Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users.

BACKGROUND/AIM: Drug abuse remains a significant social problem in many countries. The aim of the study was to estimate association between pulmonary histopathological changes and results of toxicological analyses in forensic autopsies of illicit drug users. METHODS: This investigation was performed in the Institute of Forensic Medicine, Belgrade, and in the Clinical Center, Department of Forensic Medicine, Kragujevac, from 2000 to 2004, and included 63 medicolegal autopsies of heroin or other drug consumers who suddenly died. Autopsies, postmortem toxicological examination of drugs and serological analyses of anti-HIV/HBV/HCV antibodies were performed. RESULTS: The deceased persons were mostly male, 46/63 (73.01%), ranged in age from 19 to 49 years (mean 31 years) and all were whites. Postmortem toxicological examination was performed on all of the deceased persons and drugs in the fatal range were identified in only eight of them (12.7%), in the toxic range in ten (15.87%), and in minimal concentrations in 35 (55.56%) of the deceased persons. Drugs identified in the fatal, toxic or minimal range included heroin-morphine (38/53), cocaine (4/53), tramadol (3/53), and lorazepam (1/53). In the 7 remaining subjects, ethanol in combination with heroin was found in 4 cases, and diazepam in combination with heroin in 3 cases. Dominant pathomorphological changes were findings in the lung tissue. Most common histological changes observed in drug users were pulmonary edema--55/63 (87.3%), acute alveolar hemorrhages--49/63 (77.78%), hemosiderin-laden macrophages (siderophages)--52/63 (82,54%), and emphysematous changes--51/63 (80,95%). CONCLUSION: Pulmonary edema is the frequent non-specific autopsy finding which is associated with virtually all routes of drug administration. The histopatological study is necessary to determinate a cause of death when a deceased person has the history of dependence or abouse of psychoactive drugs with negative toxicological results.

[Influence of biometeorological phases on incidence of suicides].

AIM: To establish an influence of biometeorological phases on suicide incidence according to age, gender, settlement, week days, months in a year, ways of suicide execution, influence of biometeorologic phases on suicide execution. METHODS: Comparative analysis of the data about suicides (by years, months, week days, settlements, age, gender) obtained by the Police Department in Kragujevac for the 2004-2008 period and everyday biometeorological phases (phase 1 CWD: cyclone, warm, dry; phase 2 CWW: cyclone, warm, wet; phase 3 CWF: cyclone, warm front; phase 4 CCF: cyclone cold front; phase 5 CCW: cyclone, cold, wet; phase 6 CCD: cyclone, cold, dry; phase 7 ACD: anticyclone, cold, dry; phase 8 ACW: anticyclone, cold, wet; phase 9 AWD: anticyclone, warm, dry; phase 10 AWW: anticyclone, warm, wet) in Kragujevac determinated by the Republic Hydrometeorology Institute of Serbia. RESULTS: In the observed period there were 144 suicides resulting in the incidence rate of 14/100 000/ year. The highest number of suicides was noted in 2005 (36), and lowest one in 2007 (24). The most suicide cases happened in January and June (18 in each), and the fewest in August (7). Three quarters occurred in urban areas. Three quarters of victims were males mostly in the age groups 41-45 and 51-55 (11 in each). Females made one quarter of victims and most of them were in the age group 61-65 years (7). Total mean age was 54,66 years. Two thirds of all suicides were executed by hanging (93) (two thirds were among males), one sixth by firearms, with nine tenths ofmen. The most incidents with significant correlation were in biometheorological phases 4 and 9 (stable sunny weather and sudden impact of weather fronts, with sudden weather changes) (38 in each), which makes over a half of all suicides. CONCLUSION: According to the results of this study, it is strongly recommended to monitor everyday biometeorological forecast, and special attention must be paid to all persons with suicide tendencies.