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The problem of finding a suitable biomarker to widen the detection window of γ-hydroxybutyric acid (GHB) intake remains a challenge in forensic toxicology. Based on previously published results, the present study deals with the evaluation of a fatty acid ester of GHB (4-palmitoyloxy butyrate [GHB-Pal]) in whole blood as a potential biomarker to extend the detection window of GHB use, e.g. in drug-facilitated sexual assaults. A liquid chromatography–mass spectrometry (LC–MS–MS) method for the quantification of GHB-Pal in whole blood was validated. Whole blood samples were collected from subjects involed in police roadside controls (n  = 113) and from narcolepsy patients (n  = 10) after the controlled administration of Xyrem® (sodium oxybate). Both sample collectives were previously tested for GHB using two different methods: ultra-performance liquid chromatography–tandem mass spectrometry (UPLC–MS–MS) and gas chromatography–mass spectrometry (GC–MS). In samples from routine police casework, GHB-Pal was detected in 67 out of 113 analysed GHB-positive samples with a mean concentration of 0.8 ng/mL ± 0.5 ng/mL (standard deviation). Among samples that were tested positive for both compounds, no linear correlation was observed between GHB and GHB-Pal concentrations (r  = 0.508). In contrast, GHB-Pal was not detected in any of the blood samples analysed from the patients. The absence of GHB and GHB-Pal in the patient cohort may be attributed to the time interval between dose intake and blood collection (approximately 3 and 6 h), during which GHB was eliminated from the body. Furthermore, GHB-Pal was only detectable at a GHB concentration of at least 16 µg/mL, which indicates that endogenous concentrations or low GHB doses may not be sufficient for GHB-Pal formation. Due to missing correlation between both compounds and the lack of GHB-Pal detection several hours after GHB administration, it can be assumed that GHB-Pal in blood is not a suitable biomarker to widen the detection window of GHB. [ABSTRACT FROM AUTHOR]

The prevalence of mitragynine (kratom) in forensic toxicology casework has steadily increased over time. Readily available and currently legal, mitragynine is widely used for its stimulant and, depending on concentration, sedative effects. Our laboratory analyzed various fluid and tissue specimens from 51 postmortem cases to investigate the distribution of mitragynine and its active metabolite 7-hydroxymitragynine. Central and peripheral blood concentrations were compared, with an average heart blood to femoral blood ratio being 1.37 for mitragynine and 1.08 for 7-hydroxymitragynine. This ratio >1.0 suggests that mitragynine has some propensity toward postmortem redistribution; however, the difference in concentrations of mitragynine and 7-hydroxymitragynine is not statistically significant. Large average mitragynine to 7-hydroxymitragynine ratios of 30.9 in femoral blood and 32.4 in heart blood were observed compared to average ratios of 14.8 in vitreous humor and 16.9 in urine. In addition, the stability of these two compounds was investigated in both matrix and organic solvent. When stored refrigerated (4°C), mitragynine was stable for up to 30 days and 7-hydroxymitragynine was stable for up to 7 days with an analyte loss of <20%. Following 60 days of refrigerated storage, 7-hydroxymitragynine concentrations dropped over 50% from initial concentrations. Methanolic preparations of mitragynine and 7-hydroxymitragynine were stable following 3 months of storage at −20°C. [ABSTRACT FROM AUTHOR]

Cognitive enhancement through stimulants such as modafinil is becoming increasingly popular, with many individuals using prescription stimulants for non-medical purposes to improve alertness, attention, and mood. The misuse of such substances has raised concerns, particularly in forensic toxicology. The UHPLC-QqQ-MS/MS method was developed to quantify modafinil in evidentiary samples and biological materials. Additionally, the authors noted the presence of sodium adducts during the analysis of samples with high concentrations of modafinil. The method was validated for accuracy, precision, and linearity, with a concentration range of 0.1–10.0 µg/mL for the evidences and 1.0–100.0 ng/mL for blood. The method successfully detected modafinil as the sole substance in all evidences, with concentrations ranging from 90.7 to 120.8 mg, corresponding to 45.5% to 80.5% of the labeled dose. The method was applied to real post-mortem human cases, where, among others, the concentration of modafinil in blood was 110 ng/mL, whereas, in another case, the concentration of modafinil in the putrefaction fluid exceeded 1000 ng/mL. The developed UHPLC-QqQ-MS/MS method is effective for the quantification of modafinil in evidentiary samples and biological materials, offering a reliable tool for forensic toxicology applications. This method can be used to evaluate modafinil use in both legal and illicit contexts, including cases of overdose or misuse. [ABSTRACT FROM AUTHOR]

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Background Papillary muscles are one of the important components of musculature of ventricles in the human heart. It plays an important role for proper cardiac valvular function of the heart. The shape of papillary muscle of right and left ventricles is important for the cardiac surgeons in surgical procedures like mitral valve replacement and use of mitral valve homograft for mitral/tricuspid replacement. Methodology This study was conducted in the Department of Anatomy, Gauhati Medical College and Hospital using 40 formalin fixed adult human heart which were collected from Department of Anatomy and Department of Forensic Medicine & Toxicology, GMCH after completing the medico-legal formalities. The ventricles were opened by making incisions along the sternocostal surface to expose the interior of heart and the shape of papillary muscles were observed both in right and left ventricles. Results & Statistical Analysis In this study the right ventricle showed 30% of conical shaped papillary muscle, 20% of the flat topped shaped papillary muscle and 10% of the truncated shaped papillary muscle were found. In the left ventricle shows 40% of the conical shaped papillary muscle, 22% of the truncated shape of papillary muscle and 15% of the flat-topped shape of papillary muscles were found. Conclusions The papillary muscles have complex anatomy structure having the shape of conical, flattop, truncated, bifurcated and trifurcated, so knowledge of these variation in papillary muscle during repair procedure and screening of hypertrophy is of utmost importance for cardiac surgeons. [ABSTRACT FROM AUTHOR]

