Krzysztof Borowiak

Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction.

CASE REPORT Intentional intoxication with natural hallucinogenic substances such as hallucinogenic mushrooms continues to be a major problem in the US and Europe, particularly in the harbor complex of northwest Poland (Pomerania). A case is described of Psilocybe intoxication in an 18-year-old man resulting in Wolff-Parkinson-White syndrome, arrhythmia, and myocardial infarction. The indole concentrations of hallucinogenic mushrooms may predict the risk for adverse central nervous system and cardiac toxicity.

Death caused by addictive inhalation of nitrous oxide.

Intoxications with nitrous oxide have been, and still are, a rarity in forensic medicine. Apart from accidental overdose during hospital procedures, intoxication with this gas is the result of voluntary inhalation. We report the fatal case of a 32-year-old male who died during inhalation of nitrous oxide from whipped dairy cream cans and hint on the role of the internet in creating new behaviors among drug addicts. We rely on the autopsy report from the Department of Forensic Medicine, Pomeranian Medical University in Szczecin, on laboratory tests, and court files. Neither the autopsy nor the toxicologic and histopathologic tests disclosed the exact cause of death. However, circumstances in which the body was discovered were indicative that death resulted from cardiorespiratory failure. The present case is interesting with regard to its rarity, diagnostic difficulties and potential harm from nitrous oxide used by the food industry.

Fatal Intoxication with a-PVP, a Synthetic Cathinone Derivative

This study presents the fatal case of a young man who was admitted to the ICAU due to sudden cardiac arrest. An interview revealed that the patient had taken some unspecified crystals. From the moment of admission, his condition deteriorated dramatically as a result of increasing circulatory insufficiency. After a few hours, sudden cardiac arrest occurred again and the patient was pronounced dead. In the course of a medicolegal autopsy, samples of biological material were preserved for toxicology tests and histopathological examination. The analysis of samples using the LC‐MS/MS technique revealed the presence of α‐PVP in the following concentrations: blood—174 ng/mL, urine—401 ng/mL, brain—292 ng/g, liver—190 ng/g, kidney—122 ng/g, gastric contents—606 ng/g. The study also presents findings from the parallel histopathological examination. Based on these findings, cardiac arrest secondary to intoxication with alpha‐PVP was determined as the direct cause of the patients death.

Chlorpropamide Toxicity with Survival Despite 27-Day Hypoglycemia

CASE REPORT In the past 5 years at our institution, 12 cases involving the ingestion of chlorpropamide 3-15 g were fatal. We report a 23-year-old woman with an estimated ingestion of chlorpropamide 5-10 g. Initial cardiovascular collapse, attributed to the blockade of potassium channel transport, responded to intensive support including 3 days of cardiac pacing. Urinary excretion of chlorpropamide and hypoglycemia persisted until day 27. The toxic mechanisms and high risk of chlorpropamide are summarized. A fatal therapeutic dose ratio as low as 4:1 has made this antidiabetic agent obsolete.

Estimation of BDNF gene polymorphism and predisposition to dependence development for selected psychoactive compounds: Genetic aspects of addiction with the selected drugs, amphetamine, tetrahydrocannabinol and opiates

The etiology of drug addiction, a central nervous system (CNS) disease, is not fully known. This complex problem is believed to be connected with concurrently affecting genetic, psychological and environmental factors. The development of addiction is connected with CNS reinforcement system and dopaminergic neurotransmission. Molecular processes are postulated to be of universal character and allow to presume a similar mechanism of dependence for both ethanol and other substances. Therefore, elements of dopaminergic transmission become excellent candidates for the examination of genetic influence on the development of addiction. A relationship between alcoholic disease and the presence of TaqIA1 and DRD2 alleles permits to initiate another investigation of gene-coding DRD2 dopamine receptor. The latest results indicate the importance of brain-derived neurotrophic factor (BDNF) in the regulation of dopaminergic route. The purpose of this research was to reveal the relationship between the Val66Met BDNF gene polymorphism and dependence of psychoactive agent. The examinations were performed with the Local Research Ethics Committee approval and patient’s consent. The study group consisted of 100 patients (88 men and 12 women) aged 18–52 years, qualified for research program according to the International Classification of Diseases, Tenth Revision (ICD-10) requirements, medical examination and detailed questionnaire.

