Vanessa Biering, Catherine Monteil-Ganière, Eric Dailly, Edouard Charles Le Carpentier, Ronan Bellouard
{"title":"Rapport d’un cas d’intoxication mortelle à la cocaïne chez une « body-packer »","authors":"Vanessa Biering, Catherine Monteil-Ganière, Eric Dailly, Edouard Charles Le Carpentier, Ronan Bellouard","doi":"10.1016/j.toxac.2025.01.071","DOIUrl":"10.1016/j.toxac.2025.01.071","url":null,"abstract":"<div><h3>Objectifs</h3><div>Présentation d’un cas clinique d’intoxication sévère liée à l’ingestion massive de cocaïne dans un contexte de « <em>body-packing</em> ».</div></div><div><h3>Méthodes</h3><div>Une patiente de 46<!--> <!-->ans a été admise en soins intensifs après un arrêt cardiaque survenu dans un contexte de malaise aigu. À la suite de l’évaluation initiale clinique, biologique et radiologique, une laparotomie d’urgence a été réalisée pour retirer les corps étrangers présents (36 paquets de cocaïne, soit environ 400<!--> <!-->g) au sein du tractus gastro-intestinal. Le suivi biologique de la patiente a permis d’étudier les cinétiques plasmatiques de la cocaïne et de ses métabolites. Malgré des soins intensifs, la patiente a évolué vers une mort cérébrale confirmée à trois jours d’hospitalisation. La cinétique des concentrations plasmatiques de cocaïne, de benzoylecgonine (BZE) et d’ecgonine méthyl ester (EME) a été réalisée par chromatographie liquide couplé à la spectrométrie de masse en tandem (Sciex QTRAP 5500 LC-MS/MS system).</div></div><div><h3>Résultats</h3><div>Les analyses biologiques initiales de la patiente lors de son admission aux urgences ont révélé une acidose métabolique avec hyperlactatémie (24 mmol/L) associé à une insuffisance rénale (créatinine à 106<!--> <!-->μmol/L, débit de filtration glomérulaire à 55<!--> <!-->mL/min/1,73m<sup>2</sup>) et à une cytolyse hépatique (aspartate transaminase à 159,8 UI/L et alanine transaminase à 130,7 UI/L). Les concentrations de la créatine kinase et la troponine étaient de 117,9 UI/L et 44 ng/L, respectivement. Les analyses toxicologiques ont montré une concentration plasmatique en cocaïne trois heures après l’arrêt cardiaque à 1410 ng/mL, avec également des concentrations élevées de ses métabolites (BZE à 9670 ng/mL et EME à 7410 ng/mL). Les dosages ultérieurs ont révélé une cinétique décroissante des concentrations de cocaïne et de ses métabolites, suggérant que le pic de concentration de la cocaïne a eu lieu en amont du premier bilan sanguin. Au 7<sup>e</sup> jour d’hospitalisation, les concentrations de cocaïne, BZE et EME étaient respectivement de 4,2 ng/mL, 2350 ng/mL et 192 ng/mL.</div></div><div><h3>Conclusion</h3><div>Les cas de «<em>body-packing</em>» impliquant l’ingestion de paquets de cocaïne restent une cause majeure d’intoxication aiguë, souvent mortelle, en médecine d’urgence. Ces situations représentent des défis diagnostiques et thérapeutiques complexes, particulièrement lorsque des complications telles que la rupture des paquets survient. Les rares données pharmacocinétiques confirment que la rupture (ou l’administration orale) au niveau du tractus gastro-intestinal d’un ou plusieurs paquets entraîne une absorption massive et rapide de la cocaïne au niveau de l’estomac, dû à l’environnement acide de celui-ci, responsable de fortes concentrations plasmatiques de cocaïne. Au niveau intestinal, la cocaïne est également absorbée mais dans une moindre mesure puisqu","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages S46-S47"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ysé Jagailloux, Fabienne Le Saos, Amélie Rouille, Jean Luc Carre
{"title":"Consommation de Delta-9-tetrahydrocannabiphorol (THCP) en « space cake » : à propos d’un cas","authors":"Ysé Jagailloux, Fabienne Le Saos, Amélie Rouille, Jean Luc Carre","doi":"10.1016/j.toxac.2024.07.004","DOIUrl":"10.1016/j.toxac.2024.07.004","url":null,"abstract":"<div><div>Nous rapportons un tableau clinique d’allure neurologique suite à l’ingestion de Delta-9-THCP sous forme de « space cake ». Un homme de 21 ans est pris en charge par le service mobile d’urgence et de réanimation pour obnubilation, score de Glasgow à 14, mydriase bilatérale réactive et myoclonies faisant suite à la consommation de « space cake » ingérés la veille, réalisés avec du THCP acheté sur internet. Les anomalies du bilan biologique sanguin réalisé lors de la prise en charge du patient consistent en une augmentation des créatine-phosphokinases à 420 U/L, une augmentation des leucocytes : polynucléaire neutrophiles à 12,75 Giga/L, monocytes à 1,3 Giga/L. Une recherche large de xénobiotiques ainsi qu’une recherche et dosage de stupéfiants ont été réalisés par LC-MS/MS (Xevo TQ-S micro et Xevo TQ-D, Waters) après extraction liquide-liquide, sur un prélèvement sanguin réalisé environ 24<!