Alexander Pilin

Czech mass methanol outbreak 2012: Epidemiology, challenges and clinical features

Abstract Objectives. Methanol poisonings occur frequently globally, but reports of larger outbreaks where complete clinical and laboratory data are reported remain scarce. The objective of the present study was to report the data from the mass methanol poisoning in the Czech Republic in 2012 addressing the general epidemiology, treatment, and outcomes, and to present a protocol for the use of fomepizole ensuring that the antidote was provided to the most severely poisoned patients in the critical phase. Methods. A combined prospective and retrospective case series study of 121 patients with confirmed methanol poisoning. Results. From a total of 121 intoxicated subjects, 20 died outside the hospital and 101 were hospitalized. Among them, 60 survived without, and 20 with visual/CNS sequelae, whereas 21 patients died. The total and hospital mortality rates were 34% and 21%, respectively. Multivariate regression analysis found pH < 7.0 (OR 0.04 (0.01–0.16), p < 0.001), negative serum ethanol (OR 0.08 (0.02–0.37), p < 0.001), and coma on admission (OR 29.4 (10.2–84.6), p < 0.001) to be the only independent parameters predicting death. Continuous hemodialysis was used more often than intermittent hemodialysis, but there was no significant difference in mortality rate between the two [29% (n = 45) vs 17% (n = 30), p = 0.23]. Due to limited stockpiles of fomepizole, ethanol was administered more often; no difference in mortality rate was found between the two [16% (n = 70) vs. 24% (n = 21), p = 0.39]. The effect of folate administration both on the mortality rate and on the probability of visual sequelae was not significant (both p > 0.05). Conclusions. Severity of metabolic acidosis, state of consciousness, and serum ethanol on admission were the only significant parameters associated with mortality. The type of dialysis or antidote did not appear to affect mortality. Recommendations that were issued for hospital triage of fomepizole administration allowed conservation of valuable antidote in this massive poisoning outbreak for those patients most in need.

Changes in colour of different human tissues as a marker of age

This study deals with age estimation based on colour changes of human tissue from the intervertebral discs, Achilles tendon and rib cartilage. The investigated colour changes are the result of the accumulation of non-enzymatic browning products in the tissue. Samples of excised tissues were photographed with a digital camera and the pictures were evaluated using the image analysis processor Lucia G 4.11 processor. The values of the intensities of the RGB channels (MeanRed, Mean Green, MeanBlue) and parameters from the IHS system (MeanSaturation, HueTypical, HueVariation, BrightVariation and MeanBrightness) were evaluated. The results confirm that colour changes of some tissues depend on ageing and are a good tool for age estimation.

The use of the D-, L- aspartic ratio in decalcified collagen from human dentin as an estimator of human age.

Among the methods dealing with the age estimation, the evaluation of the ratio of the D-, L- form of the aspartic acid in tissues with a low metabolic turnover is considered to be the most precise. We introduced demineralization of the dentin with 0.5 M EDTA adjusted to pH = 7.4. The advantage of such a procedure is that after demineralization we obtained pure insoluble protein (collagen) and soluble noncollagenous proteins in one step. In this study we analyzed insoluble collagen. The amino acids obtained after the hydrolysis were derivatized into TFA isopropyl esters and analyzed by gas chromatography on Chirasil L-Val capillary column. We analyzed human dentin from the lower canines. The correlation coefficient was 0.93 for our set of 71 persons. The result concurred with those of other scientists.

Characterization of Two Historic Smallpox Specimens from a Czech Museum

Although smallpox has been known for centuries, the oldest available variola virus strains were isolated in the early 1940s. At that time, large regions of the world were already smallpox-free. Therefore, genetic information of these strains can represent only the very last fraction of a long evolutionary process. Based on the genomes of 48 strains, two clades are differentiated: Clade 1 includes variants of variola major, and clade 2 includes West African and variola minor (Alastrim) strains. Recently, the genome of an almost 400-year-old Lithuanian mummy was determined, which fell basal to all currently sequenced strains of variola virus on phylogenetic trees. Here, we determined two complete variola virus genomes from human tissues kept in a museum in Prague dating back 60 and 160 years, respectively. Moreover, mass spectrometry-based proteomic, chemical, and microscopic examinations were performed. The 60-year-old specimen was most likely an importation from India, a country with endemic smallpox at that time. The genome of the 160-year-old specimen is related to clade 2 West African and variola minor strains. This sequence likely represents a new endemic European variant of variola virus circulating in the midst of the 19th century in Europe.

A rare case of evisceration

Abstract A case of homicide is described where the body of a young woman was found in the countryside in a state of advanced decomposition. The autopsy revealed that almost all the internal organs were missing, but not due to putrefaction. The thoracic cavity was opened in the professional manner normally used during an autopsy. The remains of the small intestine were tied with strands of hair braided into a thin cord.

DETERMINATION OF THE SIZE OF A FOREIGN BODY IN THE EYE USING IMAGE ANALYSIS OF ITS ROENTGENOGRAM

The case of a computer-enhanced image analysis of X-ray pictures of a pellet in the orbit of a man who sustained a shotgun injury to his right eyeball is presented. The man was shot accidentally during a pheasant hunt. Two hunters were shooting simultaneously but they were using three different sizes of pellet--3.0, 3.5 and 4.0 mm. One of the pellets hit a third man in the eye. He sustained serious injury with a resultant loss of sight in this eye despite immediate medical treatment. Unfortunately the pellet could not be removed from the orbit, but it was necessary to establish who was responsible for the injury. The problem lay in determining the specification and size of the pellet at that moment. The problem was solved using computer-enhanced video image analysis of the X-ray pictures of the pellets. The image processor LUCIA G (http(/)/www.lim.cz) was used.