Comparative analysis of post-mortem drug concentrations in cerebrospinal fluid and blood.

This study aimed to compare the concentration of various xenobiotics in both cerebrospinal fluid (CSF) and blood. We examined 175 autopsy cases covering a wide range of ages, causes of death, and drug ingestion histories, with cerebrospinal fluid and blood samples available for toxicological testing. Analytes studied included opioids, benzodiazepines, antidepressants, antipsychotics, and illicit substances such as cannabinoids, stimulants and new psychoactive substances, including synthetic cathinones and synthetic cannabinoids. We found that concentrations in CSF were generally lower than in blood. A significant correlation was observed between drug concentrations in CSF and blood for many analytes (p < 0.05). However, the strength and direction of the correlation varied considerably depending on the physicochemical properties of the drugs, suggesting that a 'one size fits all' model may not be applicable. The results indicate that cerebrospinal fluid (CSF) can be used to detect a variety of xenobiotics, particularly amphetamines, synthetic cathinones and synthetic cannabinoids, in cases where conventional biological materials are not available. Additionally, using the results obtained in the future can lead to a better understanding of pharmacokinetic processes and the effect of post-mortem redistribution. Further research is needed to refine our understanding of these relationships.

Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)-Multicenter Study.

BACKGROUND: Iatrogenic distal coronary artery perforation can be a life-threatening complication. While there are different dedicated devices for the embolization of distal perforations, there are scarce data about the embolization using the fragmented balloon catheter, the so-called cut balloon technique (CBT). METHODS: We included consecutive patients with distal coronary perforations treated with CBT in four cardiac centers between 2017 and 2023. Clinical, angiographic and procedural characteristics as well as in-hospital outcomes were recorded. RESULTS: Twenty-six patients (68% men, mean age: 71 ± 10.6 years) with 25 distal coronary perforations and one septal collateral perforation were included. Eleven patients (42%) had elective percutaneous coronary intervention, while fifteen patients (58%) were treated for acute coronary syndrome. The site of perforation was most frequently distributed in the left anterior descending artery (40%), followed by the circumflex artery (28%) and right coronary artery (24%). The diameter of balloons for CBT ranged from 1.5 to 4.0 mm, with most balloons (76%) being either 2.0 or 2.5 mm in diameter. Most balloons (88%) were previously used for lesion predilatation. The numbers of cut balloons needed to seal the perforation were 1, 2 and ≥3 in 48%, 20% and 32% of cases, respectively. The in-hospital prognosis was favorable, with cardiac tamponade requiring pericardiocentesis in only four (16%) patients. Neither emergency surgery nor cardiac death occurred. CONCLUSIONS: CBT is a safe, efficient and easy-to-implement technique for the embolization of coronary perforations. Most distal coronary perforations can be sealed with one or two fragments of cut balloons, obviating the need for additional devices.

Is the needle still needed? Relationship between laboratory features of pleural effusion and results of lung CT examinations in patients with pneumonia and lung cancer.

INTRODUCTION AND OBJECTIVE: Thoracocentesis is an invasive procedure routinely performed in the diagnosis of causes for the presence of pathological fluid in the pleural cavity. In many patients, a computed tomography scanning (CT) is also performed to diagnose the cause of the presence of fluid in the pleural cavity. The diagnostic value of CT is particularly high in situations in which performing thoracocenthesis could be associated with an increased risk of complications. The aim other study was to assess the relationship between the objective radiological features and the results of laboratory tests of fluid collected by thoracocenthesis in patients with pneumo-nias (n=18) and lung cancer (n=35). MATERIAL AND METHODS: The examined group consisted of the patients with pneumonia (n=18) and lung cancer (n=35) which resulted in the presence of fluid in the pleural cavity. In the patients thoracocentesis, CT lung scanning was also performed, according to the medical indications. Three scans with the greatest amount of fluid were identified, and the mean density of the fluid expressed in Hounsfield units was calculated within the area. These calculations were compared with the results of laboratory fluid tests. RESULTS: The maximum number of Hounsfield units (HU) was significantly lower in the group of lung cancer patients, compared to those diagnosed with pneumonia (74.3% sensi-tivity and 55.6% specificity). The pH of pleural fluid was significantly lower in patients with lung cancer, compared to those with pneumonia (74.3% sensitivity and 66.7% specificity). CONCLUSIONS: According to the results, radiological differentiation of pneumonia and lung cancer resulting in pleural effusion, to some extent is possible; however, the needle is still needed.

