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INTRODUCTION In Poland, the problem of suicide attempts has not been the subject of a comprehensive analysis. We examined the magnitude of the phenomenon and suicide trends over the past 3 decades, focusing on the number of suicide deaths and attempts, the method and place of suicide, gender, age, day of the week, and state of mind. MATERIAL AND METHODS We used official nationwide data collected by the Central Statistical Office (CSO) and the National Police Headquarters (NPH) for the years 1990-2018. The final statistical data collected by the CSO was verified on the basis of medically certified deaths. RESULTS Despite the correlation between the information from the CSO and NPH on the classification of suicides, in the opinion of authors', the published data is underestimated or incorrectly categorized. There were 187,502 suicide attempts in Poland between 1990 and 2018, 75.8% of which resulted in death. In 2018, the suicide rate in Poland was 13.6 per 100,000 people and was higher than in 1990 (9.7). The highest risk for suicides is observed for men aged 45-54 years, at the turn of winter and spring, on Mondays, and in rural areas. The critical period is Mondays at the turn of winter and spring. Hanging is the most commonly used suicide method. CONCLUSIONS Based on the collected statistical data, it should be stated that suicide attempts have for many years been a significant social problem in Poland, for which no systemic solutions have been introduced.

There is a need for a reliable and independent evaluation and confirmation of the postmortem interval (PMI) based on objective factors other than only postmortem changes or temperature measurements. Estimating the PMI by examining the concentration of potassium ions in the vitreous humor (VH) has a tradition in forensic toxicology dating back to the mid-20th century. So far, the methods for determining the presence of potassium ions have not been characterized in terms of the measurement uncertainty of types A and B, which directly affect the estimation of time of death uncertainty. The study evaluated the uncertainty of the determination of potassium ion concentrations using potentiometric ion-selective electrode (ISE) and microwave-induced plasma with optical emission spectrometry (MIP-OES) methods. In addition, the influence of the estimated measurement uncertainty on the results of the analysis of potassium ions in the VH was investigated. The estimated values of the expanded uncertainty determined by the type A experimental method indicate lower uncertainty in the determination of potassium ion concentration in the case of MIP-OES than ISE; that is, for concentrations of 2, 10, and 25 mg/L of potassium ions, the expanded uncertainties by MIP-OES were 1.2%, 2.2%, and 2.5% and the uncertainties by ISE were 12.2%, 6.1%, and 3.1%, respectively. Similarly, in the case of estimating the uncertainty of type B, the MIP-OES method compared to ISE was characterized by almost two times lower expanded uncertainty; that is, for MIP-OES, it was 2.53%, and for ISE, it was 4.75%. Both methods of uncertainty estimation, types A and B, can be used interchangeably, as they provide comparable results.

Preterm birth may result from overlapping causes including maternal age, health, previous obstetric history and a variety of social factors. We aimed to identify factors contributing to preterm birth in respect to new social and environmental changes in the reproductive patterns. Our cross-sectional study included 495 mother–infant pairs and was based on maternal self-reporting in an originally developed questionnaire. Neonates were divided into two groups: 72 premature babies (study group) and 423 full-term babies (control group). We analyzed maternal, sociodemographic and economic characteristics, habits, chronic diseases, previous obstetric history and pregnancy complications. For statistical analysis, Pearson’s Chi-squared independence test was used with a statistical significance level of 0.05. Preterm births were more common among mothers living in villages (p < 0.001) and with lower education level (p = 0.01). Premature births were also positively associated with mothers who were running their own businesses (p = 0.031). Mothers with a history of previous miscarriages gave birth at a significantly older age (p < 0.001). The most frequent pregnancy complications were hypothyroidism (41.4%), pregestational and gestational diabetes mellitus (DM; 17.8%) and hypertension (8.1%). Pregestational DM significantly influenced the occurrence of prematurity (p < 0.05). Pregestational DM, being professionally active, a lower education level and living outside cities are important risk factors of prematurity.

Modulation of dopamine transmission evokes strong behavioral effects that can be achieved by psychoactive drugs such as haloperidol or cocaine. Cocaine non-specifically increases dopamine transmission by blocking dopamine active transporter (DAT) and evokes behavioral arousal, while haloperidol is a non-specific dopamine D2 receptor antagonist with sedative effects. Interestingly, dopamine has been found to affect immune cells in addition to its action in the central nervous system. Here we address the possible interactions between haloperidol and cocaine and their effects on both immune cells and behavior in freely moving rats. We use an intravenous model of haloperidol and binge cocaine administration to evaluate the drugs’ impact on the distribution of lymphocyte subsets in both the peripheral blood and the spleen. We assess the drugs’ behavioral effects by measuring locomotor activity. Cocaine evoked a pronounced locomotor response and stereotypic behaviors, both of which were completely blocked after pretreatment with haloperidol. The results suggest that blood lymphopenia which was induced by haloperidol and cocaine (except for NKT cells), is independent of dopaminergic activity and most likely results from the massive secretion of corticosterone. Haloperidol pretreatment prevented the cocaine-induced decrease in NKT cell numbers. On the other hand, the increased systemic dopaminergic activity after cocaine administration is a significant factor in retaining T CD4+ and B lymphocytes in the spleen.Abstract Figure

Criminal poisonings are among the least frequently detected crimes in the world. Lack of suspicion of this type of event by police officers and prosecutors, clinical symptoms imitating many somatic diseases and technical difficulties in diagnostics, as well as high research costs make the actual frequency of these events difficult to estimate. The substance used for criminal poisoning is often characterized by: lack of taste, color and smell, delayed action, easy availability and difficulty to detect. The aim of the study was to analyze selected cases of political poisoning that took place in the years 1978–2020, to describe the mechanisms of action of the substances used and to evaluate the diagnosis and treatment. The analyzed cases of criminal poisoning concerned: Georgi Markov (ricin), Khalid Maszal (fentanyl), Wiktor Yushchenko (TCDD dioxin), Jasir Arafat (polonium 210Po isotope), Alexander Litvinenko (polonium 210Po isotope), Kim Jong-Nam (VX), Sergei Skripal (Novichok) and Alexei Navalny (Novichok). Contemporary poisons, to a greater extent than in the past, are based on the use of synthetic substances from the group of organophosphorus compounds and radioactive substances. The possibility of taking appropriate and effective treatment in such cases is the result of many factors, including the possibility of quick and competent rescue intervention, quick and reliable detection of the toxic substance and the possibility of using an antidote.