A 77‐year‐old professional gold craftsman ingested a white powder used in goldsmithing, mistaking the powder for a health supplement. He detected a strange taste and immediately fell sick, reported the incident to 911, and was taken to the emergency room. He died approximately 8.5 h post‐ingestion despite treatment. There were no significant findings in the autopsy, the victim's heart blood sample, gastric contents, and the white powder the victim had taken were submitted to the department of forensic toxicology. Using scanning electron microscopy energy dispersive X‐ray analysis, potassium and gold (Au) were detected in the white powder. Ion chromatography analysis detected cyanide. Concentrations of cyanide were 0.5 mg/L in heart blood and 13.3 mg/L in gastric contents. Qualitative and quantitative analyses of Au in the heart blood sample and gastric contents using inductively coupled plasma‐optical emission spectrometry detected concentrations of 79.8 mg/L and 2010.1 mg/L, respectively. Au and cyanide synergistically enhance cytotoxicity through inhibition of detoxification and increasing intracellular accumulation. In the present case, the detected blood cyanide concentration was sub or minimally lethal, and the blood Au concentration was high. The cause of the victim's death was the combined toxicity of Au and cyanide. [ABSTRACT FROM AUTHOR]

Background: Approximately 1% of Sweden's 90 000 annual deaths were reported caused by poisoning. In this study, we aim to describe this poisoning population's characteristics, autopsy frequency and results of toxicology testing. Method: A national cohort study based on Swedish national registers. All deceased subjects older than 18 years with poisoning as the cause of death registered between 1 January 2000 and 31 December 2021 were included. Causes of death according to primary ICD‐10 code were analysed along with the substances found in forensic chemistry testing. Results: There were 27 057 poisonous deaths during the study periods 2 018 495 adult deaths. Subjects deceased due to poisoning had a median age of 53 years, and 18 838 (70%) were men. A private home was the most reported location of death (52%). In total, 23 260 (87%) did undergo some sort post‐mortem examination. Drugs (synthetic narcotics, opioids, heroin) caused 12 448 (46%) deaths, and alcohols explained 9056 cases (33%). Positive toxicological tests were found in 22 550 (83%) of the subjects. The most common separate substances were ethanol, zopiclone and nordazepam. Conclusion: Poisoning caused 1.3% of Swedish deaths. Men in their 50s were the most common victims, and their deaths were often cause by synthetic narcotics, other opioids or alcohol. The autopsy frequency was lower than expected for poisonous deaths. [ABSTRACT FROM AUTHOR]

The long-term stability of drug concentrations in human plasma samples, when stored under normal laboratory conditions over several years, is important for research purposes and clinical re-evaluation, and forensic toxicology. Fifty human plasma samples from a former clinical trial were re-analyzed after storage at −20°C for 11 years. Plasma samples were extracted using solid-phase extraction. Isotope labeled sufentanil-d5 was used as internal standard. Sufentanil plasma concentrations were determined by ultra-performance liquid chromatography with gradient elution, followed by tandem mass spectrometry with electrospray ionization. The linear dynamic range was 25–2500 pg/mL, the limit of detection was 10 pg/mL, and the lower limit of quantification was 25 pg/mL. Intra- and inter-assay error did not exceed 6%. The deviation of the measured sufentanil plasma concentrations between the re-analysis and the first analysis was −63 ± 14% (mean ± SD). Therefore, sufentanil concentrations in human plasma were not stable in samples frozen at −20°C over 11 years. [ABSTRACT FROM AUTHOR]

In illicit drug markets, the most recently expanding new synthetic opioid subclass is benzimidazoles, also known as nitazenes, which were originally developed as analgesics in the 1950s. The emergence of this classical, potent drug family has attracted extensive research interest in the field of forensic toxicology; however, information on their psychological and physical dependence is very limited. Herein, we evaluated the rewarding effects of four nitazene analogs using a battery of in vivo experiments, with a positive control drug (isotonitazene). The four test materials, metonitazene, etodesnitazene, metodesnitazene, and flunitazene, were administered to male C57BL/6J mice by i.p. administration at 0.5, 2, 20, and 20 mg/kg, respectively. In comprehensive behavioral observation tests, representative opioid-related physiological and behavioral states, including analgesia, stereotypic circling behavior, hyperlocomotion, and Straub tail response, were observed. A set of conditioned place preference tests revealed that all the four analogs induced palatability in mice. Furthermore, measurements of dopamine levels in the nucleus accumbens shell by in vivo microdialysis resulted in significant elevations in all test material-treated groups, suggesting that the nitazenes elicit the rewarding effect through a neural circuit originating from the μ-opioid receptor activation at the ventral tegmental area. Our findings add important data regarding the psychological dependence of nitazenes and highlight the abuse potential of these four materials and other prevailing nitazene analogs. [ABSTRACT FROM AUTHOR]

Volumetric absorptive microsampling (VAMS) is an emerging technique in clinical and forensic toxicology. It is recognized as a promising alternative to traditional sampling methods, offering an accurate and minimally invasive means of collecting small volumes of biological samples, such as blood, urine, and saliva. Unlike conventional methods, VAMS provides advantages in terms of sample stability, storage, and transportation, as it enables samples to be collected outside laboratory environments without requiring refrigeration. This review explores several VAMS methodologies, with a particular focus on its application for the quantification of drugs and other substances in clinical and forensic toxicology. It compares VAMS to other microsampling techniques, such as dried blood spots (DBSs), highlighting VAMS's superiority in addressing issues related to sample volume consistency and environmental impact. Despite its advantages, VAMS also presents certain limitations, including higher costs and difficulties in detecting underfilled samples. Overall, VAMS stands out as a microsampling technique with the potential to enhance patient compliance and operational efficiency, positioning itself as a viable tool for toxicological analysis in both clinical and forensic contexts. [ABSTRACT FROM AUTHOR]

Background. In forensic toxicology, positive immunoassay (IA) test results do not hold forensic validity and need to be confirmed with mass spectrometry (MS). On the other hand, a negative result is a strong indication that the drug and/or the drug metabolites are not present in the sample and that confirmatory analyses are not necessary. Consequently, a negative IA result must have forensic validity since it can be admitted in court during a trial. Objectives. Screening cutoffs for the analysis of hair samples using immunoassays (IAs) were retrospectively optimized based on the Society of Hair Testing (SoHT) confirmation cutoffs and the utility of the test for forensic applications was discussed. Materials and methods. Hair samples taken from 150 patients with a history of drug addiction were analyzed with ILab 650, Werfen (Milan, Italy) using DRI® reagents. Confirmatory analyses were subsequently performed using the ACQUITY UPLC® System, Waters Corporation (Milford, USA). Screening cutoffs were retrospectively optimized using receiver operating characteristic (ROC) analysis. Results. A total of 162 single positive results were obtained for confirmatory analysis (10 for amphetamines/ methamphetamines, 11 for MDMA, 37 for cocaine, 40 for THC, 33 for methadone, and 31 for opiates). The optimized screening cutoffs were 0.27 IA ng/mg for amphetamines, 0.51 IA ng/mg for MDMA, 0.59 IA ng/mg for cocaine, 0.14 IA ng/mg for cannabinoids, 0.63 IA ng/mg for methadone, and 0.26 IA ng/mg for opiates. An area under the curve (AUC) greater than 0.95 was obtained with very high sensitivity and specificity for all drugs. Conclusions. The presented screening method proved to be a useful technique on hair samples for the classes of drugs most commonly found in Italy and Europe and can be applied to forensic analysis. [ABSTRACT FROM AUTHOR]