--> <!-->heures après l’ingestion de Delta-9-THCP. Les analyses toxicologiques retrouvent du Delta-9-THCP à la concentration de 0,60<!--> <!-->μg/L et du cannabidiol (CBD) à la concentration de 0,80<!--> <!-->μg/L. L’analyse toxicologique d’un échantillon d’inflorescence de chanvre acheté par nos soins en magasin et déclaré comme contenant du Delta-9-THCP a été réalisé et retrouve une teneur en Delta-9-THCP de l’ordre de 11 %. Le tableau clinique présenté par le patient, majoritairement neurologique, a été rapidement résolutif sous surveillance clinique.</div></div><div><div>We report a neurological clinical case following Delta-9-THCP ingestion in the form of “space cake”. A 21-year-old man was treated by the Emergency Rapid Response Unit for obnubilation with a Glasgow score of 14, bilateral reactive mydriasis and myoclonus following the consumption of “space cake” the previous day, made with THCP purchased on the internet. Abnormal biology findings consisted in an increased in creatine phosphokinases to 420 U/L, an increase in leukocytes: polynuclear neutrophils to 12.75 Giga/L, monocytes to 1.3 Giga/L. Qualitative and quantitative analyzes were carried out using LC-MS/MS method (Xevo TQ-S micro and Xevo TQ-D Waters) after liquid-liquid extraction, on a blood sample taken approximately 24<!--> <!-->hours after Delta-9-THCP ingestion. These analyses revealed Delta-9-THCP at a concentration of 0.60<!--> <!-->μg/L and cannabidiol (CBD) at a concentration of 0.80<!--> <!-->μg/L. Toxicological analysis of a sample of hemp inflorescence purchased directly in store and containing Delta-9-THCP was also carried out, with a Delta-9-THCP content of around 11%. The clinical picture presented by the patient, mainly neurological, rapidly resolved under clinical supervision.</div></div>","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages 77-81"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of biological health among moderate-severe chemical veterans based on telomere length","authors":"Leila Nasiri , Mohammad Reza Vaez-Mahdavi , Tooba Ghazanfari , Hossein Hassanpour , Sussan Kaboudanian Ardestani","doi":"10.1016/j.toxac.2024.11.003","DOIUrl":"10.1016/j.toxac.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Sulfur mustard (SM) is a noxious gaseous substance that has been employed as a chemical warfare agent during armed conflicts. Individuals who have been exposed to SM continue to have adverse effects over an extended period of time. This study assessed the biological health of veterans with moderate-severe SM-chemical injuries categorized as having short or long telomere lengths (TL).</div></div><div><h3>Methods</h3><div>The calculation of the biological health score (BHS) involved the assessment of 18 biomarkers that are associated with the functioning of four physiological systems, namely the endocrine, inflammatory, cardiovascular, and metabolic systems, as well as two specific organs, namely the liver, and kidney. Forty-three people exposed to SM gas in 1987 at a moderate-severe level served as volunteers.</div></div><div><h3>Results</h3><div>The individuals with short TL subjected to moderate-to-severe SM had much-reduced testosterone levels and higher levels of LDL, cholesterol, and CRP compared to those with long TL. The results of principal component analysis revealed that testosterone had the highest degree of influence on intergroup variance among individuals who were subjected to moderate-severe levels of SM. Regarding moderate-severe SM-chemical veterans, our results demonstrated an inverse relationship between BHS and relative TL. Comparing the groups with short and long telomeres, the BHS was noticeably greater in the former.</div></div><div><h3>Conclusion</h3><div>The findings suggest that elevated BHS levels and reduced relative TL in veterans with moderate-severe SM exposure are indicative of diminished health quality. These indices may be valuable in assessing the health status of individuals exposed to SM, and using BHS and TL measurements might enhance the accuracy of such evaluations.</div></div>","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages 102-110"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah S. Mohammed , Walaa G. Abdelhamid , Olfat E. Mostafa , Doaa Elwasly , Ehab A.M. El-Shoura , Sarah A. Elmorsy