A fatal case of poisoning with a cathinone derivative: α-PiHP and its postmortem distribution in body fluids and organ tissues.

New psychoactive substances continue to appear on the drug market, and alpha-pyrrolidinoisohexanophenone (α-PiHP) is one of the most popular cathinone derivatives. In this article, we report a case of death caused by α-PiHP. Based on the toxicological results of the studied case along with autopsy, histopathological findings and crime-scene information, fatal intoxication with α-PiHP was accepted as the final cause of death. α-PiHP and its metabolite (OH-α-PiHP) were detected and quantified in all postmortem materials (blood collected from the heart, the femoral vein and the dural venous sinuses; vitreous humor; cerebrospinal fluid; cerebral cortex; brainstem; cerebellum; bile; liver; kidney; heart; pancreas; spleen; thyroid gland; lung; adipose tissue; stomach and intestine). To date, this is the first case of determination of α-PiHP and its metabolite in postmortem specimens. In our opinion, α-PiHP and its metabolite concentration database can be helpful in the interpretation of fatal cases.

Phenolic Composition and Antioxidant Activity of Alchemilla Species.

The genus Alchemilla, belonging to the Rosaceae family, is a rich source of interesting secondary metabolites, including mainly flavonoids, tannins, and phenolic acids, which display a variety of biological activities, such as anti-inflammatory, antimicrobial, and antioxidant. Alchemilla species are used in traditional medicine for treatment of acute diarrhea, wounds, dysmenorrhea, and menorrhagia. In this review, we focus on the phenolic compound composition and antioxidative activity of Alchemilla species. We can assume that phytomedicine and natural products chemistry are of significant importance due to the fact that extract combinations with various bioactive compounds possess the activity to protect the human body rather than disturb damaging factors.

LC-ESI-MS/MS Identification of Biologically Active Phenolics in Different Extracts of Alchemilla acutiloba Opiz.

Liquid chromatography electrospray ionization tandem mass spectrometric (LC-ESI-MS/MS) qualitative and quantitative analysis of different extracts from the aerial parts and roots of Alchemilla acutiloba led to the identification of phenolic acids and flavonoids. To the best of our knowledge, isorhamnetin 3-glucoside, kaempferol 3-rutinoside, narcissoside, naringenin 7-glucoside, 3-O-methylquercetin, naringenin, eriodictyol, rhamnetin, and isorhamnetin were described for the first time in Alchemilla genus. In addition, the antioxidant, anti-inflammatory and cytotoxic activity of all extracts were evaluated. The results clearly showed that among analyzed extracts, the butanol extract of the aerial parts exhibited the highest biological activity comparable with the positive controls used.

Acute liver injury in the course of COVID-19.

Although coronavirus disease 19 (COVID-19) most often affects the respiratory system, in the course of this disease, dysfunction of many other organs may also develop. The case is presented of a female patient, treated for a long time due to chronic obstructive pulmonary disease, complicated by chronic complete respiratory failure, and who was undergoing non-invasive mechanical ventilation at home. She was admitted to the Pneumonology Department due to exacerbation of the symptoms of her underlying disease. Several tests for SARS-CoV2 infection gave a negative result. During the patient's stay in the clinic, a rapid increase was observed in symptoms of respiratory failure, heart failure, and laboratory signs of acute liver damage. The next PCR test result proved to be positive. In addition to the case report, the possible impact of SARS-CoV2 infection on liver damage is also also discussed, along with a literature review on this topic.

Phenolic Composition and Antioxidant Activity of Plants Belonging to the Cephalaria (Caprifoliaceae) Genus.

The genus Cephalaria, belonging to the Caprifoliaceae family, is a rich source of interesting secondary metabolites, including mainly saponins which display a variety of biological activities, such as immunomodulatory, antimicrobial and hemolytic effects. Besides these compounds, flavonoids and phenolic acids were identified in Cephalaria species. Cephalaria is employed in traditional medicine e.g., to cure cardiac and lung diseases, rheumatism, and regulate menstruation. In this review we focus on the phenolic compound composition and antioxidative activity of Cephalaria species. The antioxidant effect can be explained by flavonoids present in all parts of these plants. However, future efforts should concentrate more on in vitro and in vivo studies and also on clinical trials in order to confirm the possibility of using these plants as natural antioxidants for the pharmacology, food or cosmetic industries.

