An Unusually High Blood Alcohol Level in a Burnt Child Homicide Victim

Background: Alcohol detection is one of the most prevalent requests in forensic toxicology laboratories for medico-legal investigation. Interpretation of analytical toxicology results is important in deciding the cause and manner of death. The aim of the present case report is to introduce an unusually high blood alcohol level in a homicide victim and interpretation of analytical toxicology results considering crime scene investigation. Case Presentation: In the present study, we report a case of a burnt body on which autopsy examination and forensic toxicology analyses were carried out. Autopsy examination showed several stab wounds in the neck and thorax regions. Forensic toxicology analysis results showed 1055 mg/dL ethanol and 71 mg/dL methanol in right heart blood using headspace gas chromatography. The leading cause of death was stab wounds. Burning seemed to be a tool for covering up the homicide. Use of alcoholic fire accelerant and contamination of the corpse with alcohol was the main reason to detect high blood alcohol levels.Conclusion: It is essential to determine ethanol in different sampling sites to reach a reliable and scientific interpretation of analytical toxicology results. Also, some important factors such as crime scene investigation should be considered in the interpretations of unusual forensic toxicology results

Occupational Exposure to Paving Asphalt Fumes, Impact on Liver and Kidney Function Test Parameters

Background: Asphalt is a mixture of aliphatic and aromatic hydrocarbons. It also contains different kinds of heavy metals. Hot mix asphalt emits hazardous volatile substances. Asphalt is used in many industries, causing serious adverse health effects for workers. Therefore, investigation of the health status of workers is of crucial importance. The present study aimed to assess the impact of asphalt vapor on hepatic and renal function tests parameters and the clinical parameters in road paving workers compared to healthy subjects.Methods: In a cross-sectional study, 41 road asphalt paving workers and 120 healthy non-exposed subjects were selected. The serum enzymes of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin, triglyceride, urea, and creatinine levels were assessed using diagnostic kits. A medical practitioner examined all subjects for any possible medical condition.Results: Liver and kidney function test parameters were significantly higher in road asphalt paving workers compared to their healthy counterparts (P<0.05 for all parameters). About 63% of workers exposed to asphalt fumes for more than 10 years showed cardiac, pulmonary, and metabolic complications. Conclusion: Significant elevations in liver and kidney function test parameters suggest that exposure to asphalt fumes is associated with hepatic and renal dysfunction in asphalt-exposed workers

Determination of Methadone and Tramadol in Vitreous Humor Specimens Using Dispersive LiquidLiquidMicroextractionandUltraHighPerformance Liquid Chromatography

Background: Drug abuse is spreading rapidly all over the world. Methadone and tramadol are among not only the most abused opioids but also important from the forensic point of view. Therefore, we need to devise a simple and sensitive method for the sample preparation and identification of abused drugs in postmortem specimens.Methods: A simple and rapid Dispersive Liquid-Liquid Microextraction (DLLME) technique coupled with Ultrahigh Performance Liquid Chromatography (UHPLC) was developed for the extraction and analysis of methadone and tramadol from postmortem vitreous humor samples. Different parameters affecting the extraction recovery, such as the type and volume of extraction and dispersion solvents, pH value, sensitivity, and specificity, were optimized and studied. Results: Under optimized conditions, the recovery ranges were 82.3%-89.6% and 85.4%-87.1% for methadone and tramadol, respectively. The linear range was 25-100 ng/mL for both methadone and tramadol with a correlation coefficient (R2) of more than 0.98. Limit of Detection (LoD) and Limit of Quantification (LoQ) were 3 and 8 ng/mL for methadone and 6 and 16 ng/mL for tramadol. The accuracy level of the methods for methadone and tramadol detection were 99.4%-100% and 99.7%-99.9%, respectively. The method was specific enough for the qualitative and quantitative determination of methadone and tramadol.Conclusion: The obtained results showed that DLLME combined with UHPLC is a fast and straightforward method for determining methadone and tramadol in postmortem vitreous humor specimens

Discrimination Between Drug Abuse and Medical Therapy : Case report of a tranylcypromine overdose-related fatality

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs

Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016

Background: Poly drug use is a public health threat causing morbidity and mortality all over the world.Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analyticalstudy, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.Methods: All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran duringthe 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, andprescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquidchromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicologylaboratory. Manner of death, demographic characteristics, and different drug categories in postmortemsamples were analyzed.Findings: A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period.Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16.Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highestcategory for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol(n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.Conclusion: The present study provides information about poly drug use-associated deaths in Tehran andhighlights the major role of substance abuse in death