Reaktywność benzodiazepin a metoda immunoenzymatyczna – problemy interpretacyjne

Introduction The progress of civilization and the development of pharmaceuticals industry have caused an increase in psychoactive substances abuse. That is why there are often cases of overdose and poisoning with these substances. Benzodiazepines are among the most commonly used drugs. They are a group of medications producing sedative, anxiolytic, hypnotic, myorelaxant and anticonvulsant effects. Benzodiazepines are a large and diversified group of compounds (over 50 different benzodiazepines are used in clinical treatment), and their metabolites are biologically active. The progress of technology allows the use of more advanced and accurate diagnostic methods. The enzyme multiplied immunoassay technique (EMIT) is a routinely used method in toxicology laboratories, and it is often employed to determine the concentration of benzodiazepines in tested material. This technique is quite easy and quick to perform. However, these advantages have different kinds of consequences, e.g. false-positive results. Therefore, it is important to confirm the results with reference methods. The aim of this study was to evaluate the reactivity of chosen benzodiazepines using the EMITRtoxTMSerum Benzodiazepines Assay. Materials and methods The precision and accuracy of the results were calculated. Nine benzodiazepines were analyzed (chlordiazepoxide, estazolam, flurazepam, medazepam, nitrazepam, nordazepam, oxazepam, prazepam, and temazepam) using the V-Twin System with EMIT technology from Siemens. Every drug was tested 3 times using different concentrations: 300 ng/mL, 1000 ng/mL, and 2000 ng/mL. Results and conclusions The EMIT test showed the highest precision for the quantitative determination of prazepam, and the lowest precision for the determination of nitrazepam and medazepam, whereas the test’s accuracy was highest for the determination of prazepam, and lowest in the case of nitrazepam.

Genetic and Molecular Aspects of Addiction with Tetrahydrocannabinol

Abstract Cannabis sativa derivatives (marijuana, hashish) are currently the most frequently self-administered “soft narcotics” worldwide. Δ9-Tetrahydrocannabinol (THC), as other psychoactive substances, leads to a chronic and recurrent central nervous system (CNS) disease, complex in terms of its etiology, molecular mechanisms, clinical course, and treatment. This phenomenon is thought to be influenced by several concurrently acting genetic, molecular, psychological, and social factors, but the molecular aspects of this process are not fully known yet. The discovery of specific THC receptors—cannabinoid receptors type 1 and 2 (CB1 and CB2)—was a decisive point in research of the biological activity of their compounds. The advance in the neuroscience and discovery of specific THC receptors from CB1 and CB2 class was crucial in research of the biological activity of this compounds but the molecular aspects of this process is not fully known yet. The biological activity of cannabinoids is closely connected with specific receptor–agonist interactions. The brain plasticity functional model offered a new perspective at the cellular and molecular mechanisms of dependence. The deregulation of the reward system of CNS, connected with stimulation of dopaminergic pathway of neurotransmission and CB receptors response, is believed to play a significant part in the addiction process. This mechanism of dependence development seems to be a universal process for most of addictive substances. A long-term exposure to THC action can influence the stimulation of genetically-related changes connected with stimulation of long-term response genes, resulting in irreversible DNA mutation. This process may explain the observed difficulties in successful treatment of addiction diseases. Apart from the natural THC residues, there exists a number of newly designed synthetic cannabinoids. Their structure relationship and biological activity are currently pivotal problems in investigations, because of the phenomena of their receptor related activity, regardless of the distinctly different chemical structures, in comparison with natural Δ9-THC

Chapter 91 – Acute and Long-Term Toxicity Caused by Addictive Inhalation of Nitrous Oxide and Impact on Neuropathology

Abstract Nitrous oxide (N 2 O) is used in many different areas of life. Described mechanisms of action involve mainly κ opioid receptors and N -methyl- d -aspartic acid and γ-aminobutyric acid receptors. Nitrous oxide poisonings have always been rare in the practice of forensic medicine. In addition to accidental overdoses from incorrect administration of anesthesia to a patient in a hospital, toxic effects may occur following the process of chronic abuse, which results in vitamin B 12 inactivation, which causes disorders of the nervous system. Sudden death due to nitrous oxide intoxication is a result of hypoxia, which in histopathologic preparations is observed as an acute anoxemic myocardial damage, pulmonary edema, and cerebral edema, with no abnormalities in the kidneys and liver. These changes, however, are not very characteristic and can be typical of many other causes of sudden death, such as sudden asphyxiation, myocardial infarction (heart attack), hemorrhage, or carbon monoxide poisoning. It should be emphasized that in the absence of information about the circumstances of death, the autopsy, routine toxicology tests, and histopathology usually do not indicate a clear cause of death as a result of nitrous oxide abuse.