A fatal case of poisoning of a 19-year-old after taking 3-MMC.

The significant increase in the number of new psychoactive substances on the drug market has recently been a serious problem. The manuscript presents a fatal case of suicide poisoning with 3-MMC (3-methylmethcathinone). The biological material collected during the autopsy of a 19-year-old woman, transferred to the toxicological Laboratory in Katowice ToxLab, was subjected to a chemical and toxicological analysis. The toxicological analysis of blood, vitreous humor and gastric contents revealed 3-methylmetcatinone at a concentration of 800 ng/ml, 153 ng/ml and 5,5 mg, respectively. The presence of 3-MMC has also been confirmed in physical evidence secured on site. 3-methylmethcathinone is a dangerous psychoactive substance that caused the death of the 19-year-old.

Fatal case of poisoning with a new cathinone derivative: α-propylaminopentiophenone (N-PP).

PURPOSE: Similar to synthetic cannabinoids, synthetic cathinone derivatives are the most popular compounds among novel psychoactive substances. Along with a growing number of new cathinones, the number of consumers wishing to enrich their experience with these compounds is also growing, and the same can be said about the growing numbers of poisonings. The reason for overdosing is a lack of consumer awareness regarding composition of the product, with which they experiment, and even more, regarding concentration of psychoactive substances contained in the taken product. In this paper, we report a case of the purposeful intake of a high dose of powder containing a novel cathinone derivative, α-propylaminopentiophenone, which resulted in the deadly poisoning of a woman. METHODS: Aiming to identify this psychoactive substance causing the fatality, the postmortem specimens collected from the autopsy was analyzed by means of high-performance liquid chromatography coupled with mass spectrometry, and the analysis of a powder material found with the victim was additionally analyzed by means of gas chromatography with mass spectrometric detection. RESULTS: In the course of analysis performed on the specimens originating from autopsy (blood, eyeball fluid, liver, kidney and brain), high concentrations of α-propylaminopentiophenone were established, which was responsible for the death of a young woman. The same psychoactive compound was also identified in the powder material. CONCLUSIONS: To the best of the authors' knowledge, this is the first case reported in the literature on fatal poisoning with α-propyloaminopentiophenone.

The newest cathinone derivatives as designer drugs: an analytical and toxicological review.

PURPOSE: Currently, among new psychoactive substances, cathinone derivatives constitute the biggest group, which are mainly classified into N-alkylated, 3,4-methylenedioxy-N-alkylated, N-pyrrolidinyl, and 3,4-methylenedioxy-N-pyrrolidinyl derivatives. These derivatives are actively being subjected to minor modifications at the alkyl chains or the aromatic ring to create new synthetic cathinones with the goal of circumventing laws. In this review, the new synthetic cathinones that have appeared on the illegal drug market during the period 2014-2017 are highlighted, and their characterization by gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry is presented. METHODS: Various key words were used to conduct an extensive literature search across a number of databases, specifically for synthetic cathinones that emerged between 2014 and 2017. RESULTS: More than 30 new cathinone derivatives were discovered. The preexisting parental compounds for the new derivatives are also referenced, and their mass spectral data are compiled in a table to facilitate their identification by forensic toxicologists. CONCLUSIONS: To our knowledge, this is the most current review presenting new synthetic cathinones. Political authorities should take measures to implement and enforce generic scheduling (comprehensive system) laws to control the diversely modified synthetic cathinones. Supplementing the existing databases with new findings can greatly facilitate the efforts of forensic toxicologists.

Identification and physicochemical characterization of 4-fluorobutyrfentanyl (1-((4-fluorophenyl)(1-phenethylpiperidin-4-yl)amino)butan-1-one, 4-FBF) in seized materials and post-mortem biological samples.

