Poisonings with diphenhydramine--a survey of 68 clinical and 55 death cases

The antihistaminic drug diphenhydramine (DPH) is mainly used as a sedative, hypnotic and antiemetic. In many countries it is over-the-counter available, very common, and generally regarded as a harmless drug. Sixty-eight non-fatal and 55 fatal poisonings with DPH alone or in combination with other drugs were investigated in the Institute of Legal Medicine of the University Hospital Charité between 1992 and 2004. The analytical investigations were performed by HPLC with photodiode array detector (HPLC-DAD). The DPH concentrations ranged from 0.5 to 8.9 microg/mL in the non-fatal cases and from 0.3 to 119 microg/mL in fatal cases. The intoxication symptoms stated during emergency admission were inconsistent, with somnolence, sedation and retardation on one hand and tachycardia, anticholinergic syndrome, agitation, hallucinations, confusion, tremor, convulsions, delirium and coma on the other. In three cases rhabdomyolysis occurred. A concentration above 5 microg/mL can be regarded as potentially lethal. In many of the survivors the time course of the concentrations of DPH and the metabolites desmethyldiphenhydramine (DM-DPH) and diphenylmethoxyacetic acid (DPMA) were investigated. Whereas DM-DPH is present in blood from the very beginning because of the high first pass metabolism, DPMA is slowly formed over several metabolic steps. For this reason, the concentration ratio DPMA/DPH can be used for an approximate estimation of the time between drug intake and sampling in clinical cases or of the survival time after drug ingestion in death cases. In some of the deaths the concentrations in heart blood were much higher than in venous blood. This is explained mainly by agonal aspiration of the vomited gastric content. Besides the majority of suicidal cases also a case of child maltreatment and a case, in which the drug was forcibly administrated in a drug facilitated crime, were investigated. From the results it follows that diphenhydramine is not less poisonous than other prescribed hypnotics. However, despite the hallucinogenic effects, an abuse for recreational purposes was not observed until now.     

Analysis of hydrogen peroxide field samples by HPLC/FD and HPLC/ED in DC mode

The goal of this paper is to describe applications of two recently developed HPLC methods for the analysis and confirmation of the presence of hydrogen peroxide residues in field studies. The procedure utilizes two different HPLC systems, one with post-column derivatization followed by fluorescence detection (HPLC/FD), and the other with electrochemical detection (HPLC/ED). The two systems were utilized to detect hydrogen peroxide in a variety of typical forensic samples including pre- and post-blast samples, as well as a series of environmental control samples. Peroxide-based organic explosives were also examined due to their propensity to produce peroxide residues following detonation. Because samples collected from post-blast scenes are frequently shipped or stored prior to analysis, the effects of storage time, temperature and type of substrate material on the recovery of hydrogen peroxide residues were also investigated. The combined results of the study demonstrate the capability of two HPLC approaches with selective detection in the analysis and investigation of suspected incidents involving peroxide based explosives.     

The possibility for determining haptoglobin phenotypes in blood stains after treatment with a luminol solution

The paper gives the results of tests for influence of luminol solution of different composition on detectability of haptoglobin fractions in the bloodstains of different ages. It was stated that alkaline luminol solutions reduce intensity of fractions and may hamper Hp phenotype determination especially in old stains.     

Biomedical patents and ethics: a Canadian solution

World Trade Organization member states are preparing for the upcoming renegotiation of the Agreement on Trade-Related Aspects of Intellectual Property Rights. One of the important elements of that renegotiation is the ethical considerations regarding the patenting of higher life forms and their component parts (e.g. DNA and cell-lines). The interface between the genetic revolution, patentability, and ethical considerations is the subject of this article. The author identifies, explores, and critiques four possible positions Canada may adopt in respect of patentability of biomedical material. First, Canada could do nothing. This approach would mean keeping biomedical materials outside the patent system and outside the stream of commerce. Canada would simply wait for an international consensus to develop before adopting a position of its own. Second, Canada could go it alone. It could implement a policy that balances the incentive effects of patents with the need to incorporate ethical and social values into the decision-making process regarding the use of biomedical materials. In respect of this option, the author proposes a model whereby non-profit bodies would hold the exclusive rights to research, use, and exploit biomedical materials. Third, Canada could follow the United States, Europe, and Japan by providing for almost unrestricted patenting of biomedical materials. This would be the most industry-friendly alternative. The fourth and final option is to use the medicare system to promote discussion of ethical considerations involved in the use of biomedical materials. The power of provincial health agencies may be used as a lever to ensure the discussion of ethical considerations concerning the use of biomedical materials. The author concludes that the fourth and final option is the best alternative for Canada while waiting for an international consensus to emerge.     

