This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.
- Klíčová slova
- Hypoglycemia, Insulin overdose, Legal consequences, Methamphetamine, Type I diabetes,
- MeSH
- bezvědomí etiologie chemicky indukované MeSH
- C-peptid krev MeSH
- diabetes mellitus 1. typu * komplikace krev farmakoterapie MeSH
- dospělí MeSH
- fatální výsledek MeSH
- hypoglykemika * krev škodlivé účinky MeSH
- inzulin * krev aplikace a dávkování MeSH
- krevní glukóza analýza MeSH
- lidé MeSH
- methamfetamin * krev škodlivé účinky otrava MeSH
- poruchy spojené s užíváním amfetaminu * komplikace MeSH
- stimulanty centrálního nervového systému * krev škodlivé účinky MeSH
- tanec MeSH
- tělesná námaha MeSH
- záchvaty chemicky indukované etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- C-peptid MeSH
- hypoglykemika * MeSH
- inzulin * MeSH
- krevní glukóza MeSH
- methamfetamin * MeSH
- stimulanty centrálního nervového systému * MeSH
Multidimensional chromatography coupled to tandem mass spectrometry (MS/MS), including simple sample preparation with protein precipitation, anion conversion with ammonium hydroxide, and solid-phase extraction using mixed-mode anion exchange in a 96-well plate format, has been validated for rapid simultaneous analysis of human insulin and its six analogs (lispro, glulisine, glargine, degludec, detemir, and aspart) in human plasma. This method is critical for clinical diagnostics, forensic investigations, and anti-doping efforts due to the widespread use of these substances. In the present study, improved chromatographic resolution was achieved using a first-dimension trap-and-elute configuration with an XBridge C18 (2.1 × 20 mm, 3.5 µm) trap column combined with second dimension separation on a Cortecs Ultra-High-Performance Liquid Chromatography (UHPLC) C18+ (2.1 × 100 mm, 1.6 µm) analytical column implemented within a two-dimensional-LC-MS/MS system. The total chromatographic run time was 11 min. This setup increases both the resolution and sensitivity of the method. A mobile phase consisting of 0.8% formic acid (FA) in water and 0.7% FA in acetonitrile was used for gradient elution. Bovine insulin was used as the internal standard. MS detection was performed in positive electrospray ionization mode, and the ion suppression due to matrix effects was evaluated. Validation criteria included linearity, precision, accuracy, recovery, lower limit of quantitation, matrix effect, and stability tests with and without protease inhibitor cocktail under different conditions (short-term stability, long-term stability, and freeze-thaw stability). The concentration range for all insulins was 50-15 000 pg/mL, with limits of quantification below the therapeutic reference range for all analytes. Intra-run precision ranged from 1.1% to 5.7%, inter-run precision from 0.7% to 5.9%, and overall recovery from 96.9% to 114.3%. The validated method has been implemented successfully by the Department of Forensic Medicine at our hospital for the investigation of unexplained deaths.
- Klíčová slova
- human plasma, insulins, liquid chromatography, mass spectrometry, method validation, stability studies,
- MeSH
- chromatografie s reverzní fází * MeSH
- extrakce na pevné fázi MeSH
- inzulin * krev analogy a deriváty MeSH
- lidé MeSH
- tandemová hmotnostní spektrometrie * metody MeSH
- vysokoúčinná kapalinová chromatografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inzulin * MeSH
This case report presents a rare case of an atypical head stab wound suffered by a drug addict and inflicted with a screwdriver during drug-induced psychosis. It describes the diagnostic and treatment procedures in the hospital and the findings of the subsequent autopsy. It also analyzes the review of the interpretation of the CT scans made upon admission and the subsequent treatment by an independent medical review panel, which revealed signs of medical mismanagement. Therefore, it also discusses the legal consequences that the case may have involved for the attending physicians in addition to the consequences for the suspected perpetrator. The report raises many issues encountered in the case in terms of the clinical treatment and forensic determination of the manner of death in cases of injuries caused by sharp instruments and highlights the importance of comprehensive evaluation of the circumstantial evidence together with the clinical or autopsy findings, since such evidence may sometimes be overlooked in clinical practice.
