Scopolamine fatal outcome in an inmate after buscopan® smoking

The Current Status of Virtual Autopsy Using Combined Imaging Modalities: A Scoping Review

Background/Objectives: Virtual autopsy (virtopsy) is a new domain of research for interdisciplinary teams of radiologists and forensic specialists. This scoping review aims to underline the current state-of-the-art research using combined imaging modalities. Methods: We searched the PubMed database using the term virtopsy for articles that are available in free full text, indexed in the Medline Database, and published in English. The query returned 49 articles on this subject that have been published since 2002. Results: The main imaging modalities used for postmortem imaging were computed tomography (PMCT), angiography (PMCTA), magnetic resonance imaging (PMMRI), and ultrasonography (PMUS). PMCT is highly effective for detecting complex osseous injuries, tracing bullet trajectories, or identifying characteristic findings in drowning cases. PMCTA is valuable for evaluating vascular lesions, particularly in natural death cases. PMMRI is superior in analyzing soft tissues, including brain and spinal structures, cerebrospinal fluid, microbleeds, and laryngohyoid lesions, and identifying cardiomyopathies in young individuals. PMUS serves as an alternative, and its portability also allows for use in forensic settings. One specific situation observed was the increased number of studies published about virtopsy during the COVID-19 pandemic. Another aspect is the increased focus on this alternative to conventional autopsy in the regions where maneuvering of the deceased is limited according to cultural and social customs. Conclusions: We underline the advantages and limitations of each imaging modality used for virtopsy. Further studies need to be developed in order to gather supplementary data regarding the use of these imaging modalities in the new era of artificial intelligence in medicine.

Perioperative considerations for patients exposed to hallucinogens

Hallucinogen exposure in patients in the perioperative period presents challenges for anesthesiologists and other anesthesia providers. Acute and chronic exposure to these substances can cause physiological impacts that can affect the function of anesthetic and analgesic medications used during perioperative care. The objective of this narrative review is to educate readers on the wide array of hallucinogens and psychedelics that may influence the perioperative management of patients exposed to these substances. A narrative review of the literature surrounding hallucinogens and psychedelics was completed. Hallucinogens and psychedelics are quite varied in their mechanisms of action and therefore present a variety of perioperative implications and perioperative considerations. Many of these substances increase serotonin levels or act directly at serotonergic receptors. However, there are other relevant actions that may include varied mechanisms from N-methyl-D-aspartate receptor antagonism to stimulation of muscarinic receptors. With hallucinogen exposure rates on the rise, understanding the effects of hallucinogens is important for optimizing management and reducing risks perioperatively for patients with acute or chronic exposure.

"Eco-friendly HPLC method for analysis of dipyrone and hyoscine in different matrices with biomonitoring"

A selective, precise, and accurate reversed HPLC method has been developed and validated for simultaneous separation and determination of two veterinary drugs, dipyrone and hyoscine, in their combined dosage form in the presence of their official impurities, namely 4-aminoantipyrine and tropic acid, in addition to the formulated preservative: phenol. The linearity range was found to be (1.00-35.00 µg/mL) for dipyrone and (2.50-50.00 µg/mL) for hyoscine. It exhibited a satisfactory linearity regression R (0.9999) for both drugs with LOD 0.22 µg/mL and 0.72 µg/mL and LOQ 0.65 µg/mL and 2.19 µg/mL for dipyrone and hyoscine, respectively. Additionally, the two cited drugs were also determined in the presence of dipyrone active metabolite 4-aminoantipyrine using diclofenac as an internal standard in bovine urine. The linearity range was found to be (15-75 µg/mL) for dipyrone, (2.5-60 µg/mL) for hyoscine, and (2.5-60 µg/mL) for 4-aminoantipyrine with linearity regression R (0.9999-0.9998). The LLOQ (15, 2.5, 2.5 µg/mL), LQC (45, 7.5, 7.5 µg/mL), MQC (55, 25, 25 µg/mL), and HQC (60, 50 50 µg/mL) were determined for dipyrone, hyoscine and 4-aminoantipyrine, respectively. UV detection was carried out at 220 nm. The method was validated according to the ICH guidelines, as well as according to FDA guidelines for determining both drugs in bioanalytical matrices and both proved accuracy and precision. A statistical comparison was made between the results obtained and those obtained by the reported method, showing no significant difference in accuracy and precision at p = 0.05. The suggested method was proved eco-friendly through a greenness assessment using two different tools (The analytical eco-scale scored 83, and the AGREE-Analytical Greenness Metric approach scored 0.83). The suggested method can be used in the routine work of quality control labs, screening for drug abuse, and ensuring clean sport for horse racing.