Pentoxifylline is a xanthine derivative used in vascular disorders that is recognized as a safe drug for patients. The paper describes a rare case of fatal and suicidal pentoxifylline poisoning in an 82-year-old man with multiple preexisting diseases (arterial hypertension, coronary artery disease, type 2 diabetes, and intermittent claudication). The patient was admitted to the clinical toxicology unit approximately 2 h after the overdose and died 36 h after the admission despite intensive care. Multiple arterial blood gas analyses and other laboratory tests were performed during the hospitalization and are reported in the paper. Postmortem examination of the biological material was carried out with the use of histopathological techniques. The toxicological studies using chromatographic techniques coupled with mass spectrometry showed that postmortem blood levels of pentoxifylline have been found in the range which is described in the available literature to be toxic and lethal. The analysis of test results and clinical data showed that the patient died as a result of increasing circulatory and respiratory failure, complicated by disorders of the acid-base and electrolyte balance (respiratory alkalosis, concomitant lactic acidosis, and hypokalemia), hyperglycemia, and coagulation disorders.

Psychoactive compounds that contain a phenylethylamine structure (such as amphetamine-type stimulants and synthetic cathinones) are one of the major classes of stimulants on the recreational drug market. Approximately 670 new psychoactive substances (NPS) are monitored only in Europe; however, new psychoactive compounds are being developed for illicit trade each year. In this context, the development of new analytical procedures for the determination of such compounds in biological specimens for forensic toxicology is of great importance. Gas chromatography–tandem mass spectrometry (GC–MS/MS) technique was applied for analysis of amphetamines and synthetic cathinones. The volumes of 200 µL of each whole blood sample and 1 mL of liquid-liquid extraction solvent were used for extraction, followed by pentafluoropropionyl derivatization. A high-throughput, robust, rapid, and sensitive procedure involving a simple liquid-liquid extraction for the simultaneous determination of 45 amphetamine-type stimulants and synthetic cathinones in whole blood was developed. The assay was validated based on its recovery (83.2–106%), interday accuracy (89.0–108%), and interday precision (≤ 8.1%). In view of the low limits of detection (ranged between 0.02 and 0.72 ng/mL) and limits of quantification (1 and 2.5 ng/mL), the developed method can serve as a less expensive and more ecologically friendly alternative to the liquid chromatography–tandem mass spectrometric methods. To the best of our knowledge, this is the first work presenting a GC–MS/MS method for the determination of NPS in blood samples. The presented procedure was applied to authentic samples from forensic cases, demonstrating its utility in the quantification of a wide number of psychoactive substances in routine toxicological analyses. The developed procedure can also be easily expanded to additional compounds.

The presence of antibiotics and their metabolites in the aquatic environment exerts a negative impact on all organisms. Moreover, the easy migration of these substances to drinking water may also have serious consequences for public health, such as drug resistance. Although antibiotics and their metabolites are detected in surface waters and wastewater, there are still no systemic solutions preventing environmental pollution with these substances. The procedure for quantification of antibiotics usually involves solid-phase extraction (SPE) followed by instrumental analysis typically using liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS), which provides sensitivity, selectivity and reliability of results. Therefore, it is necessary to take decisive steps aimed at the determination of critical concentrations of antibiotics, which will make it possible to maintain safe values that will not exert a negative impact on the natural environment and human health. This work presents the current state of knowledge based on data from 2009 to 2018 (review of ten years of scientific papers) on the presence of antibiotics and their metabolites in the aquatic environment in Poland and Europe and methods used for the determination of antibiotics in different types of water (surface water and wastewater). The main strategies used for the removal of antibiotics during wastewater treatment processes in the context of antibiotics' concentrations were also presented.

Prenatal exposure to toxic substances is an important public health problem. Many biological specimens obtained from the fetus or mother are used for biomonitoring. Each material reflects exposure in a specific time period and has different advantages and disadvantages in terms of accuracy, time window of detection and cost/benefit ratio. Recently, meconium has become the matrix of choice in toxicology screening for detecting exposure to xenobiotics. Alcohol metabolites and illicit drugs, pharmaceuticals, nicotine, heavy metals, persistent organic pollutants and their metabolites have been detected in meconium samples. Meconium testing is non-invasive, highly accurate and able to detect prior exposure in utero from 12 to 13 weeks of gestation. This paper reviews current studies focused on meconium analysis for the assessment of fetus exposure to xenobiotics. Analytical procedures for the determination of these compounds and their metabolites and the possibilities and limitations of their use in clinical toxicology are also presented and discussed.