- Klíčová slova
- Cavernous sinus, Drug-induced psychosis, Hemorrhagic shock, Screwdriver, Stab wound, Suicide,
- MeSH
- bodné rány * patologie diagnostické zobrazování MeSH
- dospělí MeSH
- lidé MeSH
- penetrující poranění hlavy * patologie diagnostické zobrazování etiologie MeSH
- počítačová rentgenová tomografie MeSH
- toxické psychózy * komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
This article describes a method of introducing postmortem CT angiography into daily forensic medicine practice involving cases of limb stab wounds investigated at the Department of Forensic Medicine, University Hospital Ostrava. The essential preparation of the vessels as well as practical tips facilitating the subsequent performance of a classic autopsy are described in detail. Article also includes brief review of published papers dealing with PMCT angiography related issues, advantages which brings CT angiography into forensic routine work, but also its limits and pitfalls.
- Klíčová slova
- Autopsy, forensic medicine, forensic pathology, forensic radiology, postmortem CT angiography, research, sharp force injuries,
- MeSH
- bodné rány * diagnostické zobrazování MeSH
- CT angiografie * MeSH
- lidé MeSH
- pitva * metody MeSH
- soudní lékařství metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: There is an increase in the sale of legal drugs in our country. One of these substances is kratom. Kratom (Mitragyna speciosa) is a partial agonist of the opioid kappa, mu, and delta receptors. It acts as a stimulant at low concentrations, making users feel more energetic and euphoric. It has sedative and antinociceptive effects at higher doses. CASE SUMMARY: An 18-year-old man collapsed during football training and required cardiopulmonary resuscitation; the initial rhythm was ventricular fibrillation managed by defibrillation. Laboratory parameters were unremarkable. Blood samples sent for toxicological evaluation were positive for kratom and caffeine. Echocardiographic examination, coronary computed tomography angiography, and cardiac magnetic resonance imaging did not prove the cause. Genetic testing did not find a pathogenic gene variant associated with familial ventricular fibrillation, but a variant of unknown significance was found in MYOM1. Given this situation, we implanted an implantable cardioverter-defibrillator (ICD) from the secondary prevention of sudden cardiac death (SCD) according to the guidelines of the European Society of Cardiology (ESC). No recurrence of ventricular arrhythmia has been reported by ambulatory ICD memory checks on our patient. DISCUSSION: In some country, kratom is freely available and sold as a plant, not a drug. Only incident cases of ventricular fibrillation after kratom use are described in the literature. There is insufficient scientific evidence linking kratom to ventricular fibrillation. This is an absolutely crucial case report of this type, which has not yet been published in similar circumstances in the world. Therefore, the development of ventricular fibrillation was assumed to be due to a combination of kratom, caffeine, and exercise. The safety profile and effects of kratom should be the subject of future research. We would like to stress the importance of reporting further case series for more scientific evidence and thus increasing the pressure for stricter availability and regulation of kratom in some countries, especially where it is over-the-counter.
- Klíčová slova
- Case report, Implantable cardioverter-defibrillator, Kratom, MYOM1, Mitragyna speciosa, Mitragynine, Ventricular fibrillation,
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
This contribution gives basic information about the mechanical behavior of the facial part of the human skull cranium, i.e., the splanchnocranium, associated with external loads and injuries caused mainly by brachial violence. The main areas suffering from such violence include the orbit, frontal, and zygomatic bones. In this paper, as a first approach, brachial violence was simulated via quasi-static compression laboratory tests, in which cadaveric skulls were subjected to a load in a testing machine, increasing till fractures occurred. The test skulls were also used for research into the dynamic behavior, in which experimental and numerical analyses were performed. A relatively high variability in forces inducing the fractures has been observed (143-1403 N). The results lay the basis for applications mainly in forensic science, surgery, and ophthalmology.
