cause of death was sudden death, and the manner of death was mainly accident. Among 13,744 drug abuse cases, the number of positive cases was 1721, with a positive rate of 12.5%, and synthetic cannabinoids were the most frequently detected substances. In 3640 traffic cases, 85.3% of drivers were suspected of drunk driving. In 103 poisoning cases, hydrogen sulfide poisoning and pesticide suicide account for a large proportion. In drug-facilitated crimes, zolpidem was the most frequently tested component. In 55 case of dog poisonings, the main poisons were cyanides and succinylcholine, and the main poisoning tools were poisonous baits and poisonous syringe darts.

CONCLUSIONS

This study profiles the toxicological characteristics of forensic toxicological cases conducted at the AFS in 2021 and provides a scientific basis for poisoning cases and drug abuse prevention.

Development, Optimization, and Validation of Forensic Analytical Method for Quantification of Anticholinesterase Pesticides in Biological Matrices from Suspected Cases of Animal Poisoning

Anticholinesterase pesticides are a main cause of the intentional or accidental poisoning of animals. Anticholinesterases include several substances that cause the overstimulation of both central and peripheral acetylcholine-dependent neurotransmission. Forensic analyses of poisoning cases require high levels of expertise, are costly, and often do not provide reliable quantitative information for unambiguous conclusions. The purpose of the present study was to develop and validate a method of high-performance liquid chromatography with diode array detector (HPLC−DAD) for the identification and quantitation of n-methyl carbamates, organophosphates and respective metabolites from biological samples of animals that were suspected of poisoning. HPLC−DAD is reliable, fast, simplistic and cost-effective. The method was validated for biological samples obtained from stomach contents, liver, vitreous humor and blood from four different animal species. The validation of the method was achieved using the following analytical parameters: linearity, precision, accuracy, selectivity, recovery, and matrix effect. The method showed linearity at the range of 25−500 μg/mL, and the correlation coefficient (r2) values were >0.99 for all matrices. Precision and accuracy were determined by the (a) coefficient of variation (CV), (b) relative standard deviation low-quality control (LQC), (c) medium-quality control (QCM), and (d) high-quality control (QCA). The indicated parameters were all less than 15%. The recovery of analytes ranged from 31 to 71%. The analysis of results showed no significant interfering peaks due to common xenobiotics or matrix effects. The abovementioned method was used to positively identify pesticide analytes in 44 of the 51 animal samples that were suspected of poisoning, demonstrating its usefulness as a forensic tool.

Evaluation of forensic autopsy cases with substance use detected in Izmir, Turkey

Using postmortem toxicological analyses, we aimed to determine the origin and cause of death and type of substance used in substance use-related deaths. A total of 7475 autopsies were performed between January 2015 and December 2017 in İzmir, Turkey. In our retrospective analysis, substance use was detected in 449 (6.0%) autopsies. The majority (96.4%) were male. The most frequent deaths (18.5%) occurred in the 25-29 age group. Of the 55.2% of the cases that died of unnatural causes, accident-related events (22.9%) were most frequent. Trauma/injury caused death in 37.0% of cases and substance intoxication in 24.7%. Cannabis use was detected in 34.3% of the samples, and multiple substance use in 25.4%. Accordingly, It is thought that a multidisciplinary approach can be successful in preventing substance use and related problems.

Analysis of psychotropic drug-related deaths in south Osaka

Objective

The aim of this study was to investigate the occurrence of deaths due to psychotropic drugs in south Osaka during a 10-year period and discuss societal factors from a medical viewpoint.

Methods

Psychotropic drug-related deaths were retrospectively investigated based on the forensic postmortem data of 1,746 decedents in 2005-2014, and we excluded cases in which stimulant drugs were detected. Of these, 133 cases (7.6%) were found to be psychotropic drug-related deaths and were analyzed.

Results

Psychotropic drug-related deaths occurred in 78 males (59%; age range, 14-95 years) and 55 females (41%; 20-84 years). The direct cause of death was acute drug intoxication in many cases, and of these, acute combined drug intoxication due to the use of multiple drugs accounted for 76% of the deaths. Most of these victims were found to have gastrointestinal and cardiovascular diseases. Cases of psychotropic drug-related deaths had especially poor medical conditions. In addition, tests were positive for blood alcohol in 23% of the cases.