New trends of drug abuse in custodial settings: A systematic review on the misuse of over-the-counter drugs, prescription-only-medications, and new psychoactive substances

The article presents a systematic literature review on the use and the psychiatric implications of over-the-counter drugs (OTC), prescription-only-medications (POM), and new psychoactive substances (NPS) within custodial settings. The searches wer carried out on 2 November 2022 on PubMed, Scopus, and Web of Science in line with PRISMA guidelines. A total of 538 records were identified, of which 37 met the inclusion criteria. Findings showed the most prevalent NPS and OTC and POM classes reported in prisons were synthetic cannabinoids receptor agonists (SCRAs) and opioids, respectively. NPS markets were shown to be in constant evolution following the pace of legislations aimed to reduce their spread. The use of such substances heavily impacts the conditions and rehabilitation of persons in custody, with consequent physical and mental health risks. It is important to raise awareness of the use and misuse of such substances in prisons (i) from an early warning perspective for law enforcement and policy makers (ii) to prompt doctors to cautiously prescribe substances that may be misused (iii) to improve and increase access to treatment provided (iv) to add such substances to routine toxicological screening procedures (v) to improve harm reduction programmes.

Determination of scopolamine and butylscopolamine in beverages, urine and Buscopan® tablets samples using electrophoresis microchip with integrated contactless conductivity detection

The number of cases in which scopolamine (SCO) was used for both recreational and predatory purposes has increased dramatically in recent decades. Linked to this, there is a concern about obtaining SCO through thermal degradation of butylscopolamine (BSCO) - an active ingredient of Buscopan® - a drug sold without a medical prescription. In this study, mixtures containing SCO and BSCO were separated and detected on a microchip electrophoresis (ME) device with integrated capacitively coupled contactless conductivity detection (C4D) using a running buffer composed of 40 mmol L-1 of butyric acid and 25 mmol L-1 of sodium hydroxide (pH 5.0). The separation was performed within ca. 115 s with a resolution of 1.3 and separation efficiency ranging from 1.4 × 105 to 1.5 × 105 theoretical plates m-1. A detection limit of 1.1 μmol L-1 was achieved for both species and the developed method revealed satisfactory repeatability with relative standard deviation (RSD) values for forty-eight injections between 4.8 and 9.4% for peak areas and lower than 3.3% for migration times. Furthermore, inter-day precision was evaluated for sixteen injections (a sequence of four injections performed over four days), and RSD values were less than 6.6% for peak areas and 2.2% for migration times. Satisfactory recovery values (95-114%) were obtained for all evaluated beverage samples (cachaça, vodka, whiskey, beer, Coca-Cola, and grape juice) as well as for artificial urine samples (95-107%). Finally, the conversion of BSCO into SCO was observed after simple heating procedure of Buscopan® sample (not subject to medical prescription), which was successfully confirmed through analysis by capillary electrophoresis coupled to the mass spectrometry (CE-MS). Based on the reported results, the use of ME-C4D devices has demonstrated a huge potential for applications in the forensic chemistry field.

Detection of scopolamine in urine and hair in a drug-facilitated sexual assault

The use of the drug scopolamine in drug-facilitated crimes is known. Nevertheless, given the high potency of the drug and its rapid metabolism, analysis in blood and urine may not be sufficient for drug detection in late crime declaration, especially following a single-dose administration in drug-facilitated sexual assault (DFSA) cases. Hair may constitute an essential supplemental matrix extending the drug detection window in such cases. This case report presents quantitative data on scopolamine findings in urine and hair in a DFSA case. A young female had consumed several alcoholic drinks at a party venue when her behaviour became noticeably peculiar. Later, she woke up next to an unknown man and had no recollection of the night's events. Blood and urine samples were collected 18 h after the incident. The initial toxicological target screening using UHPLC-TOF-MS detected scopolamine in the hydrolysed urine sample, and quantification yielded 41 µg/L scopolamine in urine, while blood was negative. Segmental hair analysis using multitarget UHPLC-MS/MS was performed on three washed 2-cm segments of hair collected five weeks after the incident, yielding 0.37 pg/mg scopolamine only in the relevant hair segment. This case report provides novel insight into the concentration in hair following a single exposure of scopolamine and the feasibility of detecting scopolamine in hair by comparison to published toxicological findings.

Misuse of Anticholinergic Medications: A Systematic Review

(1) Background: Over the last decade, misuse and diversion of medications has appeared to be increasingly concerning phenomena, including a range of different molecules. As current knowledge on the abuse of centrally acting anticholinergics is limited, the aim of the present study is to review the relevant published data, focusing on the following molecules: benztropine, biperiden, scopolamine, orphenadrine, and benzhexol/trihexyphenidyl (THP). (2) Methods: A systematic literature review was carried out using Pubmed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Research methods were registered on PROSPERO (CRD42021257293). (3) Results: A total of 48 articles, including case reports, surveys, and retrospective case series analyses, were included. Most articles focused on benzhexol/THP (n = 25), and benztropine (n = 4). The routes of administration were mostly oral, and macrodoses together concomitant illicit drugs, e.g., cocaine, have been recorded. Toxidromes included both physical (e.g., tachycardia, tachypnoea, dilatated pupils, dry skin, urinary retention, ataxia, etc.) and psychiatric symptoms (e.g., anxiety, agitation, delirium, etc.). Fatal outcomes were very rare but reported. (4) Conclusion: Results from the present study show that anticholinergic misusing issues are both widespread worldwide and popular. Considering the potential adverse effects associated, healthcare professionals should be vigilant and monitor eventual misusing issues.

Scopolamine fatal outcome in an inmate after buscopan® smoking

Scopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.