Alcohol consumption during pregnancy constitutes one of the leading preventable causes of birth defects and neurodevelopmental disorders in the exposed children. Fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG) and ethyl sulfate (EtS) have been studied as potential biomarkers of alcohol consumption. However, most analytical approaches proposed for their analysis in meconium samples consist of separated extraction procedures requiring the use of two meconium aliquots, which is costly in terms of both time and materials. Therefore, the aim of this study was to develop and validate a method for the simultaneous extraction of 9 FAEEs, EtG and EtS from one meconium aliquot. The sample was homogenized using methanol, and then FAEEs were extracted with hexane while EtG and EtS were isolated using acetonitrile. Then, extracts were applied to solid-phase extraction columns and analysed by gas chromatography mass spectrometry (FAEEs) and liquid chromatography tandem mass spectrometry (EtG and EtS). Calibration curves were linear with r values greater than 0.99. The LODs ranged from 0.8 to 7.5 ng/g for FAEEs and were 0.2 ng/g and 0.8 ng/g for EtS and EtG, respectively. LOQs ranged from 5 to 25 ng/g for FAEEs and were 1 ng/g and 2.5 ng/g for EtS and EtG, respectively. Accuracies and precisions were between 93.8 and 107% and between 3.5 and 9.7%, respectively. The recovery values ranged from 89.1 to 109%. The method proved to be sensitive, specific, simple and fast and allowed for the reduction of the amount of organic solvent used for extraction compared to other published data while higher recoveries were obtained. The method was used for analysis of meconium samples in two cases of mothers who were consuming alcohol during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s00216-021-03248-0.

Prefrontal cortical regions play a key role in behavioural regulation, which is profoundly disturbed in suicide. The study was carried out on frozen cortical samples from the anterior cingulate cortex (dorsal and ventral parts, ACd and ACv), the orbitofrontal cortex (OFC), and the dorsolateral cortex (DLC) obtained from 20 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 21 non-suicidal controls. The relative level of ribosomal RNA (rRNA) as a marker of the transcriptional activity of ribosomal DNA (rDNA) was evaluated bilaterally in prefrontal regions mentioned above (i.e. in eight regions of interest, ROIs) by reverse transcription and quantitative polymerase chain reaction (RT-qPCR). The overall statistical analysis revealed a decrease in rDNA activity in suicide victims versus controls, particularly in male subjects. Further ROI-specific post hoc analyses revealed a significant decrease in this activity in suicides compared to non-suicides in five ROIs. This effect was accentuated in the ACv, where it was observed bilaterally. Our findings suggest that decreased rDNA transcription in the prefrontal cortex plays an important role in suicide pathogenesis and corresponds with our previous morphometric analyses of AgNOR-stained neurons. Supplementary Information The online version contains supplementary material available at 10.1007/s00406-021-01232-4.

Benzodiazepines (BZDs) and Z-drugs have been particularly important treatments for sleeping and anxiety disorders for many years. However, recently, a number of new benzodiazepines (named designer benzodiazepines, DBZDs) were synthesised, but some of them have never been used in the clinic; they reached the black drug market as new psychoactive substances and are used for recreational purposes. The abuse of these substances has led to many crimes and even deaths. Therefore, it is necessary to develop new methods for their quantification for forensic and clinical toxicology. A liquid chromatography-tandem mass spectrometry-based method was developed for the simultaneous determination of 20 classical BZDS, 4 DBZDs and 3 Z-hypnotic drugs in human whole blood. As a sample preparation step, liquid-liquid extraction requiring the use of only 0.5 mL of blood sample and 1 mL of extraction solvent was applied. The selectivity, linearity, carry-over effects, limits of detection (LOD) and quantification (LOQ), precision, accuracy (both intra- and inter-day assays) and recovery were evaluated for validation. Calibration curves were linear with r values > 0.98. The LODs ranged from 0.01 to 0.33, and the LOQs were assumed to be 1 ng/mL. Inter-day precisions and accuracies were in the ranges of 87.8% - 108.5% and 1.8% - 11.2%, respectively. The recovery values ranged from 81.0% to 106.7%. The developed method proved to be sensitive, specific, simple, and fast and can be quickly modified and expanded for new compounds by the optimization of MRM. The method was applied for analysis of blood samples in 145 toxicological cases over a three-year study (2017 - 2019), which allowed us to obtain information on the prevalence of the use of these substances. The most frequently determined compounds were nordazepam (87 cases; 60%), diazepam (81 cases; 55.9%), temazepam (72 cases; 49.7%), oxazepam (56 cases; 38.7%), and midazolam (36 cases; 24.8%). The ranges of concentrations were wide and are presented as box plots. The results were used for the preparation of medico-legal opinions, which proved the utility of the method for routine toxicology analyses.

Purpose The 4-chloromethcathinone (4-CMC) is a synthetic derivative of cathinone and belongs to new psychoactive substances. Neither data on the effects of 4-CMC on the human body, nor on nontoxic, toxic and lethal concentrations in biological materials have been published in the literature. This paper describes the results of an analysis of the blood concentrations of 4-CMC determined in 15 forensic cases related to nonfatal intoxication including driving under the influence, and fatalities including overdoses, suicide and traffic accidents. Methods A new method for the quantification of 4-CMC using gas chromatography–mass spectrometry (GC–MS) was developed. The symptoms of 4-CMC use were also studied based on an analysis of the documents prepared during the collection of samples or at autopsies. Results The limits of detection and quantification of the method for blood samples were 0.3 and 1 ng/mL, respectively. The calibration curve was linear in the studied concentration range (1–500 ng/mL) with the correlation coefficient at 0.9979. The extraction recoveries varied in the range of 94.3–98.8%. The accuracy and precision were acceptable. The determined concentrations in nonfatal cases ranged from 1.3 to 75.3 ng/mL, and in fatalities from 56.2 to 1870 ng/mL. Conclusions Our study can assist in the recognition of the possible effects caused by 4-CMC and can be helpful during the preparation of forensic toxicological opinions for courts of law. The validation parameters indicate the sensitivity and accuracy of the method. This is the first work presenting a validated method for the determination of 4-CMC in blood samples by GC–MS.