Demographic and Clinical Characteristics of Patients Who Died of Methanol Toxicity During COVID 19 Period in Loghman-e Hakim Hospital in Tehran

Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests.Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients.Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication

Analytical perspectives of chemical adulterants in herbal sexual enhancer drugs

Context: Detection of active pharmaceutical ingredients in herbal drugs has been described in numerous studies. However, few reports have been published in relation to the analysis of counterfeit herbal supplements for the detection of synthetic drugs in Iran. Aims: To analyze herbal drugs used as sexual performance enhancer from forensic and analytical toxicology point of view. Methods: Eighty herbal drugs gathered from herbal shops in Bushehr city, Iran were analyzed. High-performance liquid chromatography and gas chromatography/mass spectrometry were used for detecting and identifying the chemical structures of probable active pharmaceutical ingredients as adulterants. Results: Among 80 samples, 23% contained only sildenafil. Three samples contained sildenafil, tramadol, and diazepam in combination with each other reported for the first time. Conclusions: This study substantiates regular analysis of purported herbal drugs is needed for more effective quality control and health promotion

Quantitative Analysis of Methanol and Ethanol in Traditional Handmade Herbal Distillates in Iranian market

Background and purpose: Medicinal plants are among highly consumed natural drugs. Many herb shops produce and sell this products without any license. Traditional herbal distillates are widely used in Iran, so, the aim of this study was to determine ethanol and methanol concentrations in handmade herbal distillates in Tehran herb shops. Materials and methods: A total of 140 samples from 14 traditional handmade herbal distillates were obtained from Tehran herb shops and analyzed using headspace gas chromatography. Results: In this study, no sample contained ethanol. Peppermint distillate had significantly higher methanol content (334.62±153 ppm) compared with other distillates (P<0.05). Also, high amounts of methanol were found in Fenugreek (321.43 ppm) and Tarragon (311.39 ppm) distillates. Pennyroyal distillate did not contain methanol and rose water had the lowest methanol content (14.61 ppm). Conclusion: Handmade herbal distillates containing high concentrations of methanol can cause health problems in regular consumers. Therefore, highly consumed herbal distillates should be monitored to determine their methanol concentration

Lead poisoning in opium-addicted subjects, its correlation with pyrimidine 5′-nucleotidase activity and liver function tests

Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium-addicted patients. Erythrocyte pyrimidine 5′-nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to find out whether opium-addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity. Methods: Forty orally opium-addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood films were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured. Results: The mean BLL for opium-addicted patients was significantly higher than control group (P < 0.001). On the contrary, P5N activity showed a valid decrease in opium-addicted patients when compared with control group (P < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group (P < 0.001). A statistically significant reverse correlation was found between BLL and P5N activity (P < 0.05, r = −0.85). The prevalence of both basophilic stippling (P < 0.001, z = 6.62) and hemolytic anemia (P < 0.001, z = 6.52) in study population was significantly associated with elevated BLL. We could not find any significant correlation between serum level of liver enzymes and BLL. Conclusions: Opium-addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage

Quantitative analysis of benzodiazepines in vitreous humor by high-performance liquid chromatography

Objective: Benzodiazepines are frequently screened drugs in emergency toxicology, drugs of abuse testing, and in forensic cases. As the variations of benzodiazepines concentrations in biological samples during bleeding, postmortem changes, and redistribution could be biasing forensic medicine examinations, hence selecting a suitable sample and a validated accurate method is essential for the quantitative analysis of these main drug categories. The aim of this study was to develop a valid method for the determination of four benzodiazepines (flurazepam, lorazepam, alprazolam, and diazepam) in vitreous humor using liquid–liquid extraction and high-performance liquid chromatography. Methods: Sample preparation was carried out using liquid–liquid extraction with n-hexane: ethyl acetate and subsequent detection by high-performance liquid chromatography method coupled to diode array detector. This method was applied to quantify benzodiazepines in 21 authentic vitreous humor samples. Linear curve for each drug was obtained within the range of 30–3000 ng/mL with coefficient of correlation higher than 0.99. Results: The limit of detection and quantitation were 30 and 100 ng/mL respectively for four drugs. The method showed an appropriate intra- and inter-day precision (coefficient of variation < 10%). Benzodiazepines recoveries were estimated to be over 80%. The method showed high selectivity; no additional peak due to interfering substances in samples was observed. Conclusion: The present method was selective, sensitive, accurate, and precise for the quantitative analysis of benzodiazepines in vitreous humor samples in forensic toxicology laboratory