Forensic science international
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The study sought to determine the physiologic effects of the prone maximum restraint (PMR) position in obese subjects after intense exercise. We designed an experimental, randomized, cross-over trial in human subjects conducted at a university exercise physiology laboratory. Ten otherwise healthy, obese (BMI>30) subjects performed a period of heavy exertion on a cycling ergometer to 85% of maximum heart rate, and then were placed in one of three positions in random order for 15min: (1) seated with hands behind the back, (2) prone with arms to the sides, (3) PMR position. While in each position, mean arterial blood pressure (MAP), heart rate (HR), minute ventilation (V˙E), oxygen saturation (SaO2), and end tidal CO2(etCO2) were measured every 5min. There were no significant differences identified between the three positions in MAP, HR, V˙E, or O2sat at any time period. There was a slight increase in heart rate at 15min in the PMR position over the prone position (95 vs. 87). There was a decrease in end tidal CO2 at 15min in the PMR over the prone position (32mmHg vs. 35mmHg). In addition, there was no evidence of hypoxia or hypoventilation during any of the monitored 15min position periods. ⋯ In this small study of obese subjects, there were no clinically significant differences in the cardiovascular and respiratory measures comparing seated, prone, and PMR position following exertion.
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In postmortem investigations of fatal intoxications it is often challenging to determine which drug/s caused the death. To improve the interpretation of postmortem blood concentrations of sedative and hypnotic drugs and/or clonazepam, all medico-legal autopsies in Sweden - where these drugs had been detected in femoral vein blood during 1992-2006 - were identified in the databases of the National Board of Forensic Medicine. For each drug, concentrations in postmortem control cases - where the cause of death was not intoxication and where incapacitation by drugs could be excluded - were compiled as well as the levels found in living subjects; drugged driving cases and therapeutic drug monitoring cases. ⋯ Concentrations observed among drugged drivers were similar to the concentrations observed among the therapeutic drug monitoring cases. Flunitrazepam was the substance with the highest number of single intoxications, when related to sales. In summary, this study provides reference drug concentrations primarily to be used for improving interpretation of postmortem drug levels in obscure cases, but which also may assist in drug safety work and in pharmacovigilance efforts.
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We present a traumatic fatality of a 19-year-old man who had ingested blotter paper containing 25I-NBOMe [2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine]. Postmortem specimens were analyzed by high performance liquid chromatography with tandem mass spectrometry (HPLC/MS/MS). ⋯ While findings based upon the method of standard additions were: gastric contents, 7.1 μg total; bile, 10.9 ng/g; brain, 2.54 ng/g and liver, 7.2 ng/g. To our knowledge the presented case is the first postmortem case of 25I-NBOMe intoxication documented by toxicological analysis of tissues and body fluids.
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The measurement of illicit drug metabolites in raw wastewater is increasingly being adopted as an approach to objectively monitor population-level drug use, and is an effective complement to traditional epidemiological methods. As such, it has been widely applied in western countries. In this study, we utilised this approach to assess drug use patterns over nine days during April 2011 in Hong Kong. ⋯ Elevated ratios of cocaine to benzoylecgonine were identified unexpectedly in three samples during the evening and night, providing evidence for potential dumping events of cocaine. This study provides the first application of wastewater analysis to quantitatively evaluate daily drug use in an Asian metropolitan community. Our data reinforces the benefit of wastewater monitoring to health and law enforcement authorities for strategic planning and evaluation of drug intervention strategies.
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Although electrolyte analysis of pleural effusion at autopsy is useful for the diagnosis of water aspiration (i.e., drowning), the method of comparing each level of sodium (Na(+)), potassium (K(+)), and chloride (Cl(-)) ions does not clearly differentiate between freshwater drowning, seawater drowning, and non-drowning. Therefore, here we introduce the summation of Na(+), K(+), and Cl(-) levels, that is SUM(Na+K+Cl), as a modified diagnostic indicator. In 21 autopsy cases of freshwater drowning, 32 cases of seawater drowning, and 43 non-drowning controls (with pleural effusion), mean SUM(Na+K+Cl) differed significantly between the groups (188.8±33.2, 403.5±107.9, and 239.3±21.7 mEq/L, respectively). ⋯ For an additional 15 bathtub deaths, mean SUM(Na+K+Cl) was 198.8±40.0 mEq/L, and in 14 of these cases (93%) the relationship between cause of death and SUM(Na+K+Cl) could be explained using this method. Forensic pathologists should not depend exclusively on chemical findings and should consider also typical pathological indicators of drowning. This new method may be useful as a supplementary diagnostic tool when used alongside consideration of the pathological findings.