This paper describes cases of poisoning caused by new psychoactive substances such as: 25B-NBOMe (2-(4-bromo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine) and 4-CMC (1-(4-chlorophenyl)-2-(methylamino)-1-propanone). The analytical procedure includes rapid and selective method for the extraction and determination of 4-CMC and 25B-NBOMe in blood samples using UPLC-MS/MS technique. To the best of our knowledge, this is the first report, that involves a fully validated method for quantification of new-designer drug - 4-CMC in postmortem blood samples. The biological material was also analyzed with the use of routine analytical methods: immunochemical techniques, gas chromatography with flame ionization detection and gas chromatography with electron impact mass spectrometry. The results of real samples analyses correspond to possible toxicological effects: death resulting from 25B-NBOMe - mediated hallucinations (661ng/mL of 25B-NBOMe and 0.887ng/mL of 4-CMC), fatal overdose of 25B-NBOMe and 4-CMC (66.5ng/mL of 25B-NBOMe and 2.14ng/mL of 4-CMC) and non-fatal intoxication of these drugs (38.4ng/mL of 25B NBOMe and 0.181ng/mL of 4-CMC). Additionally, O-demethylathed O, O-bis-demethylathed and glucuronidated metabolites of 25B-NBOMe in biological specimens were detected.

Prefrontal cortical regions, which are crucial for the regulation of emotionally influenced behaviour, play most probably a dominant role in the pathogenesis of suicide. The study was carried out on paraffin-embedded brain tissue blocks containing specimens from the anterior cingulate cortex (dorsal and ventral parts), the orbitofrontal cortex, and the dorsolateral cortex obtained from 23 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 25 non-suicidal controls. The transcriptional activity of ribosomal DNA (rDNA) as a surrogate marker of protein biosynthesis was evaluated separately in layers III and V pyramidal neurons in regions of interest (ROIs) mentioned above by the AgNOR silver staining method bilaterally. The overall statistical analysis revealed a decrease of AgNOR area suggestive of attenuated rDNA activity in suicide victims versus controls, particularly in male subjects. Further ROI-specific post-hoc analyses revealed decreases of the median AgNOR area in suicides compared to non-suicides in all 16 ROIs. However, this effect was only significant in the layer V pyramidal neurons of the right ventral anterior cingulate cortex. Our findings suggest that decreased rDNA transcription in prefrontal pyramidal neurons plays possibly an important role in suicide pathogenesis. Electronic supplementary material The online version of this article (10.1007/s00406-019-00996-0) contains supplementary material, which is available to authorized users.

Poisonings constitute a significant medical, social and economic problem worldwide. In Poland there is no nationwide registry of poisonings, which results in a lack of accurate epidemiological data. Few publications dealing with the problem are based on data obtained from toxicology units and therefore do not include information about cases treated at emergency departments and other non-toxicology units. We analyzed all admissions due to poisonings reported to the Polish National Health Fund by all hospital units in Poland in the 2009-2011 period. Diagnoses were encoded according to the ICD-10 classification. A total of 254,425 admissions were reported, 85,398 in 2009, 85,230 in 2010 and 83,797 in 2011. The male to female ratios were 1.88, 1.75 and 1.80 respectively. The most frequent causes of admissions were poisonings with ethanol (n = 121,874; 47.9%), carbon monoxide (n = 17,179; 6.8%) and benzodiazepines (n = 10,340; 4.1%). Alcohols were the reason for 104,680 admissions in men (63.2%) and 22,612 admissions in women (25.5%; p

The purpose of this study was a toxicological interpretation of exposure to chlorine with unusual course. Medical, clinical and court records, as well as reviews of the literature, served as the basis for this interpretation. The first case of poisoning concerns a 52-year-old man who for a short time (probably several hours), during the industrial cleaning of facilities with sodium hypochlorite, was exposed to chlorine in a presumed high concentration. The man was obese and suffered from hypertension and moderate atherosclerosis, and therefore could be more susceptible to the toxic effects of chlorine. After exposure no pulmonary edema or symptoms typical for acute respiratory distress syndrome were present. The second case concerns the chronic poisoning of a 56-year-old man who worked for eight years, 8 h a day, 5 days a week, in a room which was next to a chlorination room. In this chamber technical sodium hypochlorite was stored and dosed. In both cases, determining a cause and effect relationship between exposure to toxic and allergic agents in the form of active chlorine, and the onset of symptoms may be difficult. The findings described above in the first and second case are particularly important in cases of compensation claims and may have a completely different etiology than previously described in medical literature.

Amphetamine, methamphetamine, phentermine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA) are the most popular amphetamine-type stimulants. The use of these substances is a serious societal problem worldwide. In this study, a method based on gas chromatography-tandem mass spectrometry (GC-MS/MS) with simple and rapid liquid-liquid extraction (LLE) and derivatization was developed and validated for the simultaneous determination of the six aforementioned amphetamine derivatives in blood and urine. The detection of all compounds was based on multiple reaction monitoring (MRM) transitions. The most important advantage of the method is the minimal sample volume (as low as 200μL) required for the extraction procedure. The validation parameters, i.e., the recovery (90.5-104%), inter-day accuracy (94.2-109.1%) and precision (0.5-5.8%), showed the repeatability and sensitivity of the method for both matrices and indicated that the proposed procedure fulfils internationally established acceptance criteria for bioanalytical methods The procedure was successfully applied to the analysis of real blood and urine samples examined in 22 forensic toxicological cases. To the best of our knowledge, this is the first work presenting the use of GC-MS/MS for the determination of amphetamine-type stimulants in blood and urine. In view of the low limits of detection (0.09-0.81ng/mL), limits of quantification (0.26-2.4ng/mL), and high selectivity, the procedure can be applied for drug monitoring in both fatal and non-fatal intoxication cases in routine toxicology analysis.