The concept of "gender" refers to the socially constructed characteristics that define feminine or masculine behavior, which are constantly changing and can influence access to healthcare and patterns of help-seeking. These factors significantly impact forensic toxicology, a key area within the medicolegal landscape, forcing the adoption of a gender-sensitive approach to better understand the differing impacts of substances on men and women. Research indicates significant disparities in drug use between genders; men are more likely to abuse alcohol and illicit drugs, while women tend to use prescription medications. Although men typically show higher rates of driving under influence (DUI) related to alcohol, significant alcohol-related DUI cases also exist among women. In postmortem toxicology, gender affects drug pharmacokinetics and pharmacodynamics, with a pressing need for more research focused on women's specific toxic and fatal ranges. The rise of new psychoactive substances (NPS) presents additional challenges; while most users are male, the gender gap appears to be narrowing. Further investigation into the gender differences in drug usage and effects, particularly regarding NPS, is essential for improving justice system responses and healthcare delivery. A gender-based approach in forensic toxicology is vital for addressing these issues effectively. [ABSTRACT FROM AUTHOR]

The external ear is highly individualised in terms of its shape, size, and other morphological characteristics, making it a useful tool for forensic identification in determining sex and personal identification. These characteristics are believed to be controlled by multiple genes and shared among genetically related individuals. To describe the uniqueness and sexual differences in external ear morphology among the ethnic Meiteis, a cross-sectional study was conducted in the Clinical Section of the Department of Forensic Medicine and Toxicology from May 2022 to April 2024. The study included 422 ethnic Meiteis, and common characteristics observed in both sexes included an oval-shaped pinna in 35.38% of individuals, nodosity of Darwin's tubercle in 74.53%, medium-sized anti-tragus in 50.66%, arched shape of the lobule in 44.67%, and proportionate form of the concha in 74.10%. The tragus types were evenly distributed, with an average of 30% for each type. The shape of the helical fold differed between males and females, with 60.03% of males having a normally rolled shape and 62.16% of females having a wide covering scapha shape, with an average occurrence of 49.14%. There was no significant sexual difference in the external ear characteristics except for the helical fold. Regarding the uniqueness, most of the ethnic Meitei population exhibited the nodosity type of Darwin's tubercle, medium-sized anti-tragus, and proportionate form of the concha, accounting for more than half of the total study population. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Homicide is a cruel act of mankind. It reveals one of the darkest sides of the society. Homicidal crimes represent a reasonable proxy for all different kinds of violent crimes in general. The study aimed to find out the different characteristics of victims and perpetrators i.e. alleged accused in homicidal deaths. Materials and Methods: The present prospective study was carried out on 179 homicidal deaths at the Department of Forensic Medicine and Toxicology of Indira Gandhi Government Medical College, Nagpur from January 2013 to October 2014. Observation and Results: Male victims were most commonly attacked by acquaintances in 33 (18.44%) cases whereas females were by their husbands or In-laws in 13 (7.26%) cases. Maximum homicidal attacks54 (30.17%) occurred at or near the victim's house. Males were common victims due to quarrels whereas females due to illicit sexual relationships. Sharp and pointed weapons were most commonly used. Maximum victims 125 (69.83%) died at the place of homicidal attack. Conclusions: Males outnumbered females in all aspects of Homicidal deaths. A specific pattern was observed which could help police investigating authorities in tracing out characteristics of victims and assailants in homicidal deaths reported shortly. [ABSTRACT FROM AUTHOR]

Background: Paraquat is a widely used herbicide that raises a significant public health concern due to its extreme toxicity even at low doses and its potential for criminal poisoning. However, most of the research is concentrated on pulmonary toxicity of the compound so far, ignoring its other systemic effects. Moreover, a perfect antidote for this poisoning remains still at large. Case Presentation: In this case report, we present probably the first case of criminal paraquat poisoning in India, involving a 40-year-old man who was poisoned by family members with paraquat-laced alcohol. Although the patient initially appeared to be recovering, his condition worsened, and he died from multi-organ dysfunction syndrome (MODS). Discussion: Paraquat poisoning presents with a spectrum of clinical features, mainly affecting the lungs and kidneys, often leading to respiratory and renal failure. However, its toxicity extends to other organs like liver causing toxic hepatitis that prompts us for a proper diagnosis and management. Current research and management protocols tend to neglect the hepatic and renal toxicities, focusing primarily on pulmonary fibrosis. The manufacture and sale of paraquat in India needs to be reviewed in the light of increasing global bans of this compound. There is also a pressing need for antidote research in dealing with agrochemical substance abuse, particularly paraquat. Conclusion: The emergence of paraquat as a lethal homicidal poison highlights the need for stringent regulations and proactive measures to safeguard public health. The whole saga of chemical/pesticide regulation in our country is very naïve when compared to the global standard. It is time to foster collaboration between regulatory bodies, healthcare professionals, and researchers to address the menace of ‘paraquat deaths’ in India.

