INMLCF - Comunicações Científicas e Pósteres
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- Toxicological analysis of cocaine adulterants in blood samplesPublication . Gameiro, Rui; Costa, Suzel; Barroso, Mário; Franco, João; Fonseca, SuzanaBackground & Objectives According to the European Drug Report of 2017, cocaine was the second most widely used drug in 2016, with 3.5 million consumers between 15 and 64 years old. This pattern of consumption also occurs in Portugal (2012). Adulterants are pharmacologically active substances developed for medical purposes (analgesics, local anesthetics, antihistamines, anthelmintics and others). However, there is little knowledge about their influence in the human body when there is concomitant use with cocaine, such as an increase of cocaine toxicity even in non-toxic concentrations. The objective of this work was to validate a method that allows the identification, confirmation and quantification of cocaine adulterants in blood samples collected in vivo or post-mortem. The studied substances (atropine, phenacetin, hydroxyzine, ketamine, lidocaine and tetramisole) were selected taking into account the literature review, the analytical standards and the technical conditions. It is also intended to make a retrospective study of the prevalence of these substances in cases with a positive result for cocaine or its metabolites, as well as their relative concentrations.
- Interactions between tramadol and selective serotonin reuptake inhibitors anti depressants in post mortem casesPublication . Fonseca, Suzana; Franco, JoãoBackground & Objectives Tramadol is very often prescribed for pain management in patients with depression in treatment with selective serotonin reuptake inhibitors (SSRI). Serotonergic antidepressants and its concomitant use with tramadol can lead to a drug–drug interaction, resulting in a decrease in the tramadol analgesic effect and a higher risk of serotonin syndrome caused by the accumulation of serotonin in the central nervous system. These interactions can also change the post-mortem concentrations of the therapeutic drugs and its metabolites, increasing the difficulty in the interpretation of forensic toxicology results, mainly when the concentrations are higher than the therapeutic level. The aim of this study was to review a five-year period of post-mortem cases, in order to examine the prevalence of concomitant use of tramadol and SSRI and the influence in the concentrations found.
- Fatal poisoning by Hemlock water dropwort roots (Oenanthe Crocata )Publication . Costa, Suzel; Franco, João; Barroso, Mário; Carvalho, S.; Fonseca, SuzanaIntrodution : This report describes the history and investigation of a suspected plant poisoning event in Portugal, involving the death of two adult males, who have mistakenly ingested Hemlock water dropwort roots Oenanthe crocata during a 36 h resistance path in May 2017 in Santarém Portugal Six hours after beginning the path, they have called to emergency services for assistance because they suddenly become unwell reporting plants ingestion and describing that they felt nauseated, vomits, seizures and disorientation Both were found dead a few hours later in a rural area In their backpacks, in addition to food supplies, they had fennel and spearmint that were probably picked up on the route Further investigations by police authorities found that during that morning they shared several photos in social media, including screenshots of wild parsnips Pastinaca sativa.
- A silent death sentence. Traumatic vertebral artery dissectionPublication . Simón, A.; Vieira, Duarte Nuno; Simoes da Silva, BeatrizAlthough some traumatic injuries are not noticeable at the time they are produced and cause little or no symptoms, they should not be considered harmless. In fact, some of them can lead to a mortal outcome, if not perceived and treated promptly. This is the case of vertebral artery dissection. Vertebral artery dissection can occur after relatively minor head and neck injuries and precipitating events, mainly associated with minor indirect mechanisms causing hyperextension or sudden rotation of the neck such as motor vehicle accidents. It occurs in association with cervical spine fractures in almost 70% of the cases. Cerebellum and brainstem infarcts are typical findings that arouse neurological symptoms. These symptoms can be delayed in time, (...)
- Drug related deaths (DRD) in Portugal update from the toxicological examinations) and liaison and interactions with hospitalsPublication . Castañera, Antonio; Simões, Susana
- Munchausen by Proxy with Haloperidol: A case reportPublication . Fonseca, Suzana; Dias, MárioIntroduction: An 8-year-old male child with extrapyramidal symptoms was admitted at 3 pm at the Urgency of Pediatric Hospital. Extrapyramidal syndrome (EPS), sometimes referred to as neuroleptic malignant syndrome, is a neurological side effect of antipsychotic medication characterized by a set of symptoms, that include: hyperpyrexia (an early sign of this syndrome), generalized muscle rigidity, tremors, hypersalivation, altered mental status (including catatonic signs), and evidence of autonomic dysfunction (irregular pulse or blood pressure. This child had previous Hospital admissions with similar symptoms and the possibility of a Munchausen by Proxy Syndrome (MBPS) was considered for evaluation. This syndrome is a form of child abuse in which the carer (usually the mother) simulates, manipulates or produces symptoms of illness in the victim. In most cases the detrimental effect is caused by applying foreign substances, sometimes difficult to detect in the clinical laboratories. Serum and urine samples were collected and a toxicological screening in urine was performed at the hospital by immunoassay revealing positive results for barbiturates and amphetamines. A second urine sample, collected 2 hours later, tested negative to all groups screened. The analytical results didn´t matched with clinical disturbances of the patient and further diagnosis procedures yielded no pathological findings. The serum and urine samples were sent to the Department of Chemistry and Forensic Toxicology of National Institute of Legal Medicine and Forensic Sciences (INMLCF) for an extensive screening for drugs and medicines.
