Daniel Romero Muñoz

Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil

Drugs are important risk factors for traffic accidents. In Brazil, truck drivers report using amphetamines to maintain their extensive work schedule and stay awake. These drugs can be obtained without prescription easily on Brazilian roads. The use of these stimulants can result in health problems and can be associated with traffic accidents. There are Brazilian studies that show that drivers use drugs. However, these studies are questionnaire-based and do not always reflect real-life situations. The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State, Brazil, during 2009. Drivers of large trucks were randomly stopped by police officers on the interstate roads during morning hours. After being informed of the goals of the study, the drivers gave written informed consent before providing a urine sample. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Urine samples were screened for amphetamines, cocaine, and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry (GC-MS). Of the 488 drivers stopped, 456 (93.4%) provided urine samples, and 9.3% of them (n=42) tested positive for drugs. Amphetamines were the most commonly found (n=26) drug, representing 61.9% of the positive samples. Ten cases tested positive for cocaine (23.8%), and five for cannabinoids (11.9%). All drivers were male with a mean age of 40 ± 10.8 years, and 29.3% of them reported some health problem (diabetes, high blood pressure and/or stress). A high incidence of truck drivers who tested positive for drug use was found, among other reported health problems. Thus, there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aimed at controlling the use of drugs by truck drivers in Brazil.

Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo

AIMS The aims of the present study were to characterize fatal traffic accident victims in a major urban center in Brazil and their association with alcohol consumption. METHODS Cross-sectional study of 907 fatal traffic accident victims in Sao Paulo, in 2005. RESULTS Adult males between the ages of 25 and 54 represented the majority of cases with positive blood alcohol concentrations (BAC). Overall, males had a higher proportion of BAC and mean BAC than females. Pedestrians, particularly those with no detectable BAC, were typically older than other victims. Most accidents (total and BAC-positive) happened on weekends between midnight and 6 a.m. Considering all victims, 39.4% were positive (BAC over 0.1g/l). When only drivers (automobile, motorcycle and bicycle) were evaluated, 42.3% had BAC over the legal limit (0.6g/l). CONCLUSIONS Alcohol is associated with nearly half of all traffic accident deaths in the city of Sao Paulo, especially for days and times associated with parties and bars (weekends between 12 a.m. and 6 a.m.).

Brazilian normal static bone histomorphometry: effects of age, sex, and race

Bone histomorphometry values for normal individuals within different populations have been well established. We studied iliac crest bone samples from 125 healthy Brazilian subjects. The effect of sex, race, and age variables on histomorphometric parameters was evaluated. Bone volume showed a trend to decrease with age in both sexes, being significantly higher in black females and Caucasian males. Interactions among sex, race, and age had no effect on trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). However, age had a significant effect on Tb.Th and Tb.Sp, and sex had an impact on Tb.Sp. Trabecular number (Tb.N) was higher in black females than in males and was higher in Asian males than in females. Among females, Tb.N was lower in Asians than in other races and was higher in blacks than in Caucasians and or in those of mulattos. In addition, Tb.N was higher in males under 10 than in males over 50 years old, was higher in females under 10 than in females in any other age bracket, and was lower in females in the 41–50 age bracket than in younger females. Osteoid volume and osteoid surface were significantly higher in males than in females, and a significant age-related difference in osteoid thickness was observed. No significant sex-related or race-related differences were found in terms of resorption, although eroded surface decreased with age. In conclusion, sex, race, and age, as well as interactions among these three variables, were found to affect some static histomorphometric indexes in healthy Brazilian subjects.

Pulmonary alterations in cocaine users

CONTEXT Brazilian researchers have recently recognized a marked increase in the number of people using abusable drugs and the consequences of this habit. It has become a major public health problem in a potentially productive segment of the general population. In the last few years, several medical articles have given special emphasis to pulmonary complications related to cocaine use. This review is based on this information and experience acquired with groups of cocaine users. OBJECTIVE To present to physicians the pulmonary aspects of cocaine use and warn about the various effects this drug has on the respiratory system, stressing those related to long-term use. DESIGN Narrative review. METHOD Pulmonary complications are described. These may include infections (Staphylococcus aureus, pulmonary tuberculosis, acquired immunodeficiency syndrome/aids, etc.), aspiration pneumonia, lung abscess, empyema, septic embolism, non-cardiogenic pulmonary edema, barotrauma, pulmonary granulomotosis, branchiolitis obliterans and organizing pneumonia, pneumonitis and interstitial fibrosis, pneumonitis hypersensitivity, lung infiltrates and eosinophilia in individuals with branchial hyperreactivity, diffuse alveolar hemorrhage, vasculitis, pulmonary infarction, pulmonary hypertension and alterations in gas exchange. It is concluded that physicians should give special attention to the various pulmonary and clinical manifestations related to cocaine use, particularly in young patients.

Human identification and analysis of DNA in bones

The introduction of molecular biology techniques, especially of DNA analysis, for human identification is a recent advance in legal medicine. Substantial effort has continuously been made in an attempt to identify cadavers and human remains after wars, socio-political problems and mass disasters. In addition, because of the social dynamics of large cities, there are always cases of missing people, as well as unidentified cadavers and human remains that are found. In the last few years, there has also been an increase in requests for exhumation of human remains in order to determine genetic relationships in civil suits and court action. The authors provide an extensive review of the literature regarding the use of this new methodology for human identification of ancient or recent bones.