The paper presents a case of suicidal asphyxiation with helium inhaled from a gas cylinder through a tube with its end placed under a plastic bag taped around the deceased young man's head. We attempted to detect helium in the deceased's lungs by means of gas chromatography with a mass spectrometry detector and it confirmed the presence of helium in the lung tissue. A modification of the method of helium isolation from the lung tissue before the chromatographic analysis was suggested. Key Words: helium, asphyxia, suicide, gas chromatography, mass spectrometry. Language: en

Medical errors are crucial factors influencing hospital mortality. We present a case of 79-year-old female, who was admitted to the hospital due to complications associated with advanced cancer disease. After several days of hospitalization, the woman died as a result of cancer as well as severe drugs intoxication. The investigation showed extremely high concentrations of chlorprothixen and tramadol in the. blood of the patient. This paper describes a number of medical errors made by hospital staff, of which the most significant was an inappropriate drugs policy.

Background:Ethyl alcohol is the most popular legal drug, but its excessive consumption causes social problems. Despite many public campaigns against alcohol use, car accidents, instances of aggressive behaviour, sexual assaults and deterioration in labor productivity caused by inebriated people is still commonplace. Fast and easy diagnosis of alcohol consumption is required in order to introduce proper and effective therapy, and is crucial in forensic toxicology analysis. The easiest method to prove alcohol intake is determination of ethanol in body fluids or in breath. However, since ethanol is rapidly metabolized in the human organism, only recent consumption can be detected using this method. Because of that, the determination of alcohol biomarkers was introduced for monitoring alcohol consumption over a wider range of time.Objective:The objective of this study was to review published studies focusing on the sample preparation methods and chromatographic or biochemical techniques for the determination of alcohol biomarkers in whole blood, plasma, serum and urine.Methods:An electronic literature search was performed to discuss possibilities and limitations of application of alcohol biomarkers in toxicological analysis.Results:Authors described the markers of alcohol consumption such as: ethanol, its nonoxidative metabolites (ethyl glucuronide, ethyl sulfate, phosphatidylethanol, ethyl phosphate, fatty acid ethyl esters) and oxidative metabolites (acetaldehyde and acetaldehyde adducts). We also discussed issues concerning the detection window of these biomarkers, and possibilities and limitations of their use in routine analytical toxicology for monitoring alcohol consumption or sobriety during alcohol therapy.

The available information on the quality and frequency of illegal psychoactive substances used or medicines misused by workers, are often out of date at the time of its publication. This is due to the dynamic introduction of new synthetic drugs on the black market, changes in trends in the recreational use of medicines and the lack of readily available and reliable tests for fast identification. Strategy for detection of narcotic and non-medical psychoactive drugs use at workplace should embrace all possible sources of information. Classical sources of information on the use of psychoactive substances at the workplace include: statistical data (general information on trends and magnitude of drug and medicine addiction collected by the Polish National Police, the National Bureau for Drug Prevention and emergency medical services), surveys, psychomotor tests and qualitative and quantitative analyses of biological material. Of the new and promising methods, used throughout the world in recent years, chemical-toxicological analysis of surface water and wastewater deserve special mention. An increasing interest in the study of urban waste water can significantly complement the source of knowledge about drug and medicine addiction using obtainable conventional methods. In recent years, a municipal wastewater analysis has become a new and very promising way of collecting updated information on the use of psychoactive substances and medicines. It seems that this kind of study may play an important role in the ongoing monitoring of drug and/or medicines use by selected groups of population (e.g., students, military, firemen, policemen, etc.).Informacje, które można uzyskać na temat jakości i częstości stosowanych przez pracowników nielegalnych substancji psychoaktywnych lub leków używanych niezgodnie z ich przeznaczeniem, są najczęściej nieaktualne już w chwili ich opublikowania. Wynika to z intensywnego wprowadzania na czarny rynek nowych, syntetycznych narkotyków, zmiany trendów w rekreacyjnym stosowaniu leków oraz braku łatwo dostępnych i pewnych testów służących do ich szybkiej identyfikacji. Strategia wykrywania stosowania narkotyków i pozamedycznego stosowania psychoaktywnych leków w miejscu pracy powinna uwzględniać wszystkie możliwe źródła informacji. Do klasycznych źródeł informacji opisujących stosowanie substancji psychoaktywnych w miejscu pracy należą: dane statystyczne (ogólne informacje na temat trendów i wielkości zjawiska narkomanii i lekomanii gromadzone m.in. przez Komendę Główną Policji, Krajowe Biuro Do Spraw Przeciwdziałania Narkomanii oraz jednostki ratownictwa medycznego), badania ankietowe, testy psychomotoryczne oraz analizy jakościowe i ilościowe materiału biologicznego. Do nowych i obiecujących metod stosowanych w ostatnich latach na świecie należy analiza chemiczno-toksykologiczna wód powierzchniowych i ścieków. Zwiększenie zainteresowania wielu instytucji państwowych i naukowców badaniem ścieków komunalnych może w istotny sposób uzupełniać wiedzę o zjawisku narkomanii i lekomanii uzyskiwaną klasycznymi metodami. Wydaje się, że takie badanie może mieć istotne znaczenie w bieżącym monitorowaniu używania substancji psychoaktywnych i/lub leków przez wybrane subpopulacje ludzi (np. studentów, wojskowych, strażaków, policjantów itd.). Med. Pr. 2015;66(6):837–847.