- Sudden death, motor vehicle accident, cerebellar tumourPublication . Simoes da Silva, Beatriz; Marques, C.; Coelho, S.; Ribeiro, O.; Vieira, Duarte NunoINTRODUCTION Portuguese forensic law determines that all the mortal victims of traffic accidents must be subjected to a forensic autopsy. In this particular case, a traffic accident with minor injury lead to unbalance a previous tumoral pathology with an unusual location (...)
- Intraventricular brain tumor: report of three casesPublication . Costa, Margarida; Henriques de Gouveia, Rosa; Simoes da Silva, BeatrizIntroduction: Colloid cysts are considered congenital non invasive benign lesions, enlarging very slowly. They account for less than 1% of symptomatic brain tumors, being the most common tumor of the 3rd ventricle (...)
- Estudo de microrganismos relacionados com infeções sexualmente transmissíveis, em contexto de crimes sexuais em Portugal - resultados preliminaresPublication . Catarina Almeida, Ana; Franco, Magda; Cainé, Laura; Amorim, AntónioOs crimes de agressão sexual são considerados como uma das agressões que merecem especial atenção dentro dos sistemas de justiça e são amplamente condenados pelas sociedades em todo o mundo. Além do impacto associado a relações sexuais não consentidas, a agressão sexual pode ter outras consequências para as vítimas, destacando-se o contacto com agentes responsáveis por infeções sexualmente transmissíveis (ISTs). As vítimas de crimes sexuais constituem uma população importante para a investigação de ISTs, dada a exposição a contactos sexuais forçados e maioritariamente desprotegidos. A subnotificação de casos, diferenças de incidência entre as populações e lacunas no processo de deteção, levam a que existam poucos estudos sobre a prevalência de IST em vítimas de crimes sexuais. No entanto, um estudo conduzido por Sachs et al. (2022) refere que a tricomoníase (12%), a gonorreia (4%) e a clamidiose (2%) são as infeções mais prevalentes entre estas vítimas. O Instituto Nacional de Medicina Legal e Ciências Forenses, recentemente, passou a disponibilizar a possibilidade de deteção laboratorial de microrganismos envolvidos nas ISTs mais comuns. Deste modo, o principal objetivo deste trabalho é o estudo dos microrganismos associados a ISTs em vítimas de crimes sexuais em Portugal, através de zaragatoas colhidas das vítimas de casos de agressão sexual para identificação do agressor. Este estudo reflete uma inovação e otimização na aplicação destas metodologias, dado que permitem o uso de uma amostra para identificar o agressor e em simultâneo detetar a presença de microrganismos relacionados com ISTs. Os resultados preliminares deste estudo, desde logo, já permitiram concluir que é possível detetar Trichomonas vaginalis e Chlamydia trachomatis em zaragatoas com amostra colhida e armazenada por um período superior a 2 anos. Neste alinhamento, estes microrganismos associados a tricomoníase e clamidiose já foram detetados em vítimas de crimes sexuais em estudos anteriores.
- Differentiation of selegiline metabolites and illicit methamphetamine and amphetamine use in elderly postmortem cases: Insights from LC-MS/MS and immunoassay techniquesPublication . Costa, Suzel; Rosendo, Luana M.; Barroso, Mário; Franco, João MiguelAbstract: Introduction: In forensic toxicology, distinguishing between pharmaceutical metabolites and illicit substances is crucial for accurate case interpretation. This study explores two post-mortem cases involving elderly individuals where methamphetamine and amphetamine were detected, raising initial concerns about illicit drug use. Aims: To demonstrate the application of liquid chromatography-tandem mass spectrometry (LC-MS/MS) and immunoassay techniques in differentiating between selegiline metabolites and illicit methamphetamine and amphetamine. Methods: Blood samples from three deceased elderly individuals (ages 91 and 89) were analyzed using LC-MS/MS for the quantitative detection of selegiline and metabolites. Initial screening revealed methamphetamine and amphetamine levels suggestive of potential illicit use. Immunoassay testing for dextro isomers (those associated with drug abuse) was subsequently performed to differentiate between isomers. Results and Discussion: LC-MS/MS analysis confirmed selegiline in both cases, with methamphetamine and amphetamine detected. Immunoassay results were negative for dextro isomers, indicating that the detected substances were L-isomers, which is consistent with selegiline metabolism rather than illicit use. Conclusion: This study highlights the critical role of combining LC-MS/MS and immunoassay techniques in forensic toxicology. The negative immunoassay results for dextro isomers clarified that the methamphetamine and amphetamine present were metabolic byproducts of selegiline therapy. Accurate differentiation between therapeutic and illicit substances is essential to avoid misinterpretation, particularly in elderly individuals, where illicit drug use is infrequent. These findings emphasize the need for comprehensive analytical approaches in forensic investigations to ensure accurate and reliable results.