Background: Didactic teaching being teacher centric usually does not generate sense of responsibility for learning among the students. The Jigsaw method is a form of cooperative learning that improves not only the cognitive but also the affective and psychomotor skills, which are required by a student to become an Indian Medical Graduate. Thus, this study was aimed at assessing the effectiveness of Jigsaw strategy in comparison to didactic teaching and to understand the perception of the students. Methodology: This was a quasi-experimental study conducted among second year MBBS students. They were randomly assigned to lecture and Jigsaw groups. A topic on general toxicology was chosen. Handouts were prepared which were given to all the students. The lecture group was taught using audio visual aids. The topic was sub divided into five subtopics for Jigsaw group. A post test consisting of MCQs was used to assess the effectiveness of the method. A validated questionnaire was used to gather feedback from the students belonging to Jigsaw Group. Descriptive statistics were used to analyze responses to the Likert scale questions. Results: The present study included a total of 65 II year MBBS students, out of which 30 students were in Jigsaw group. A total of 94% students agreed to participate actively in the Jigsaw session. Most of the students (93%) students listened to and respected the ideas of their peers. A total of 72% students found this method of learning useful in Forensic Medicine and Toxicology. Only 53% of the students felt that the time for preparation and presentation of the topic was sufficient. Conclusions: The present study advocates this cooperating learning method to be an effective tool in better understanding of the subject, to improve communication skills and to inculcate lifelong learning attitude among the medical graduates. The jigsaw method, however, requires more time for planning and execution, to yield positive outcomes.

Silylation is a widely used derivatization technique for the gas chromatographic analysis of benzodiazepines, a class of psychoactive drugs commonly encountered in forensic and biological samples. This study investigated the optimal experimental conditions for the silylation of benzodiazepines using N,O-bis(trimethylsilyl)trifluoroacetamide containing 1% trimethylchlorosilane (BSTFA + 1% TMCS), a widely employed silylating agent. Ten structurally different benzodiazepines, including variations within the classic 1,4-benzodiazepine core and triazolo ring derivatives, were selected to address the effect of structural diversity on silylation. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) were used to optimize the silylation of benzodiazepines by means of GC-MS analysis. PCA identified key experimental factors influencing silylation efficiency and distinct response patterns of different benzodiazepines. HCA further categorized the benzodiazepines based on their silylation behavior, highlighting the need for tailored derivatization strategies. The results indicated that the BSTFA + 1% TMCS concentration and solvent volume were pivotal for achieving high silylation efficiency, whereas the temperature, reaction time, and catalyst were less critical. The optimized method was successfully applied to 30 real forensic samples, demonstrating its efficacy in detecting and identifying various benzodiazepines, including designer drugs like etizolam. This study provides a foundation for improving drug detection methodologies in forensic toxicology and provides useful insights into the dynamics of benzodiazepine silylation and the use of individualized analysis parameters. [ABSTRACT FROM AUTHOR]

ABSTRACT New psychoactive substances (NPS)—designed to mimic various legal or illegal substances—are an emerging worldwide health problem. Their identification and quantification in either complex seized samples or powders are critical; moreover, their determination in biological fluids is an intriguing goal in the forensic toxicology field. Synthetic cathinones are one of the most important groups among NPS. The current paper was designed as a pilot study to investigate the application of NMR techniques to identify and quantify unknown NPS compounds in deuterated dimethyl sulfoxide (DMSO‐d6) and in urine using the synthetic cathinone benzylone (3,4‐methylenedioxy‐N‐benzylcathinone, BMDP) as a pilot compound. In the first part of our study, nuclear magnetic resonance (NMR) spectroscopic characterization was performed using 1D and 2D homonuclear and heteronuclear NMR spectroscopic methods as long as diffusion ordered spectroscopy (DOSY). Following the above, the assignment of benzylone in DMSO‐d6 was performed, and a distinct spectroscopic pattern was proposed. In the second part of our study, a NMR spectroscopic approach was applied for benzylone identification and quantification in a spiked with benzylone urine. Following the above, the assignment of benzylone in spiked urine was performed. A distinct pattern of the H11, H14, H15, and H8 signals on the 1H NMR spectra was observed and suggested as a “NMR spectroscopic pattern/signature” enabling the identification of benzylone moieties in urine. On the other hand, the applied NMR techniques showed low sensitivity in quantitating benzylone in spiked urine. Overall, our results are promising in using NMR for structure determination of unknown compounds in urine. [ABSTRACT FROM AUTHOR]

People diagnosed with substance use disorder (SUD) might represent a high‐risk subpopulation for New Psychoactive Drugs (NPS) consumption, and hair analysis offers a unique perspective to assess drug prevalence in this population. The present study aims to assess the prevalence of NPS and their co‐consumption with traditional drugs of abuse (DoA) in individuals diagnosed with SUD. Hair samples from patients under care at the addiction treatment service of Bologna, Italy, for a diagnosed SUD, were collected during 2023 and analyzed by ultra‐high‐performance liquid chromatography‐mass spectrometry (UHPLC–MS/MS), using a previously validated method. Among the 88 patients included, 95.5% tested positive for at least one substance, of which 88.1% for traditional DoA only, and 11.9% for NPS in addition to DoA. Among the positive samples, patients were found positive for more than two drugs in 67.9% of cases. The combination of DoA and NPS was more frequent in the younger age group (<21–30 years old, compared to 31–70, p = 0.025). Ketamine was detected in 8.0% of all samples, with mean hair levels 49.68 pg/mg (ranging 8.55–81.90 pg/mg) and was frequently accompanied by cocaine (85.7% of cases). Fentanyl was detected in 3.4% of all samples, while, among NPS, buphedrone was the only one detected. Our retrospective study highlights that the consumption of NPS is relatively low compared to other vulnerable or high‐risk populations. However, the prevalence of polydrug consumption and the high rate of ketamine–cocaine combination warrant careful monitoring even in this population. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsWorkplace Drug Testing (WDT) is a worldwide practice that is crucial in anti-drug efforts. This study aimed to provide compherensive information about the WDT applications in Türkiye with data obtained from two major cities in two different regions of Türkiye.The retrospective assessment of forensic toxicological analysis results in urine, hair or urine&hair samples collected from 220 WDT cases in İzmir (3rd largest city) and Adana (5th largest city) from 2016 to 2022 years was carried. The screening and confirmation analysis were performed with immunoassay and liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively.Cases with a positive result from one of urine or hair tests were accepted as positive. 20.5% (n = 45) of the cases were detected positive, and most applicants were identified as drivers (84.4%, n = 38). Urine samples of 23.5% (n = 52) were screened by immunoassay, and THC (n = 1) and opiate (n = 1) were detected. In the LC-MS/MS analysis, benzodiazepines were detected most in urine as a single substance, while cannabinoids and codeine were detected in the hair. Multidrug combinations used in treatment were detected in urine and hair. It was detected both alone and among the substances accompanying cannabinoids and amphetamines.This study presents 7-year WDT results of two different major cities in Türkiye. The method of WDT application differs across the country so a standard procedure should be performed. In our country, where zero tolerance against substance use is adopted, the detection of illegal and controlled substances in cases clearly shows that WDT practice should be routinized. [ABSTRACT FROM AUTHOR]

