Dislodged teeth in four intact child mummies from Graeco/Roman Egypt (332 BCE – c. 395 CE) – child abuse, accident or careless embalmers?

In a computerised tomographic (CT) scanning and x-ray imaging of four ancient Egyptian Graeco/Roman child mummies, it was observed that deciduous teeth had been dislodged and that the cervical spines were flexed. The objective of this study was to determine whether the cause of the tooth loss and spinal flexion were linked or whether they related to ante-mortem accident or abuse.Three mummies were examined using high speed helical CT scanners and the fourth mummy was examined using x-ray film. The images were loaded into an advanced visualisation workstation for further examination and to provide accurate data to identify exfoliated teeth and the flexion of the cervical spine.The age range of the children was approximately eighteen months to six years. The study showed that in two cases the dislodged teeth were within the oral cavity and in the third case the dislodged teeth were found close to empty sockets. In the fourth mummy two upper teeth were dislodged but could not be identified in the oral cavity due to the lack of clarity in the x-ray films.In all cases natural exfoliation or dental extraction as a cause of tooth loss was rejected due to the age of each child and identification of dislodged teeth which lacked evidence of root resorption. The reason for the dislodgement of teeth appeared to be due rough post-mortem handling by embalmers when grasping the mandible to flex the cervical spine and manipulate the head towards the chest. Ante-mortem accident, child abuse, periodontal disease or extractions were rejected as the cause of tooth loss

Fenitrothion: toxicokinetics and toxicologic evaluation in human volunteers.

An unblinded crossover study of fenitrothion 0.18 mg/kg/day [36 times the acceptable daily intake (ADI)] and 0.36 mg/kg/day (72 X ADI) administered as two daily divided doses for 4 days in 12 human volunteers was designed and undertaken after results from a pilot study. On days 1 and 4, blood and urine samples were collected for analysis of fenitrothion and its major metabolites, as well as plasma and red blood cell cholinesterase activities, and biochemistry and hematology examination. Pharmacokinetic parameters could only be determined at the higher dosage, as there were insufficient measurable fenitrothion blood levels at the lower dosage and the fenitrooxone metabolite could not be measured. There was a wide range of interindividual variability in blood levels, with peak levels achieved between 1 and 4 hr and a half-life for fenitrothion of 0.8-4.5 hr. Although based on the half-life, steady-state levels should have been achieved; the area under the curve (AUC)(0-12 hr) to AUC(0-(infinity) )ratio of 1:3 suggested accumulation of fenitrothion. There was no significant change in plasma or red blood cell cholinesterase activity with repeated dosing at either dosage level of fenitrothion, and there were no significant abnormalities detected on biochemical or hematologic monitoring

Developing limits for driving under cannabis

ABSTRACT Objective Development of a rational and enforceable basis for controlling the impact of cannabis use on traffic safety. Methods An international working group of experts on issues related to drug use and traffic safety evaluated evidence from experimental and epidemiological research and discussed potential approaches to developing per se limits for cannabis. Results In analogy to alcohol, finite (non-zero) per se limits for delta-9-tetrahydrocannabinol (THC) in blood appear to be the most effective approach to separating drivers who are impaired by cannabis use from those who are no longer under the influence. Limited epidemiological studies indicate that serum concentrations of THC below 10 ng/ml are not associated with an elevated accident risk. A comparison of meta-analyses of experimental studies on the impairment of driving-relevant skills by alcohol or cannabis suggests that a THC concentration in the serum of 7-10 ng/ml is correlated with an impairment comparable to that caused by a blood alcohol concentration (BAC) of 0.05%. Thus, a suitable numerical limit for THC in serum may fall in that range. Conclusions This analysis offers an empirical basis for a per se limit for THC that allows identification of drivers impaired by cannabis. The limited epidemiological data render this limit preliminary

Fatalities caused by novel opioids: a review

Drugs related to morphine represent not only large range of important therapeutic applications for the relief of moderate to severe pain but also give rise to a relatively large series of novel opioids that mimic the action of this naturally occurring analgesic. Most of these are based on fentanyl structures that are much more potent, and dangerous, than fentanyl itself. This publication reviews reports of fatalities attributed to 15 novel opioids with the view to assessing mortality associated with their misuse as well as reviewing published analytical procedures that would be able to detect these and other novel opioids. These drugs include reports of deaths to acetylfentanyl, acrylfentanyl, butr(yl)fentanyl, carfentanil, 2- and 4-fluorofentanyls, 4-fluorobutyrfentanyl, 4-fluoroisobutyrfentanyl, furanylfentanyl, α- and 3-methylfentanyls, 4-methoxyfentanyl, ocfentanil, as well as AH-7921, U-47700 and MT-45. Most of these cases reporting a drug-caused death involved other drugs in addition to the opioid. No obvious minimum fatal concentration was discerned for any of the opioids for which details were provided, however, the more potent members required detection limits well under 1 ng/mL and often even well below 0.1 ng/mL requiring use of the most sensitive mass spectral detection procedures, particularly when screening specimens using a non-targeted mode. Four other novel opioids have been reported in admissions to hospitals include 4-chloroisobutryfentanyl, cyclopentylfentanyl and tetrahydrofuranfentanyl, all of which are likely to have the potential to cause death. It is also likely that other analogues will appear with time

Drugs and accident risk in fatally-injured drivers

ABSTRACT Risk analysis studies to investigate the contribution of drugs to accident causation are limited. We have used a method based on establishing the responsibility of a driver to investigate the involvement of drugs other than alcohol in 1052 fatally injured drivers. The proportion of drivers deemed to be responsible in a drug-free group were compared to drivers with target drugs found in their blood stream. Drugs (including alcohol) were detected in 49% of the drivers. Alcohol was detected in 36% of the cases, whilst drugs were detected in 22%. 13% had only drugs detected. The remaining 9% of the population involved a combination of drugs and alcohol. The order of prevalence of drugs were marijuana (112 cases), amphetamines and related stimulants (35), benzodiazepines (34) and opiates (34). Drivers in whom only opiates were detected had an odd's ratio of 2.4, whilst marijuana cases provided a relative risk of 0.6. Drivers in whom stimulants were detected gave an odd's ratio of 1.4 whilst benzodiazepines gave an odd's ratio of 1.0. By contrast the odd's ratio for alcohol was 6.8. Drivers with higher than therapeutic concentrations detected represented 22 drivers (2.1%). Most of these drivers were found to be culpable. Multiple drug cases also tended to be culpable. The culpability rate in this group was 89% compared to 70% in drug-free drivers. These data show that only a small proportion of impaired drivers are drug effected, the remainder being impaired by alcohol. The relative risk for psychoactive drugs is also not uniform, with marijuana use providing the least effect on risk, whilst opiate use seems to provide the largest increase in risk compared to the other drug groups studied