An involvement of the central serotonergic system has been implicated in the pathogenesis of suicide. The dorsal raphe nucleus (DRN) is the main source of serotonergic innervation of forebrain limbic structures disturbed in suicidal behaviour. The study was carried out on paraffin-embedded brainstem blocks containing the DRN obtained from 27 suicide completers (predominantly violent) with unknown psychiatric diagnosis and 30 non-suicidal controls. The transcriptional activity of ribosomal DNA (rDNA) in DRN neurons as a surrogate marker of protein biosynthesis was evaluated by the AgNOR silver staining method. Significant decreases in AgNOR parameters suggestive of attenuated rDNA activity were found in the cumulative analysis of all DRN subnuclei in suicide victims versus controls (U test P values 80 %) suggests a diagnostic value of the observed effect. However, the possible application of the method in forensic differentiation diagnostics between suicidal and non-suicidal death needs further research. Electronic supplementary material The online version of this article (doi:10.1007/s00406-015-0655-4) contains supplementary material, which is available to authorized users.

We described two cases of poisoning with amygdalin. Clinical signs presented by two females were mild and lasted up to 5 hours.The usage of amygdalin may be connected with serious side effects. The cyanide and prussic acid which are deliberated in digestive system are responsible for toxicity in such cases. The rarity of poisoning with amygdalin as well as high cost of analysis are responsible for the reason that most labs are not prepare for such procedure.

Methoxetamine (MXE) is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED) at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C) and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml) was within the non-toxic range, while MXE (0.32 μg/ml) was within the toxic range of concentrations. Amphetamine was also detected in the patient’s hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient’s blood and urine suggest the possibility of adverse interactions between them.

The paper presents the results of determination of selected organic pollutants in atmospheric precipitation. Samples of atmospheric precipitation in the form of rain water and snow were collected in five places in the area of Gdansk, which enabled some conclusions to be drawn on the influence of sampling position on the content of samples. Two different groups of compounds were determined: polycyclic aromatic hydrocarbons (PAHs) and pesticides. All applied analytical methods were previously checked out and used for other types of water samples (e.g. river waters, sea waters, drinking water). Capillary gas chromatography with specific detectors was used for final determination. Samples were collected during two separate periods of six months each, which permits us to find out some qualitative and quantitative changes of organic compounds in an urban area in different seasons. The most often detected pesticides were: terbuthylazine and chlorfenwinfos, whereas bromophos and atrazine occurred rarely. If detected, the concentration of pesticides ranged from 1 to 920 ng dm −3 . The total concentration of the measured polycyclic aromatic hydrocarbons varied between 1 ng dm −3 and 12.8 μg dm −3 . Among all PAHs phenanthrene, fluoranthene and pyrene were the most often determined compounds.

The aim of this study is a qualitative and quantitative characterisation of organic pollutants in post-flood sediments in the Odra basin and the description of their sources with indication of especially polluted sites (so called hot spots) in the most suspected places in the drainage area. It was found that maximum allowable concentration levels for PCBs (polychlorinated biphenyls), VOC's (volatile organic compounds) and pesticides were not exceeded. Among regulated compounds, the exceeding values of the permissible level of concentration were found only for PAHs (polycyclic aromatic hydrocarbons) in sediments. Sixteen investigated samples, out of 72 had very high content of total PAHs. Sampling sites in which concentration levels of PAHs were found high, were located near power plants or roads with heavy traffic.

A new isolation procedure for the determination of nitrogen/phosphorous containing pesticides and organochlorine pesticides in water was tested, and statistical evaluation of the recoveries was performed. The procedure, designed specifically for the analysis of semi-volatile compounds in water containing Suspended Particulate Matter (SPM), utilizes a specially designed filtration vessel coupled directly to an SPE cartridge. The studies were based on surface water samples (from the Vistula River) spiked with pesticides. SPM separation and analyte isolation/concentration were carried out in a special filtration vessel. Pesticides were sorbed both on the SPE cartridge and on the suspended matter. The cartridge and the filter with the suspended matter were extracted separately with a solvent, which enabled the determination of analyte distribution between the two. For organochlorine pesticides, between 3 and 60 % of the initial amount was found on the filter, while the recoveries in the filtrate ranged from 30 to 98 %. Total recoveries of organochlorine pesticides from surface water samples spiked with pesticides using the method described were high, ranging from 90 to 101 %. The amounts of nitrogen/phosphorus containing pesticides recovered from the filter were lower than 2 %, while those from the filtrate ranged from 69 to 92 %. Total recoveries of nitrogen/phosphorus containing pesticides from surface water samples were high, ranging from 71 to 92 %.

The paper proposes tests to assess psychomotor impairment in drivers suspected of using substances acting similarly to alcohol. The authors also present a proposal for the protocol to be used in sampling and testing of saliva, blood and urine when psychoactive substance abuse has been suspected. A detailed procedure is based on the joined experience of German, U.S. and Polish police from Gdansk. The purpose of the appendix is to help police officers to perform and document tests confirming psychomotor impairment, as well as to provide the basis for saliva, urine and blood analysis.

Interpretation of analytical results indicating borderline-legal alcohol concentration values after the substance intake or intoxication requires consideration of many factors, such as: road safety, measurement uncertainty, determination of ethanol in breath, alcohol metabolism in the body, the possibility of residual alcohol in the mouth. Decree No 738 of the Chief of Police issued on 21 June 2011, introduces the obligation to verify the results ranging close to the borderline concentration of 0.1 mg/l by executing the third measurement, but the interpretation of these results is questionable. The paper proposes a new manner of taking measurements and their interpretation. Upon arriving at the scene the police should record the starting time of testing the driver and wait 15 minutes (the time required to eliminate residual alcohol). If, after that time, the first result falls within the borderline values legally described as the condition after alcohol consumption or alcohol intoxication, the second and third measurements should be taken immediately. Thus, three measurements taken quickly in a few minutes should not be affected by the alcohol metabolism in the body. If two of the three determined values are less than or equal to 0.09 mg/l, the driver should be pronounced sober. If two of the three results are within the range of 0.10-0.25 mg/l, the result indicates condition after alcohol intake. If two of the three results are equal to or more than 0.26 mg/l, the status of the driver may be described as alcohol intoxication.