Mycotoxins, specifically aflatoxin B1 (AFB1), ochratoxin A (OTA), trichothecenes (TCNs), and patulin, are a group of secondary metabolites that can contaminate food, leading to severe health implications for humans. Their detection and analysis within forensic toxicology are crucial, particularly as they can be implicated in cases of poisoning, foodborne illnesses, or lethal chronic exposure. However, little is known about the application that mycotoxins could have in forensic investigations and especially about the possibility of extracting and quantifying these molecules on tissues or post-mortem fluids collected at autopsy. We propose a review of the scientific literature on autopsy case studies in which the presence of mycotoxins on cadavers in cases of acute and chronic exposure has been investigated and identified. This review demonstrates how the analysis of mycotoxins on cadavers could be fundamental in the study of mushroom poisonings or even in the investigation of the chronic effects of mycotoxins on the human organism, by virtue of the known carcinogenic and mutagenic effects of many of them. This paper aims to explore the multifaceted role of mycotoxins within forensic sciences, focusing on their detection methods, implications in criminal contexts, and their potential as forensic evidence, thereby underscoring the critical importance they could assume in post-mortem toxicology, public health prevention, and forensic investigations. [ABSTRACT FROM AUTHOR]

Mass-spectrometry-based assays nowadays play an essential role in biomedical research and clinical applications. There are different types of commercial mass spectrometers on the market today, and triple quadrupole (QqQ) is one of the time-honored systems. Here, we overview the main areas of QqQ applications in biomedicine and assess the current level, evolution, and trends in the use of QqQ in these areas. Relevant data were extracted from the Scopus database using the specified terms and Boolean operators defined for each field of the QqQ application. We also discuss the recent advances in QqQ and QqQ-based analytical platforms, which promote the clinical application of these systems, and explain the indicated substantial increase in triple quadrupole use in biomedicine. The number of biomedical studies utilizing QqQ increased 2–3 times this decade. Triple quadrupole is most intensively used in the field of endocrine research and testing. On the contrary, the relative rate of immunoassay utilization—a major competitor of chromatography–mass spectrometry—decreased in this area as well as its use within Therapeutic drug monitoring (TDM) and forensic toxicology. Nowadays, the applications of high-resolution accurate mass (HRAM) mass spectrometers in the investigated areas represent only a small fraction of the total amount of research using mass spectrometry; however, their application substantially increased during the last decade in the untargeted search for new biomarkers. [ABSTRACT FROM AUTHOR]

Background: Drugged driving is associated with an increased risk of road accidents worldwide. In Italy, driving under the influence (DUI) of alcohol and drugs is a reason for driving disqualification or revocation of the driving license. Drivers charged with driving under the influence of alcohol and drugs must attend a Local Medical Commission (LMC) to undergo mandatory examinations to regain the suspended license. Our study mainly aims to report on the analysis performed on hair samples collected from 7560 drivers who had their licenses suspended for drugged or drunk driving between January 2019 and June 2024. Methods: A rapid, sensitive, and selective method for the determination of ethyl glucuronide in hair by UPLC/MS-MS was developed and fully validated. Results: The most frequently detected substances were cocaine (ecgonine methyl ester, norcocaine, and benzoylecgonine) and cannabinoids (Δ9-tetrahydrocannabinol, cannabidiol, and cannabinol), followed by opiates (codeine, morphine, and 6-MAM), methadone (EDDP), and amphetamines (amphetamine, methamphetamine, MDA, MDMA, and MDEA). To perform a more in-depth analysis, we also compared hair color with the drug classes that tested positive. The results showed a significant prevalence of dark hair that tested positive for one or more substances, followed by gray/white hair and light hair. Conclusions: Our study provides an interesting and alarming insight into drug exposure in the general population with serious public health threats, discussing the main aspects of hair matrix analysis and focusing on its advantages and reliability in the interpretation of results. [ABSTRACT FROM AUTHOR]

Both postmortem toxicological and medical-forensic examinations are very important in the case of analyzing various types of chemical substances. Hydroxyzine (HZ) is a first-generation antihistamine drug with a sedative effect that disrupts cognitive function and affects the ability to drive motor vehicles. Enzymatic oxidation of the hydroxy-methyl group to the carboxyl group leads to the formation of its main metabolite—cetirizine (CZ). CZ is the active substance of antiallergic drugs. Because it does not cross the BBB (blood–brain barrier) easily, it is less likely to cause drowsiness or affect memory and impair cognitive function. Therefore, in criminal studies, it is often important what medication had been taken by a person involved, e.g., in a car accident, HZ or CZ. The analysis of both antihistamine drugs is challenging, as usually very low concentrations of the compound of interest need to be determined. Thus, an ultra-sensitive UHPLC–QqQ-MS/MS method was developed for simultaneous determination of HZ and CZ in biological fluid samples. The lower limit of quantification (LOQ) for HZ and CZ was calculated as 0.345 and 0.3696 ng/mL, respectively. Together with a reduced sample volume to 200 μL, it makes the developed method suitable for a sensitive multidrug forensic toxicological analysis. Samples were extracted with simple and fast liquid–liquid extraction (ethyl acetate, pH 9). The present method for the determination of HZ and CZ in human blood proved to be simple, fast, selective, and sensitive. The quantification by LC–MS/MS was successfully applied to the samples coming from 28 authentic biological fluids (blood, urine, vitreous humor, bile and stomach content), both antemortem and postmortem. The performed studies confirm that the developed method is characterized by a high extraction efficiency. Its accuracy, reproducibility, simplicity, and selectivity suggest its application in clinical, toxicological, and forensic laboratories. [ABSTRACT FROM AUTHOR]

Etomidate is a nonbarbiturate sedative derived from imidazole. Prolonged and excessive use of etomidate can lead to the suppression of adrenocortical function, myoclonus, and even death. This report describes a rare case of a 47-year-old man who died from acute intoxication after oral ingestion of liquid containing etomidate. The cause of death was conclusively attributed to etomidate based on a comprehensive investigation, including autopsy, histopathological examination, toxicological analysis, and biochemical analysis. This is the first reported case of a fatality solely resulting from the oral ingestion of etomidate, which can provide valuable insights for future forensic investigations involving etomidate poisoning. Therefore, it is imperative to share this case with the scientific community. [ABSTRACT FROM AUTHOR]