- Klíčová slova
- biomechanics, dynamic loading, experiment, forensic science, fracture, modal analysis, orbital, splanchnocranium, static loading, traumatology,
- Publikační typ
- časopisecké články MeSH
This paper presents a retrospective review of patterns found in cases of homicides by sharp force over a 13-year period at the Department of Forensic Pathology of the Ostrava University Hospital, Czech Republic. The review summarizes all frequently discussed aspects of such cases including the number and localization of injuries, the presence of defensive wounds, the type of the offending weapon, the cause of death, the place of death, victims' and perpetrators' profiles, their relationship, or toxicological findings. Furthermore, special attention was paid to the evaluation of any accompanying blunt force trauma that may be indicative of an escalation of the assault. The set of data was statistically analyzed. Even though most of the results of this review are consistent with available published studies, noteworthy differences have emerged in some aspects such as the sex and age of the victims, the relationship between the number of injuries suffered and the victims' sex, or the severity of alcohol intoxication in victims.
- Klíčová slova
- Assault escalation, Blunt force trauma, Defensive wounds, Homicide, Sharp force trauma,
- MeSH
- lidé MeSH
- oběti zločinu * MeSH
- otrava alkoholem * MeSH
- retrospektivní studie MeSH
- soudní patologie MeSH
- tupá poranění * patologie MeSH
- vražda MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
INTRODUCTION: Tension pneumopericardium is a life-threatening condition, manifesting most commonly as hemodynamic instability caused by cardiac tamponade. Reduced cardiac output and blood pressure can lead to difficulties in the detection of arterial bleeding from associated injuries while the increased venous pressure can increase the rate of bleeding. CASE REPORT: This is the case of a patient after a car accident, with bilateral serial fractures, bilateral pulmonary contusion, bilateral pneumothorax, emphysema of the neck and chest, pneumomediastinum and pneumopericardium, and other injuries. During treatment, the patient developed a gradually progressing hemodynamic instability, resulting in pulseless electrical activity. Further progression of the case is detailed in the paper. CONCLUSIONS: Tension pneumopericardium is a rare complication of a high-energy blunt thoracic trauma that manifests through hemodynamic instability. Its treatment requires early diagnosis and immediate decompression of the pericardial cavity, which should, where possible, be performed even before putting the patient on mechanical ventilation as ventilation bears a high risk of worsening the pneumopericardium due to the increased air pressure in the lungs. During diagnosis and treatment of associated injuries, we must bear in mind that the hemodynamic changes caused by pneumopericardium can mask typical signs of such injuries.
- Klíčová slova
- hemodynamic instability, mechanical ventilation, pneumopericardium, trauma,
- MeSH
- lidé MeSH
- pneumoperikard * diagnostické zobrazování etiologie MeSH
- pneumotorax * terapie MeSH
- polytrauma * komplikace MeSH
- poranění hrudníku * komplikace MeSH
- umělé dýchání škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- disekce aorty * diagnostické zobrazování etiologie MeSH
- dopravní nehody MeSH
- koronární cévy * diagnostické zobrazování MeSH
- lidé MeSH
- motorová vozidla MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Autoerotic asphyxia is a form of deviant sexual behavior that seeks sexual gratification by means of manipulation with one's own body resulting in asphyxia, and may sometimes turn out to be fatal. Autoerotic fatalities involving autoerotic asphyxia are divided into two groups: "typical" autoerotic fatalities involve mechanical compression of the neck, chest or abdomen, whereas "atypical" autoeroticism involves sexual self-stimulation by other means. Cases where asphyxiophilic behavior is accompanied by volatile substance abuse are reported to be rather rare, but may involve a high risk of fatal results. This paper presents a case of accidental "atypical" autoeroticism involving victim's abuse of toluene, which, combined with asphyxiophilic airway occlusion, led to death. For the sake of comprehensiveness, both a verbal description and a schematic representation of the major metabolic pathways of acute and chronic abuse metabolic markers is provided.
- Klíčová slova
- Autoerotic asphyxia, Autoerotic death, Death scene investigation, Intoxication, Toluene, Volatile substances,
- MeSH
- asfyxie etiologie MeSH
- lidé MeSH
- parafilie * komplikace MeSH
- poruchy spojené s užíváním psychoaktivních látek * komplikace MeSH
- sexuální chování MeSH
- toluen MeSH
- úrazy a nehody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- toluen MeSH