The study highlighted the problem of intoxication using substances and/or preparations, to which nowadays young people have unrestricted access. Based on the case developed in the Department of Forensic Medicine of the Medical University of Gdansk, our team members were able to gather information showing "ingenuity" of today's teenagers, which was reflected in the types of preparations used to induce a state of euphoria and intoxication. The study was based on the case of a 17-year-old woman, who took Acodin in combination with compressed air used to clean computer keyboards in order to induce psychoactive effects. The study used qualitative and quantitative methods: GC-FID and GC-MS. The results were compared with data from the literature.

Pesticides as environmental pollutants are described in detail along with their sources and paths of entry into various elements of the environment. Comprehensive literature data on the concentration of these pollutants in natural and treated waters and wastewaters are discussed. A wide selection of isolation and preconcentration techniques for these pollutants in water is presented and discussed. An emphasis is put on solid-phase extraction. In the case of the authors' work, a more detailed description is given.

Sodium azide (NaN3) is an inorganic matrix compound with a very high toxicity. Mechanism of action is not clarified, and it is assumed to interfere with the processes of oxidative phosphorylation. The acute intoxications with sodium azide are extremely rare. We described a case of 19-year-old man who was found dead. In the course of prosecution the empty container, with label "NaN3, 20 g", was found near the body. There were traces of white powder detected in the container. Azide ions were determined by derivatization, i.e. they were transformed to pentafluorobenzaldehyde azide compound. Analysis of the final extract after derivatization was performed by gas chromatography coupled with mass spectrometry GC/MS. The largest concentration of azide ions were determined in the stomach content and vitreous humour, and much less one in whole blood, urine and kidney fluid.

Methoxetamine (MXE) is an analogue of ketamine.We present a 25-year-old male who, after getting an information from the Internet, started to use MXE to avoid the excitement connected with recreational codeine abuse. For about 8 - 10 months he injected about 100 mg of MXE intramuscularly. On the day of admission the patient decided to take much higher dose of 750 mg of MXE. For the first 3-4 hours of hospitalization the profound agitation, which demanded the usage of high doses of benzodiazepines, was observed every several minutes. After 6-7 hours of supportive treatment the patient returned to his baseline mental status.MXE presents the new healthcare threat because of easy accessibility via Internet, and lack of legal restrictions in many countries. The low dose of MXE can cause "peace and serenity", however, higher dose may act opposite.

Important source of objective information about the nature and the scale of the usage of psychoactive substances becomes test of municipal waste water or surface water. From the analytical chemistry point of view municipal waste water are a complex mixture of substances therefore the authoritative analysis requires careful planning of both the place of sampling and the use of effective methods of research. The aim of this work was the attempt to estimate the scale of the usage of narcotic drugs in the academic campus Kortowo in Olsztyn during the students May holidays "Kortowiady". The positive results of the concentration of 11 -nor-9-carboxy-delta9-tetrahydrocannabinol (THC-COOH) and amphetamines in the samples of effluent shall indicate the need to continue research in this field and improvement methods for the determination of narcotic drugs.

We presented the male who was addicted to ethanol, and who drank the mixture of different toxic alcohols. Toxicological screening of ingested fluid found 42% vol propan-1-OL, and 17% vol propan-2-OL (isopropanol). After regaining consciousness, the patient stated that substance is becoming more and more popular as a new type of cheap alcohol, and because of its "low price and high power".1. It is advisable to consult all cases of poisoning with inedible alcohols with Regional Centers of Toxicology. 2. There is an urgent need to create a reference toxicological laboratories, which would have the ability to diagnose poisoning with different xenobiotics. 3. Further training for students and doctors, about diagnosis and therapy of acute poisonings, should be done. 4. The endemic foci of intoxication with inedible alcohols should be checked and discovered.

Pheromones are a mysterious world of chemical signals involved in conspecific communication. They play a number of key functions important for preservation of life of individual organisms, for their defence, survival of offspring and preservation of species. The best-known groups of pheromones include: trail pheromones, territorial pheromones, sex pheromones, aggregation pheromones, dispersion pheromones, repellent pheromones, social pheromones and alarm pheromones. Alarm pheromones are pheromones that are emitted by animals in threatening situations and inform members of the same species of danger. The identified alarm pheromones are synthesised by insects and aquatic organisms. Also humans are able to emit and perceive pheromones. Although alarm pheromones have not been isolated and identified in man so far, there is presumably evidence for their presence in humans. Pinpointing human alarm pheromones, determinants of experienced stress and inductors of provoked fear could have widespread consequences. Their identification could also be of significant importance for the practical utilisation of results by institutions responsible for safety and defence as well as law enforcement/crime detection and antiterrorist activities.

The objective of the study was the presentation of the type and extent of drug addiction in the region covered by the Department of Forensic Medicine of the Medical University of Gdańsk based on the results of analyses of biological samples collected from the living and deceased subjects during the decade from 1996 to 2005. The studies were based on 110 cases of lethal intoxication after psychoactive substances overdosing and 63 cases of living people involved in the infringement of the law. Body-fluids (blood, urine) and post-mortem samples (stomach contents, small intestine contents, liver, kidney, brain and lung tissues) were collected and stored at -20 OC. The screening analysis of urine was performed using the Fluorescence Polarization Immunoassay method (TDx, Abbott) and the enzyme immunoassay method (Syva Rapid Test, Dade Behring). The confirmation of positive results was carried out by thin-layer chromatography (TLC), as well as gas and liquid chromatography with various detectors (GC/FID, GC/NPD, GC/MS, LC/UV-DAD). In the last 10 years, there was noted a 3-fold increase in the number of cases that required an analysis of narcotics content, and in the last 4 years, such cases exceeded 10% of the total number of investigated cases. The number of analyses aiming at determination of amphetamine and cannabinol contents in living people (mainly among individuals that caused traffic accidents) increased. Among deceased subjects, deaths were predominantly caused by intoxication with opiates or combinations of opiates and other narcotic substances and medications. The presence of both ethanol and drugs was detected and confirmed mainly in post-mortem biological materials.

