Measurement of drugs in neonatal hair; a window to fetal exposure

Because the hair neonates are born with grows during the last 3 months of pregnancy, the presence of drugs (e.g. cocaine) or environmental toxins (e.g. nicotine) reflects fetal exposure to such compounds. In the case of cocaine, hair measurement are several fold more sensitive than maternal history or urine measurements. Measurements of cotinine in neonatal hair are capable of distinguishing between fetal exposure to passive versus active smoking. Because most cocaine users also smoke cigarettes, neonatal measurements of both cocaine and cotinine will allow cumulative quantification of fetal risk.     

Postmortem redistribution of digoxin in rats

Adult male Wistar rats were treated with either 0.1 or 3 mg/kg body weight X day of digoxin for five days, then killed and stored at 4 degrees C for 12 h in an attempt to mimic the normal preautopsy procedures in our hospital. In rats treated with 0.1 mg/kg body weight X day, the antemortem serum digoxin concentrations (SDC) were 1.1 +/- 0.4 ng/mL while the 12-h postmortem concentration was markedly increased (16.3 +/- 5.9 ng/mL) (P less than 0.01). In rats treated with 3 mg/kg body weight X day, SDC was not changed significantly (11.2 +/- 4.8 ng/mL antemortem and 13.3 +/- 6 ng/mL postmortem). Postmortem redistribution of digoxin was assessed by injection of 125I-labelled digoxin with or without pretreatment with the unlabelled drug. The results indicate that after death passive redistribution of digoxin may take place. When the SDC are within the therapeutic or low toxic range, digoxin may reenter the blood. High antemortem serum concentrations of digoxin may prevent such passive redistribution. Therefore, antemortem digoxin intoxication cannot be reliably inferred on the basis of high postmortem levels of the drug. Digoxin intoxication can be ruled out when postmortem SDC remain within the therapeutic range. The above changes cast doubt on some of the forensic and cardiologic literature, which has in the past been based on incorrect assumptions concerning postmortem behavior of digoxin.     

Discrepancy between CYP2D6 phenotype and genotype derived from post-mortem dextromethorphan blood level

OBJECTIVE: To describe the death of a toddler after a therapeutic dose of dextromethorphan and its investigation. STUDY DESIGN: Case report, cytochrome P450 phenotype and genotype determination in the victim and post-mortem drug redistribution study performed in rats. RESULTS: A 20-month Asian male who received 3 mg of dextromethorphan once at 09:00 h and again at 22:00 h was found dead at 04:35 h. Post-mortem examination showed signs of early bronchopneumonia (bacterial cultures were negative); dextromethorphan and dextrorphan blood concentrations taken from the heart cavity were 500 ng/ml (1. 84 micromol/l) and 200 ng/ml (0.78 micromol/l), respectively. Despite the dextromethorphan level being almost 100-fold higher than expected after therapeutic doses, intentional or unintentional overdose was extremely unlikely; other potential causes were investigated. Post-mortem drug redistribution study performed in rats showed that dextromethorphan does not undergo extensive redistribution after death (6+/-5-fold increase) and could not explain the observed dextromethorphan level. The dextromethorphan/dextrorphan concentration ratio of 2.5 found in this toddler was compatible with a slow CYP2D6 metabolizer phenotype. However, the toddler exhibited a fast metabolizer genotype. Potential reasons for this discrepancy are discussed. CONCLUSION: CYP450 phenotypes derived from post-mortem blood levels should be interpreted with caution and preferably confirmed by a genotype analysis.     

Withdrawn: Hair Analysis for Drug‐Facilitated Crime: The Critical Role of Hair Growth Rate

The following article from the Journal of Forensic Sciences, “Hair Analysis for Drug‐Facilitated Crime: The Critical Role of Hair Growth Rate” by Koren G, Bellaish E, Maman K, published online on 3rd September 2019 (1) on Wiley Online Library has been withdrawn at the authors’ request, and in agreement between the authors, the Journal’s Editorial Office, and John Wiley & Sons, Inc. The withdrawal has been agreed to by all parties due to material included in the article being involved in current litigation. Reference 1. Koren G, Bellaish E, Maman K. Hair analysis for drug‐facilitated crime: the critical role of hair growth rate. J Forensic Sci 2019;54(5):1574–5. https://doi.org/10.1111/1556-4029.14013 .     

Detection of polybrominated biphenyl ethers (PBDEs) in pediatric hair as a tool for determining in utero exposure

This study presents the prevalence of ethanol and illicit drugs in fatal road traffic accident victims in the Centre of Portugal between January 1990 and December 2007. Among the violent deaths, road traffic accidents presented the highest percentage (around 35%; n=3095), but decreasing throughout the years. Accidents were preponderant in males (about 80%; n=2402), between 21 and 30 years-old. Accidents involving drivers (55%; n=1310) were of the most common, being the car the main vehicle (45%), followed by the motorcycle (40%). An alcohol analysis request was present in 50% of the cases (n=1687), but increasing each year. Ethanol concentrations >1.2g/L, the legal limit in Portugal, were found in 55% (n=283) of the cases. Concerning drugs of abuse requests, only 4.4% (n=137) and 17.3% (58 cases) of the cases included the analysis at the Forensic Pathology Department (FPD) and at the Medico-Legal Office (MLO), respectively. Among the road accident cases analysed, 18 were positive, mainly in men (84%), between 21 and 30 years-old; opiates (47.1%; n=8) and cannabinoids (50%; n=4) were the most found, at the FPD and at the MLO, respectively. In conclusion, ethanol was identified as a key factor to traffic accidents, which explains the definition of specific legislation and methods of enforcement to prohibit this form of impairing. Nevertheless, ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in road-traffic crashes, recommending additional actions of supervision and control.     

Food,state power,and rebellion: The case of maize

Why do rebellions occur and persist in some countries but not in others? Evidence shows that natural resources affect the fighting capacity of rebel groups; yet, by focusing on lucrative resources that are rare in most rebellion-afflicted countries, such as oil and diamonds, scholars neglected one necessary input for rebellion: staple crops. Focusing on maize, the world’s most prevalent staple, this study argues that, as one of the most important resources for rebel groups, maize can have a destabilizing effect on the state’s ability to thwart rebellion. These claims are corroborated statistically on a new time-varying, high-resolution global dataset of staple crop productivity, and then qualitatively through an analysis of archival records on the Mau Mau rebellion. In identifying an overlooked, global linkage between agricultural abundance, state capacity, and intrastate violence, this study explains strong geographical and temporal variations in rebellions at both the subnational and global levels.