Estimation of blood and urine levels of eight metals and essential trace elements collected from living Subjects compared to urine, cardiac and femoral postmortem blood, and other postmortem samples: A forensic toxicology study.

Along with the regular toxicology testing, different samples collected during the autopsy might be subjected to metal level estimation to investigate the cause of death in some cases. Utilizing a scientific procedure on postmortem specimens is crucial for interpreting forensic toxicological analytical results. Even modest procedural errors made by incompetent forensic toxicologists and chemists who lack proper specialized training and knowledge can alter the scientific conclusions and hence the legal verdict. The current work studies an overview of eight metals and element levels in living and deceased human bodies. It could be a substantial contribution to establishing normal or so-called "reference" metal levels under antemortem and postmortem situations, hence aiding in identifying reliable future interpretations of results produced by numerous researchers in the same field. AIM OF THE WORK: The current work aimed to study the concentration of eight metals in the blood samples (cardiac and femoral), urine, and other samples (Spleen, liver, and renal tissues) collected from human cadavers at different postmortem intervals in addition to blood and urine samples collected from the living population as a contribution to establishing normal or so-called "reference" metal levels under antemortem and postmortem situations. SUBJECTS AND METHODS: Postmortem autopsy blood samples (cardiac and femoral), urine, and other samples (Spleen, liver, and renal tissues) were collected from 400 deceased subjects. These samples were analyzed for the estimation of the eight metals under research, namely, Arsenic (As), Selenium (Se), Silver (Ag), Cadmium (Cd), Antimony (Sb), Mercury (Hg), Zinc (Zn) and Lead (Pb). In addition, blood and urine samples from 400 living volunteer subjects were analyzed for the same eight elements under study. RESULTS: In the postmortem group, the mean metal levels in cases with absent, early, and advanced putrefaction simultaneously in µg/L were 2.45 ± 3.30, 3.25 ± 5.18, and 3.81 ± 1.95 for As. For Se, the results were 10.74 ± 4.21, 10.54 ± 5.28, and 9.96 ± 4.14. 4.04 ± 1.74, 3.48 ± 1.32, and 3.74 ± 0.91 were the results for Ag. For Cd, they were 8.35 ± 3.91, 12.15 ± 3.05, and 24.51 ± 31.25 with P < 0.0001**. 1.48 ± 1.85, 1.61 ± 1.85, and 1.62 ± 1.74 were the same results for Sb; 6.07 ± 2.44, 5.22 ± 2.17, and 5.39 ± 1.82 for Hg. 395 ± 79.8, 553 ± 51.7, and 704 ± 97.2 for Zn with a P-value <0.005*. As for lead, the results were 15.61 ± 24.19, 14.76 ± 23.05, and 24.61 ± 52.72. As the postmortem interval increased, Cd and Zn levels increased (p < 0.0001, <0.005* simultaneously).

Toxicology Practice During COVID-19 Pandemic: Experience of the Dammam Poison Control Center-Eastern Province, Saudi Arabia.

BACKGROUND: The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems. OBJECTIVE: To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics. METHODS: Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019. RESULTS: Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086). CONCLUSION: The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.

Fully Automated Forensic Routine Dried Blood Spot Screening for Workplace Testing.

In this study, we describe the transfer of a new and fully automated workflow for the cost-effective drug screening of large populations based on the dried blood spot (DBS) technology. The method was installed at a routine poison control center and applied for DBS and dried urine spot (DUS) samples. A fast method focusing on the high-interest drugs and an extended screening method were developed on the automated platform. The dried cards were integrated into the automated workflow, in which the cards were checked in a camera recognition system, spiked with deuterated standards via an in-built spraying module and directly extracted. The extract was transferred online to an analytical LC column and then to the electrospray ionization tandem mass spectrometry system. The target compounds were analyzed in positive multiple-reaction monitoring mode. Before each sample batch or analysis day, calibration samples were measured to balance inter-day variations and to avoid false negative samples. An internal standard was integrated prior the sample extraction to allow in process control. A total of 28 target compounds were analyzed and directly extracted within 5 min per sample. This fast screening method was then extended to 20 min, enabling the usage of a Forensic Toxicology Database to screen over 1,200 drugs. The method gives confident positive/negative results for all tested drugs at their individual cut-off concentration. Good precision (±15%, respectively ±20% at limit of quantification) and correlation within the calibration range from 5 to 1,000 ng/mL was obtained. The method was finally applied to real cases from the lab and cross-checked with the existing methodologies.

Incidence and predisposing factors of vancomycin-induced nephrotoxicity in children.

INTRODUCTION: To investigate the pattern of vancomycin-associated nephrotoxicity in children and to examine potential predisposing factors for nephrotoxicity, including average serum trough concentrations ≥10 µg/mL. METHODS: Patients ≥1 week old to ≤15 years with normal baseline serum creatinine values who received vancomycin for ≥48 h between October 2010 and September 2012 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of ≥0.5 mg/dL or ≥50% baseline increase over 2 days. Patients with average serum trough concentrations ≥10 µg/mL were compared with a lower trough group. RESULTS: Renal toxicity occurred in 72 (27.2%) of the 265 studied pediatric cases. High trough vancomycin levels ≥10 µg/mL were presented in 59 pediatric patients suffering from nephrotoxicity. Using multiple regression analysis, cases admitted to the intensive care unit (ICU) and to whom aminoglycoside medication was administered concurrently with vancomycin medication showed a significant high renal toxicity incidence [odds ratio (OR) 2.91; 95% confidence interval (CI) 1.70, 8.61; P value <0.03)] and (OR 9.11; 95% CI 4.11, 24.13; P < 0.05), respectively. CONCLUSION: Renal function tests and continuous monitoring of vancomycin trough levels for children receiving vancomycin therapy, especially admitted to the ICU and given other aminoglycoside medications, are essential.