Problem of adulteration of herbal medicines with synthetic drugs is getting a common and dangerous phenomenon in Poland. The purpose of this study was the qualitative estimation of content of the Chinese herbal medicine for slimming "Meizitanc" as well as the estimation of hazard for human health and life. Twenty herbal packages which were secured by police in the 2006 year were investigated. The main ingredient of herbal medicine "Meizitanc" was sibutramine. The average mass of sibutramine hydrochloride in the "Meizitanc" capsule was about 10 mg. Additionally the trace amount of xylene and a starch were detected in the capsules. The presence of mentioned above substances were confirmed by different analytical methods like: gas chromatography with mass spectrometry GC/MS, thin layer chromatography TLC, high-pressure liquid chromatography HPLC/UV-DAD and infrared spectrometry IR. There were not determined any herbal-originated substances, which were mentioned on the packages. It was not found any pharmacologically active substance in one of the twenty examined packages.The medicine containing sibutramine should be used under the strict medical control. For safety of the patients all herbal products should be buy from authorized her

The aim of the study was to evaluate the impact of smoking, verified by the measurement of cotinine levels, on life satisfaction of patients with coronary artery disease. The questionnaire was answered by 36 patients (26 men and 10 women) aged from 48 to 7.6 (mean 63.5) years. The questions regarded the current attitude toward smoking, subjective self-assessment of health and life satisfaction while smoking and after cessation. Cantril's ladder has been used among others to assess life satisfaction. In order to verify the answers regarding current smoking cotinine (nicotine metabolite) serum, urine and saliva levels have been measured. There were 38.8% of current smokers in the studied group of patients after PTCA. The fact of current smoking was negated by 19.4% of smokers during medical exam. Objective verification of smoking is necessary in questionnaire studies on tobacco consumption. Measurement of cotinine in body fluids (serum, urine, saliva) may be useful in these cases. After cessation of smoking 93.9% respondents reported major subjective improvement in self-assessment of health. 54.5% of smokers admitted having been ashamed of the habit, and 60.6% the feeling of disturbing others while smoking. The increase of general life satisfaction measured by Cantril's ladder was observed in 94.7% of responders after cessation of smoking.

The present paper emphasizes the most common mistakes committed at the beginning of an analytical procedure. To shorten the time and decrease the cost of determinations of substances with similar to alcohol activity, it is postulated to introduce mass-scale screening analysis of saliva collected from a living subject at the site of the event, with all positive results confirmed in blood or urine samples. If no saliva sample is collected for toxicology, a urine sample, allowing for a stat fast screening analysis, and a blood sample, to confirm the result, should be ensured. Inappropriate storage of a blood sample in the tube without a preservative can cause sample spilling and its irretrievable loss. The authors propose updating the "Blood/urine sampling protocol", with the updated version to be introduced into practice following consultations and revisions.

The aim of this study was the preparation of reliable procedure of the determination of nicotine and cotinine both in classic (serum, urine) and alternative biological materials (hair, saliva) and evaluation of their significance for clinical and forensic toxicology. Biological material samples (blood, urine, saliva) were taken from patients after Percutaneous Trans-luminal Coronary Angioplasty (PTCA). The determination of cotinine and nicotine concentration in the biological material should be optimized depending on the aim of analysis. Liquid-liquid extraction procedure and high performance liquid chromatography HPLC/UV-DAD are reliable, specific and relatively cheap. Serum and saliva are valuable biological materials which allow to determine temporary nicotine and cotinine content on the similar level of concentrations. In the near future it will be able to replace blood with saliva sample because of an easy and non-invasive way of sampling. Evaluation of cotinine concentration in urine allows to distinguish the passive from the active tobacco smokers. Hair analysis allows to control a nicotine abstinence as well as a long-term evaluation of the history of smoking. However usage of hair is limited because of difficulty with sampling. Interpretation of results in analysis of alternative materials (hair, saliva) pose a problem because of lack of sampling standardization and lack of standardization of final analysis method.

The aim of our study was the evaluation of tobacco smoking among students of VI year of Medical University of Gdańsk. Anonymous questionnaire was done among one hundred and ten students including 70 women and 40 men in the age from 23 to 29 (24.82 +/- 1.03) years.1. There were 12.7% of daily smoking students including 8.6% women and 15% men. 2. Almost 79% volunteers ineffectively attempted to give up smoking within last year. 3. The smoking students abused alcohol (with high likelihood) and used recreational drugs twice more than nonsmoking colleagues. 4. Almost all volunteers (96.4%) want to use smoking cessation intervention in their patients. 5. Above 75% students declared to broaden their knowledge about diagnostic and smoking cessation therapy.

The aim of the study was an objective assessment of active and passive exposure to cigarette smoke among patients after percutaneous transluminal coronary angioplasty (PTCA). A questionnaire was answered by 24 patients (18 men and 6 women) aged 48 to 76 (av. 61.2) years. Cotinine (metabolite of nicotine) level was measured in blood, urine and saliva of the patients as objective verification of the questionnaire answers.1. Among the PTCA patients 41.6% of them were active smokers. 2. 30% of smokers concealed the fact of active smoking. 3. We assume that smoking habit among the patients should be verified by measurement of cotinine in serum, saliva and urine. 4. The main motivations for smoking cessation were myocardial infarction, PTCA and hospitalizations. 5. All patients were aware of the harmful effects of smoking and were able to identify the main risks.