How to deal with virtual property crime: Judicial dilemma and a theoretical solution from China

In recent years, China has evidenced a large number of criminal precedents on virtual property crime, but how to deal with it remains controversial, both theoretically and practically. Thus, systematic studies based on relevant precedents and doctrines are urgently needed from three perspectives: the conceptual boundary of virtual property, the judicial application of virtual property crime and the determination of the quantitative element of virtual property crime. Accordingly, the current research also seeks to shed light on other countries facing the same issues. In the context of criminal law, virtual property should be screened by three substantive criteria: digitization, value and scarcity. Whether virtual property is identified as a property right or a contractual claim in the field of civil law will not substantially affect the determination of criminal responsibility. Virtual property has both property and data features, and the different legal interests carried by both should be protected by criminal law. For the judicial application of virtual property crime, there are three approaches: property crime, data crime and computer crime. The three do not have a ranking or mutually exclusive relationship, and the principle of ideal concurrence (Idealkonkurrenz) should be applied. When determining the quantitative element of property crime, two different types of users and game operators should be distinguished, and the actual property damage standard should be favoured. When considering data and computer crime to determine the quantitative element, we should not rely excessively on the criteria of illegal income and economic loss, but should make a comprehensive Judgment around the degree of legal interest infringement.     

Poisoning with sodium hypochlorite solution. Report of a fatal case, supplemented with an experimental and clinico-epidemiological study.

A case of fatal poisoning in a 1-year-old girl after ingestion of a household cleanser containing 4.5% sodium hypochlorite (Klorin) in an alkaline solution (pH 12.0) is reported. The forensic medical and toxicological investigations were supplemented by animal studies. These studies indicate that 5, 10, and 15 ml of Klorin/kg body wt given to rats is highly toxic, and that local tissue damage and secondary systemic involvement develops with a severity corresponding to the amount administered. The rats, all of which died, showed various degrees of degeneration and necrosis of the esophagoventricular mucosus membranes, changes analogous to those found at the autopsy of the child. A follow-up investigation of similar cases reported to the Swedish Poison Information Centre, during a limited time, was made to complete the picture.     

Police services detention centres: a proposed solution for action

Police services face daily challenges dealing with the health issues displayed by individuals in their custody. They often find themselves isolated from the services that can help the most. This paper scopes relevant literature on these challenges and some of the interprofessional interventions which have emerged to address them, such as the diversionary practices of crisis intervention teams, street triage, nurses in custody suites, and court liaison and diversion. Remote presence technology is proposed to be an innovative solution that can help to provide more efficient and effective pathways for care in Police Detention Centres. Remote presence technology has the ability to significantly affect the way interprofessional collaboration can take place for those in police custody.     

Stable hydrogen isotope analysis as a method to identify illegally trapped songbirds

We measured stable hydrogen isotope ratios in the primary feathers of two subspecies of goldfinches, confiscated by the Police and the Royal Society for the Prevention of Cruelty to Animals (RSPCA) on suspicion that they had been illegally taken from the wild. We found significant differences in the delta2H values of the two subspecies indicating that they were sourced from different geographical regions. Our results correlated with isotopic precipitation maps and with the known distribution of the two subspecies of goldfinch. We believe that this technique could be used by law enforcement agencies to determine the origin of birds in cases where the species or subspecies involved are geographically distinct.