During the last decade, a substantial growth in new psychoactive substances (NPS) has been recorded. Within this group, a considerably fast-growing sub-group is represented by the opioids, which are based on modifications of the fentanyl structure. In this study, identification and analytical characterization of a new fentanyl derivative, 4-fluorobutyrfentanyl (1-((4-fluorophenyl)(1-phenethylpiperidin-4-yl)amino)butan-1-one, 4-FBF), is described. Apart from the seized powder, 4-FBF was also identified in the e-cigarette liquid secured in Case 1. The concentration of the compound in the liquid was 35 mg/mL. The main component of the liquid was glycerol, and nicotine was also present. This substance was detected in seized material that originated from the illegal drug market in Poland. To the best of the authors' knowledge, this report presents the first two analytically confirmed cases of fatal intoxication associated with 4-FBF. Case 1 was a 26-year-old male drug user who was found dead at home. Case 2 was a 25-year-old female, occasional user of NPS and drugs, who was also found dead at home. The concentrations of 4-FBF in blood were 91 and 112 ng/mL and in urine 200 and 414 ng/mL. The concentrations of 4-FBF in liver and kidney were 902 and 411 ng/g, and 136 and 197 ng/g, for Case 1 and Case 2, respectively. Copyright © 2016 John Wiley & Sons, Ltd.

[Late diagnosis of Gaucher's disease - care reports]. / Pózne rozpoznawanie choroby Gauchera ­ opisy przypadków.

Gaucher's disease if one of the most frequent, among extremely rare, lysosomal storage diseases. It is the autosomal recessive inherited metabolic disorder, which can present in three main clinical forms. Type 1 - the most benign, in a not-neuropathic form, and types 2 and 3, both in neuropathic form, which manifest serious neurological symptoms. AIM: The aim of the study was to draw attention to the late diagnosing of Gaucher's disease in the Polish population and to popularize the knowledge about this ultra-rare disease. CASE REPORTS: Having analyzed the cases of our patients, we have concluded that the diagnosis of Gaucher's disease type 1 is often made with a time delay of up to several years. The lack of deeper knowledge about the disease and its symptoms among the physicians was found a main reason for this time lag. The disease is usually not taken into consideration in difference diagnosis due to its "ultra-rare" character. Furthermore, the course of the disease is usually occult with no spectacular symptoms, whereas the frequently occurring chronic weakness and bone pains are not treated as serious pathology. CONCLUSIONS: Early diagnosis of the Gaucher's disease gives patients the chance of an appropriate, effective substitutive therapy, as well as recovery of organ disturbances.

[Cannabinoid and cathinone designer drugs - the workings and selected methods of analysis]. / Dopalacze z grupy kannabinoidów i katynonów ­ dzialanie oraz wybrane metody analizy.

Recently, there has been an increase in the consumption of designer drugs, substances aimed at producing psychoactive, energizing, euphoric or anesthetic effects. Designer drugs are substitutes of actual narcotics, whose possession is banned under Polish law according to the Act of 29 July 2005. The latest reports suggest that the number of synthetic psychoactive substances is increasing. In the span of 2012, a total of 28 new synthetic cannabinoids were discovered in member states of the European Union. Synthetic psychoactive substances appear in different forms on the market: tablets (often very colourful and interestingly-shaped), seeds, dried product (sprayed with synthetic substance and redried), crystals or powder. The way of application is greatly diverse, and depends on the form in which a drug is produced and dispensed. The methods of intoxication include smoke inhalation (oftentimes blends are smoked), intranasal or oral application, placing crystals on the eye, or injection. Said methods correspond, with varying degrees, to invoking different psychotic effects, such as agitation, panic attacks, paranoia, hallucinations, overall irritation, and aggression. Various cardiovascular effects, such as tachycardia or increase in blood pressure, may follow as well. However, the primary influence is on the nervous system, inhibiting the reuptake of neurotransmitters such as serotonin, noradrenalin and dopamine, and leading to their increased concentration at the presynaptic cleft, which in turn causes feelings of agitation and pleasure. The knowledge regarding the strength, toxicity, and metabolism of designer drugs is yet sparse. The same pertains to the knowledge regarding the handling of overdose cases.

Identification and characterization of new designer drug 4-fluoro-PV9 and α-PHP in the seized materials.

In this study, we present identification and physicochemical characterization of new cathinone derivatives, 4-fluoro-PV9 and already known α-PHP in seized materials. Although the disclosure of α-PHP from an illegal product had been reported and characterized to some extent, the data on α-PHP are also presented together with those of 4-fluoro-PV9. The data of characterization for the two compounds were obtained by high-performance liquid chromatography (HPLC)-mass spectrometry and HPLC-diode array detection, electrospray ionization/ion trap mass spectrometry in MS2 and MS3 modes, gas chromatography-mass spectrometry, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, ultraviolet-visible spectroscopy, and nuclear magnetic resonance spectroscopy. To our knowledge, this is the first report for identification and detailed characterization of 4-fluoro-PV9 circulated on the illegal drug market.