This study investigated methylamphetamine (MA) exposures in the deaths of children (≤ 12 years old) reported to the Coroner in the state of Victoria, Australia, between 2011 and 2020. Demographics, autopsy findings including the cause of death, self-reported prenatal or caregiver drug use, child protection services information, and toxicological findings were summarized by descriptive statistics. Validated methods of liquid chromatography-tandem mass spectrometry were used in the analysis of drugs. There were 50 child deaths with MA detected in blood, urine, and/or hair with 64% (n = 32) identified in 2018–2020. Most children were 1–365 days old (66%, n = 33) and the cause of death was unascertained in 62% (n = 31) of cases. MA was toxicologically confirmed in hair (94%, n = 47) significantly more than blood (18%, n = 9). Prenatal or caregiver drug use was self-reported in 44% (n = 22) and 42% (n = 21) of cases, respectively. Moreover, only 54% (n = 27) of deceased children were a child protection client at their time of death. These findings suggest the number of deceased children exposed to MA has increased over the past 10 years, which is consistent with the greater supply of crystal MA in the Australian community. Hair analysis provided additional means to identify cases that were unknown to child protection services and may have implications for other children in the same drug exposure environment. [ABSTRACT FROM AUTHOR]

Background: 4-MDMB-BUTINACA, a next-generation synthetic cannabinoid, presents significant public health and forensic challenges due to its evolving nature and potential toxicity. Methods: This study evaluates the subacute toxic effects and pharmacokinetics of 4−Fluoro MDMB−BUTINACA (4F-MDMB-BUTINACA) in adult male albino rats, administered orally for seven days at doses of 1 mg/kg, 5 mg/kg, and 15 mg/kg. The hematological, biochemical, and histopathological parameters were assessed and compared to controls. Results: The pharmacokinetics were determined using GC–MS/MS with a positive chemical ionization and granisetron as an internal standard. A histological analysis revealed inflammatory cell aggregation, congestion, hemorrhage, edema, and fibrosis in various tissues, with renal examinations showing tubule degradation, glomerular atrophy, Bowman's space expansion, edema, and hemorrhage. The liver exhibited cellular infiltration, while cardiac muscle fibers showed myocardial fiber degradation and inflammatory cell aggregation. Biochemical assays indicated significant alterations (p < 0.05) in the serum levels of AST, ALT, ALP, GGT, total protein, albumin, triglycerides, urea, MCHC, MCV, RDW, platelets, neutrophils, eosinophils, and basophils compared to the controls. Conclusions: The validated bioanalytical method revealed rapid absorption of 4F-MDMB-BUTINACA, with a plasma half-life of 2.371 h, a volume of distribution of 2272.85 L, and a plasma clearance rate of 664.241 L/h. In conclusion, 4F-MDMB-BUTINACA is a highly toxic synthetic cannabinoid, particularly affecting the liver, kidneys, and heart. [ABSTRACT FROM AUTHOR]

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Molecularly imprinted polymers (MIPs) are synthetic receptors designed to selectively bind specific molecules, mimicking natural antibody–antigen interactions. Produced through polymerization around a target molecule (template), MIPs create imprints that confer high specificity and binding affinity upon template removal. Initially developed in the 1970s with organic polymers, MIPs now play critical roles in separation sciences, catalysis, drug delivery, and sensor technology. In forensic science, MIPs offer potential for sample preparation, pre-concentration, and analyte detection, especially with complex biological and non-biological matrices. They exhibit superior stability under extreme conditions, enabling their use in challenging forensic contexts such as detecting new psychoactive substances or trace explosives. Despite advantages like reusability and high selectivity, MIPs face limitations in forensic analysis due to their complex synthesis, potential template leakage, and non-specific binding. Moreover, the lack of standardized protocols limits their mainstream adoption, as forensic applications require validated, reproducible methods. This review systematically assesses MIPs in forensic toxicology, focusing on their current capabilities, limitations, and potential for broader integration into forensic workflows. Future research should address standardization and evaluate MIPs' effectiveness in diverse forensic applications to realize their full potential. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions ‘Street’ benzodiazepines (BZD) are structurally and pharmacologically related to BZDs licensed for human use. In this study we investigated how street BZDs contribute to overall BZD use and death prevalences in England, Wales and Northern Ireland.Data were analysed from deaths reported to the National Programme on Substance Use Mortality with post‐mortem BZD detections (1999–2021), BZDs seized from music festivals (2017–2021) and drug samples with BZD detections submitted to Welsh Emerging Drugs and Identification of Novel Substances (WEDINOS) (2017–2021).About 14,837 deaths with BZD detections were identified, with polydrug use evident in 99.3% of cases (n = 14,733/14,837). Deaths following BZD use increased by over 200% from 2010 (n = 556) to 2020 (n = 1245). Most BZD detections were of those available via NHS prescription (96.2%), although in most cases (61.9%) the BZD—majority diazepam (77.3% of detections)—had been illicitly sourced. While street BZD deaths represented only 8.5% of overall BZD deaths, street BZD deaths increased by over 1200% between 2015 (n = 26) and 2020 (n = 326). There were increasing proportions of street BZD deaths in each geographical region but was more marked in Northern Ireland. The proportion of individual BZDs seized at music festivals and submitted to WEDINOS largely reflected that of individual BZDs detected in deaths.While deaths following street BZD use are increasing, most BZDs detected in deaths were prescribable BZDs that were often illicitly sourced. The types of BZD detected in post‐mortem samples, festival seizures and WEDINOS submissions has evolved over time to reflect changes in BZD prevalence on the illicit drug market. [ABSTRACT FROM AUTHOR]