Álcool em vítimas de suicídio em São Paulo

CONTEXTO: A tendencia a comportamentos violentos e impulsivos e aumentada apos o consumo de alcool, sendo importante para a etiologia de mortes por causas externas. Nesse contexto, os suicidios aparecem como uma atitude impulsionada pelo consumo de alcool, ou como uma expressao da mesma patologia que leva ao abuso de substância. OBJETIVOS: Como carecemos de dados nacionais sobre suicidios sob a influencia de alcool, o objetivo do presente estudo foi analisar a prevalencia do consumo de alcool previamente ao suicidio. METODOS: Leitura direta de 632 laudos necroscopicos de vitimas de suicidios necropsiadas no Instituto Medico-Legal do Estado de Sao Paulo no ano de 2005. RESULTADOS: Dos 632 casos analisados, 33,1% apresentaram alcoolemia positiva, sendo essa prevalencia maior para os homens (37,1%) do que para as mulheres (20,1%). Os enforcamentos apresentaram a maior prevalencia de alcoolizados, com 38,9% dos casos; as intoxicacoes apresentaram a maior media, com 1,78 g/L. CONCLUSOES: Os resultados mostram que cerca de um terco dos suicidios na amostra foram cometidos subsequentemente ao consumo de alcool, com diferencas entre os diversos metodos.

Alcohol consumption in homicide victims in the city of São Paulo.

AIMS To assess the association between alcohol use and victimization by homicide in individuals autopsied at the Institute of Legal Medicine in São Paulo, Brazil. DESIGN Cross-sectional study. SETTING Excessive consumption of alcohol is a serious public health issue and a major factor in triggering violent situations, which suggests a strong association between alcohol ingestion and becoming a victim of homicide. PARTICIPANTS Data from 2042 victims of homicides in 2005 were obtained from medical examiner reports. MEASUREMENTS The victims gender, age, ethnicity and blood alcohol concentration (BAC) were collected. The method of death and homicide circumstances, as well as the date, time and place of death were also studied. FINDINGS Alcohol was detected in blood samples of 43% of the victims, and mean BAC levels were 1.55 +/- 0.86 g/l. The prevalence of positive BAC levels was higher among men (44.1%) than women (26.6%), P < 0.01. Firearms caused most of the deaths (78.6%), and alcohol consumption was greater among victims of homicide by sharp weapons (P < 0.01). A greater proportion of victims with positive BAC were killed at weekends compared to weekdays (56.4 and 38.5%, respectively; P < 0.01), and the correlation between homicide rates and the average BAC for the central area of the city was positive (r(s) = 0.90; P < 0.01). CONCLUSIONS These results highlight alcohol as a contributing factor for homicide victimization in the greatest urban center in South America, supporting public strategies and future research aiming to prevent homicides and violence related to alcohol consumption.

A qualitative study of compact bone microstructure and nuclear short tandem repeat obtained from femur of human remains found on the ground and exhumed 3 years after death.

Forensic identification of human remains is composed of anthropological study of race, sex, age, etc. By using these traditional methods, inconclusive or nonidentified cases could be subjected to DNA analysis. However, in spite of advances in human identification techniques, especially by PCR-amplified DNA, some limitations that affect the ability of obtaining DNA from human remains still persist. Light microscope sections of postmortem compact bones from human remains are presented here for the purpose of increasing a forensic examiners prediction of successful nuclear DNA typing. Femoral compact bones were obtained from 7 human remains found on the ground, in different degrees of decomposition, and were cleaned by boiling to remove soft tissues, 8 collections of bones having undergone natural decomposition, not boiled (as no soft tissue was adhered), and 5 cadavers 12 to 16 hours postmortem. The histologic sections were stained by hematoxylin and eosin, the loci CSF1PO, TPOX, TH01, F13A01, FESFPS, vWA, D16S539, D7S820, D13S317, and amelogenin were amplified by PCR, and the polyacrylamide gel was stained with silver. The results presented here clarify questions concerning the viability of DNA for identification analysis, and they also may help to establish better strategies for optimization of DNA extraction and analysis in compact bones of human remains.

Determination of opiates in whole blood and vitreous humor: a study of the matrix effect and an experimental design to optimize conditions for the enzymatic hydrolysis of glucuronides.

Undoubtedly, whole blood and vitreous humor have been biological samples of great importance in forensic toxicology. The determination of opiates and their metabolites has been essential for better interpretation of toxicological findings. This report describes the application of experimental design and response surface methodology to optimize conditions for enzymatic hydrolysis of morphine-3-glucuronide and morphine-6-glucuronide. The analytes (free morphine, 6-acetylmorphine and codeine) were extracted from the samples using solid-phase extraction on mixed-mode cartridges, followed by derivatization to their trimethylsilyl derivatives. The extracts were analysed by gas chromatography-mass spectrometry with electron ionization and full scan mode. The method was validated for both specimens (whole blood and vitreous humor). A significant matrix effect was found by applying the F-test. Different recovery values were also found (82% on average for whole blood and 100% on average for vitreous humor). The calibration curves were linear for all analytes in the concentration range of 10-1,500 ng/mL. The limits of detection ranged from 2.0 to 5.0 ng/mL. The method was applied to a case in which a victim presented with a previous history of opiate use.

Child abuse: skin markers and differential diagnosis

Reports of child abuse have increased significantly. The matter makes most physicians uncomfortable for two reasons: a) Little guidance or no training in recognizing the problem; b - Not understanding its true dimension. The most common form of child violence is physical abuse. The skin is the largest and frequently the most traumatized organ. Bruises and burns are the most visible signs. Physicians (pediatricians, general practitioners and dermatologists) are the first professionals to observe and recognize the signs of intentional injury. Dermatologists particularly, can help distinguish intentional injury from accidental, or from skin diseases that mimic maltreatment.