Conclusion

The descriptive results revealed several factors that may be related to psychotropic drug-related deaths. To prevent drug abuse, several factors were deemed to be important, including improvements in the medical state of an individual, the avoidance of social isolation, and from a medical standpoint, the management of prescription drugs by medical personnel.

Cocaine toxicological findings in cases of violent death in Sao Paulo city - Brazil

Violence is a dreadful phenomenon spread throughout the world, resulting in unfortunate events that can ultimately cause death. It is known that some countries play a much worrying role in this scenario than others. Brazil is one of them. The present work has focused on identifying the use of cocaine in 105 postmortem cases arriving at the Institute of Legal Medicine of Sao Paulo (IML-SP), the largest Brazilian city. Both blood and hair samples have been analyzed through ultra-performance liquid chromatography coupled to electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS) in order to distinguish between recent or chronic cocaine use. The purpose of this work was to evaluate the proportion of cocaine use amongst violent individuals whose violence has ultimately led to their death. In order to do so, two previous methods, validated in-house, based on methanolic extraction for hair and protein precipitation for blood, have been used for this purpose and the final residue was analyzed through UPLC-ESI-MS/MS system. When looking at the demographics from the 105 postmortem cases analyzed, the results have shown the most critical age range to be between 18 and 25 years old and the least frequent between 37 and 45 years old. Gender wise, a rather extreme difference was found as 97 of the individuals were men and finally, considering the manner of death, the four-category criteria established appear to be fairly similar with 34 cases related to general violence and risk behavior, 26 to drug abuse suspicion, 23 to homicide resulting from opposition to police intervention and 22 to possible suicide.

[The morphofunctional features of the heart associated with acute morphine poisoning during the period of chronic drug intoxication]

The objective of the present study was to improve forensic medical diagnostics of the cases of death associated with morphine poisoning based on the investigation into the biochemical changes in blood and pericardial fluid as well as morphological changes in the myocardial structures. The studies were carried out with the use of thin-layer chromatography, colorimetric and morphological methods including hematoxylin and eosin, Lee's methylene blue, and van Gieson's picrofuscin staining. These techniques were supplemented by light and polarization microscopy. The study has demonstrated the presence of morphine in 99.16% of the blood and pericardial samples obtained in the cases of poisoning. The comparison of the results of biochemical and pathomorphological studies of the myocardium made it possible to evaluate the functional and morphological conditions of the heart in the case of acute morphine poisoning during the period of chronic drug intoxication.

Evaluation of poisoning deaths in the Cukurova Region, Turkey, 2007-2011

Complications of substances detected in poisoning deaths are important in order to observe changes in poisoning patterns and to monitor effects of preventive work. The aim of the present study was to describe the characteristics of substances investigated and detected in poisoning deaths by Adana Group Authority of the Council of Forensic Medicine, Department of Forensic Chemistry, Cukurova, Turkey, between 2007 and 2011 retrospectively. A total of 7681 examinations were performed, of which, 7% (n = 564) determined positive for at least one compound investigated. Ages of the cases ranged from 1 to 97 years (mean ± SD: 36.10 ±19.16). Carbon monoxide (CO) poisonings were found most frequently with an incidence of 27.0%, followed by prescription medications with 25.0%. Illegal drug poisonings were present in 20.0% of blood and urine samples analyzed. Pesticides, mostly endosulfan, were found in 13.0% of the 564 cases investigated. In the blood samples analyzed, methyl and ethyl alcohol were detected in 14.0% and volatile substances in 1.0%. Overall, this study has managed to contribute substantial additional information regarding the epidemiology of poisoning in Cukurova region, Southern Turkey. The results confirm other epidemiological data that indicate CO as the major cause of poisoning deaths in Turkey.

Review of advances in the thin layer chromatography of pesticides: 2008-2010

Techniques and applications of thin layer chromatography (planar chromatography) for the separation, detection, qualitative and quantitative determination, and preparative isolation of pesticides and their metabolites and other related compounds are reviewed for the period from November 1, 2008 to November 1, 2010. Analyses are described for a variety of samples types and pesticide classes. In addition to references on residue analysis, studies such as pesticide structure-retention relationships, identification and characterization of plant pesticides and synthesized pesticides, metabolism, degradation, mobility, identification of biomarkers for detection of herbicide effects in plants, and lipophilicity are covered.