This study performed advanced toxicological assessments of the new substance AP-238 using nine 'green' in silico methods, focusing on acute toxicity, organ-specific effects, skin and eye irritation, genetic toxicity, and cardiotoxicity. A quantitative assessment of AP-238's acute toxicity (AT) was performed by predicting theoretical LD50 values for both rats and mice across different administration routes using various in silico methods. Results indicated the highest toxicity via intravenous administration in mice, with a t-LD50 of 53 mg/kg, while oral administration in rats exhibited a lower toxicity range, with t-LD50 values between 666.43 and 1838.77 mg/kg, depending on the predictive model used. The identification of toxicophores (the fragment connecting the benzene ring to the piperazine ring, including the α, β, and γ carbon atoms near the nitrogen atom) in AP-238 suggests a high likelihood of lung toxicity (61%), with additional risks to the cardiovascular (58%) and renal systems (56%), emphasizing specific molecular fragments associated with these adverse effects. Genotoxic evaluations presented a mixed view, with low to moderate probabilities of a positive Ames test, suggesting some uncertainty but generally indicating a reduced risk of genetic toxicity. Eye and skin irritation risks were deemed minimal, supported by several models with high confidence. Cardiotoxicity assessments revealed varied information on the potential effects of AP-238 on the hERG channel, with some studies suggesting a nonsignificant impact, while others indicated moderate risk, although with low reliability in the predictions. This highlights the nuanced challenges in assessing the safety of novel substances through 'green' in silico methods. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Since their emergence on the drug market, synthetic cannabinoids (SC) are still gaining increasing importance in forensic toxicology. The representatives of the so‐called new psychoactive substances have in common that they have not undergone preclinical safety studies. Hence, knowledge on toxicokinetic (TK) data is sparse. As an alternative to human studies not being allowed for ethical reasons, a sophisticated pig model was applied in the present study to assess the TK of the SC 5F‐MDMB‐P7AICA.Pigs pulmonarily received 5F‐MDMB‐P7AICA via an ultrasonic nebulizer. The parent compound and its main metabolite 5F‐MDMB‐P7AICA dimethyl butanoic acid were determined in serum and whole blood using liquid chromatography–tandem mass spectrometry. Obtained data was analysed by population (pop) TK modelling. The final pop TK model parameters for pigs were upscaled via allometric scaling techniques for the prediction of human exposure.The serum concentration–time profiles of the parent and the pop TK analysis revealed that a 4‐compartment model best describes the TK data. The administration of the aerosol into the lung compartment follows zero‐order kinetics. A transit compartment was further included to accurately describe the time delay between detection of the parent and the metabolite. Despite the different structure, TK parameters were found to be comparable to other examined SC.The predictions of human SC exposure suggest that multiple administration of 5F‐MDMB‐P7AICA substantially enhances the window of detection. The simulations pose extrapolation of the data used for model development with respect to dose linearity and allometric scaling to humans. [ABSTRACT FROM AUTHOR]

Turkey’s pivotal position bridging Asia and Europe, amid ongoing civil unrest in the south, has turned it into a crucial hub for drug trafficking along the Silk Road. Yet, there is a notable dearth of research on the influx of new psychoactive substances along this route. The aim of this study was to determine the frequency of use of 5F-EMB PICA, MDMB-4-en PINACA, isotonitazene, 3-fluoroamphetamine, 2-methylamphetamine, and flualprazolam. A quantitative analysis of urine and blood samples of 250 participants was performed which were sent to our Forensic Toxicology Laboratory for drug/stimulant investigation. The analysis was carried out using liquid chromatography sequential mass spectrometry. The average age of starting substance use was 19.51 ± 7.25 years, and the mean duration of substance use was 6.34 ± 5.77 years. The MDMB-4-en PINACA substance was detected in 18.4% of 250 participants, while no other NPS group substances were found. The MDMB-4-en PINACA was detected in 18% of all urine samples and 12.4% of blood samples. The frequency of use of MDMB-4-en PINACA has increased significantly in our region, albeit in a short period of time. MDMB-4-en PINACA should be added to the systematics of toxicology laboratories. [ABSTRACT FROM AUTHOR]

Drug and toxin-related deaths are common worldwide, making it essential to detect the postmortem concentration of various toxic substances at different stages of decomposition in a corpse. Indeed, determining the postmortem interval (PMI) and cause of death in an advanced stage of decomposed corpses has been a significant challenge in forensic investigations. Notably, the presence of drugs or toxins can have a significant impact on the microbial profile, potentially altering the succession of microbial communities and subsequent production of volatile organic compounds (VOCs), which, in turn, affect insect colonization patterns. This review aims to highlight the importance of investigating the interactions between drugs or toxins, microbial succession, VOC profiles, and insect behavior, which can provide valuable insights into forensic investigations as well as the ecological consequences of toxins occurring in decomposition. Overall, the detection of drugs and other toxins at different stages of decomposition can yield more precise forensic evidence, thereby enhancing the accuracy of PMI estimation and determination of the cause of death in decomposed remains. [ABSTRACT FROM AUTHOR]

Background: A growing number of studies investigated the factors that contribute to driving under the influence (DUI) of alcohol in relation to gender. However, a gendered approach of the scientific evidence is missing in the literature. To fill this gap, a gender-driven systematic review on real case studies of the last two decades was performed. In addition to the gender of the drivers involved, major independent variables such as the period of recruitment, the type of drivers recruited, and the geographical area where the study was conducted, were examined. Afterwards, a meta-analysis was performed comparing alcohol-positive rates (APR) between male and female drivers in three subgroups of drivers: those involved in road traffic accidents, those randomly tested on the road, and volunteers. Methods: Three databases were searched for eligible studies in October 2023. Real-case studies reporting APR in man and women convicted for DUI of alcohol worldwide were included. Univariate analysis by ANOVA with post-hoc tests identified the independent variables with a significant impact on the dependent variable APR, according to a relationship subsequently investigated by standard multiple linear regression. The meta-analysis of random effects estimates was performed to investigate the change in overall effect size (measured by Cohen's d standardized mean difference test) and 95% confidence interval (CI). Results: Among papers addressing driver gender, univariate analysis of independent variables revealed a higher Alcohol Positive Rate (APR) in men, particularly in drivers involved in crashes, with a noticeable decrease over time. Analyzing the gender of drivers involved in crashes, the meta-analysis showed that men had a significantly higher APR (30.7%; 95%CI 26.8–35.0) compared to women (13.2%; 95%CI 10.7–16.1). However, in drivers randomly tested, there was no significant difference in APR between genders (2.1% for men and 1.4% for women), while in volunteers, there was a statistically significant difference in APR with 3.4% (95%CI 1.5–7.6) for men and 1.1% (95%CI 0.5–2.7) for women. Conclusion: Despite a progressive decrease in the epidemiological prevalence of alcohol-related DUI over time, this phenomenon remains at worryingly high levels among drivers involved in road traffic accidents in both genders, with a higher prevalence in men. It's important for policymakers, professionals, and scientists to consider gender when planning research, analysis, interventions, and policies related to psychoactive substances, such as alcohol or other licit drugs. Forensic sciences can play a vital role in this regard, enabling a thorough analysis of gender gaps in different populations. [ABSTRACT FROM AUTHOR]

Various samples—including two vials with a pharmaceutical appearance—were submitted to the laboratory for identification. The aim of this work was to describe the unique characteristics observed during the analysis of the powder contained in the vial. Samples were submitted to HPLC‐DAD, UHPLC‐TOF‐MS, and/or UPLC‐MS–MS analysis. The majority of the samples were easily identified as standard drugs of abuse. The main difficulty lay in identifying the powder in the vials. No match was found in the library through HPLC‐DAD analysis. Fortunately, the vials were labeled as "Melanotan II", although the UV spectrum was not available. Mass spectrometric analysis of melanotan II was challenging, as it is a small peptide with a molecular weight of 1024 Da, which is significantly heavier than classical drugs that the laboratory usually handles. As a result, mass spectrometer's parameters can be limited to detect masses up to 1000 Da. Additionally, melanotan II is multi‐charged which is also unusual for compounds typically targeted in our daily work. Finally, the reference standard allowed us to confirm the identification with both instruments, and determine the purity of 30%. Melanotan II is not approved on the market due to safety concerns. It is used illegally mainly for tanning, explaining its nickname "Barbie drug". To conclude, analysis of melanotan II was challenging as it is heavy and doubly charged. Moreover, its UV spectrum was initially not available in the literature. The difficulties faced by forensic scientists in detecting this drug may explain its popularity on the illicit market. [ABSTRACT FROM AUTHOR]

Diester diterpenoid alkaloids (DDAs) are the main active ingredients of herbaceous perennial plants Aconitum. DDAs possess cardiotoxic and neurotoxic properties. Although most deaths caused by DDA poisoning are accidental, a few instances of suicide and homicide have been reported. Presented is a case of an acute aconitine (AC) poisoning following the ingestion of approximately 50 mL of homemade medicinal liquor. We described the clinical manifestations after poisoning and detailed postmortem changes, and detected the concentrations of AC and hypaconitine (HA) by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The decedent experienced a burning sensation in the gastrointestinal tract after poisoning, followed by flushing and paralysis of the face and limbs, and severe cardiac arrhythmia. An autopsy revealed cyanosis of the lips and nail beds; conjunctival hemorrhage in both eyes; pulmonary edema; tissue hemorrhage and congestion in multiple organs; and inflammatory cell infiltration in the stomach, duodenum, pancreas, and cardiac muscle. The concentrations of AC and HA were as follows: cardiac blood, 38.4 ng/mL and 7.1 ng/mL; pericardial fluid, 7.3 ng/mL and 41 ng/mL; urine, 28.1 ng/mL and 574 ng/mL; bile, 38.5 ng/mL and 108 ng/mL; gastric contents, 0.06 mg and 0.56 mg; liver tissue, 10.7 ng/g and 109.6 ng/g; and medicinal liquor, 0.568 mg/mL and 0.664 mg/mL, respectively. The clinical manifestations, anatomy findings, and quantitative data on the concentrations of AC and HA in body fluids and tissues will aid forensic investigations of deaths caused by acute AC poisoning. [ABSTRACT FROM AUTHOR]

The complexity of the drug market and the constant updating of drugs have been challenging issues for drug regulatory authorities. With the emergence of new psychoactive substances (NPS) and the nonmedical use of prescription drugs, forensic and toxicology laboratories have had to adopt new drug screening methods and advanced instrumentation. Using high‐performance liquid chromatography coupled with Orbitrap mass spectrometry, we developed a screening method for common NPS and other drugs. Two milliliters of mixed solvent of n‐hexane and ethyl acetate (1:1, v:v) were added to 500 μL of blood or urine sample for liquid–liquid extraction, and methanol extraction was used for hair samples. The developed method was applied to 3897 samples (including 332 blood samples, 885 urine samples, and 2680 hair samples) taken from drug addicts in a province of China during 2019–2021. For urine and blood samples, the limits of detection (LODs) ranged from 1.68 pg/mL to 10.7 ng/mL. For hair samples, the LODs ranged from 3.30 × 10−5 to 4.21 × 10−3 ng/mg. The matrix effects of urine, blood, and hair samples were in the range of 47.6%–121%, 39.8%–139%, and 6.35%–118%, respectively. And the intra‐day precision was 3.5%–6.0% and the inter‐day precision was 4.18%–9.90%. Analysis of the actual samples showed an overall positive detection rate of 58.9%, with 5.32% of the samples indicating the use of multiple drugs. [ABSTRACT FROM AUTHOR]

For the past decade, illicitly manufactured fentanyl has been a primary contributor in drug overdose deaths regardless of age. The pediatric population is particularly vulnerable to fentanyl exposure, yet there are limited case reports involving this population. Postmortem cases from 2019 to 2023 were retrospectively analyzed to determine the prevalence of fentanyl in decedents between 0 and 12 years of age. Over this time frame, the fentanyl positivity rate increased from 2.6 to 6.2% (n = 632). The most commonly reported age group was 0–4 years, with a peak around 1 year of age for toddlers. Fentanyl concentrations in blood (n = 573) ranged from 0.19 to 360 ng/mL (mean 18 ng/mL, median 6.9 ng/mL). Polydrug use was present in 428 cases; midazolam (n = 96) and methamphetamine (n = 66) were the most common drugs found concurrently in blood with fentanyl, followed by markers of illicitly manufactured fentanyl, such as xylazine (n = 23), para‐fluorofentanyl (n = 18), and acetyl fentanyl (n = 17). This report contrasts the differences in postmortem pediatric fentanyl toxicology results for three groups of case histories: likely medical intervention (n = 113), pregnancy/birth related (n = 136), and inadvertent/intentional exposure (n = 196). Overall, this study provides a retrospective review of postmortem pediatric fentanyl concentrations in a variety of biological matrices and highlights the need for comprehensive toxicology testing in postmortem pediatric casework. [ABSTRACT FROM AUTHOR]