{"title":"Urinary tissue inhibitor metalloproteinase-2 and insulin-like growth factor-binding protein-7 as early predictors of the development and prognosis of acute kidney injury in acutely poisoned patients","authors":"Sarah S. Mohammed , Walaa G. Abdelhamid , Olfat E. Mostafa , Doaa Elwasly , Ehab A.M. El-Shoura , Sarah A. Elmorsy","doi":"10.1016/j.toxac.2024.06.002","DOIUrl":"10.1016/j.toxac.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Drug-induced nephrotoxicity accounts for 20% of hospital and community-acquired </span>acute kidney injury (AKI). Nephrotoxic drugs could induce tubular cell necrosis and renal failure. Few studies have evaluated AKI and its consequences in patients with acute poisoning. This study aimed to assess the </span>urinary tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein-7 (IGFBP-7) as diagnostic and prognostic markers of AKI in critically ill, acutely poisoned patients.</div></div><div><h3>Patients and methods</h3><div>We conducted a prospective study including all critically ill poisoned adult patients admitted to the ICU of the Poison Control Centre, Ain-Shams University Hospitals from September 2022 to June 2023.</div></div><div><h3>Results</h3><div>TIMP-2, IGFBP-7, and their multiplication product (TIMP<!--> <!-->×<!--> <span>IGFB/1000) can differentiate between AKI and non-AKI with an AUC of 0.996, 0.990, and 0.995, respectively. They were significantly higher in AKI, stage 3. TIMP-2 was significantly higher among patients who required mechanical ventilation (</span><em>n</em> <!-->=<!--> <span><span>26, 65%). Both biomarkers and their product were significantly higher among the non-survivors (27.5%). They showed a positive correlation with serum BUN, creatinine levels, length of ICU stay, poisoning severity score, as well as sequential organ failure assessment (SOFA) and </span>Simplified Acute Physiology Score<span> (SAPS II) scores. TIMP-2, IGFBP-7, and TIMP</span></span> <!-->×<!--> <!-->IGFB/1000 are useful in the early prediction of the development and progression of AKI in acutely intoxicated patients.</div></div><div><h3>Conclusion</h3><div>Combining clinical scores with biomarkers helps in stratifying the severity and mortality risk associated with AKI.</div></div>","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages 39-52"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Index des auteurs","authors":"","doi":"10.1016/S2352-0078(25)00131-3","DOIUrl":"10.1016/S2352-0078(25)00131-3","url":null,"abstract":"","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages S65-S67"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Soumission chimique et phanères","authors":"Pascal Kintz , Laurie Gheddar , Nadia Arbouche , Alice Ameline","doi":"10.1016/j.toxac.2025.01.036","DOIUrl":"10.1016/j.toxac.2025.01.036","url":null,"abstract":"<div><h3>Objectifs</h3><div>Les cheveux, et à un degré moindre les ongles, ne doivent plus être considérés comme des matrices alternatives. Ce sont des matrices biologiques spécifiques qui permettent d’obtenir des informations capitales pour répondre à des interrogations judiciaires dans le cadre d’une exposition à une arme chimique. La recherche dans les cheveux des xénobiotiques est une opportunité pour démontrer une exposition unique ou répétée, vérifier son évolution et documenter la matérialité des faits.</div></div><div><h3>Méthode</h3><div>Si l’aspect analytique est de mieux en mieux maîtrisé, la difficulté majeure dans ce domaine reste l’interprétation des résultats. À travers des exemples issus de la routine du laboratoire, les auteurs passeront en revue les facteurs susceptibles d’influencer les concentrations mesurées et leurs conséquences sur la rédaction finale du rapport d’expertise.</div></div><div><h3>Résultats</h3><div>Sur le plan analytique, il est admis que la préparation des cheveux, matrice solide, n’est jamais complète et efficace à 100 % et va influencer la concentration finale mesurée. Il existe une différence entre les concentrations mesurées dans les mêmes cheveux mais extraits après pulvérisation des cheveux et ceux après découpe aux ciseaux en petits fragments. Afin d’éviter les risques de contamination externe, la Society of Hair Testing (SoHT) a mis en place des seuils de positivité, mais ceux-ci sont régulièrement pris en défaut, en particulier lors d’exposition unique ou chez les jeunes enfants. La présence de métabolite(s) spécifique(s) a été proposée pour démontrer un passage spécifique, mais cette approche n’est pas satisfaisante, puisqu’il n’existe pas de métabolite détectable dans les phanères pour de nombreux agents de la soumission chimique. La dose minimale détectable dans les cheveux n’est pas établie pour de nombreuses molécules (cannabis, principaux NPS, certaines benzodiazépines comme l’alprazolam ou le lorazépam…). Enfin, de nombreux facteurs sont susceptibles d’influencer la concentration mesurée, voire même une absence de détection tels que la longueur des segments analysés, l’ethnie de la victime, les traitements cosmétiques, y-compris le lissage thermique, les séjours prolongés en piscine ou dans de l’eau de mer, les UVs solaires, … À l’opposé des cheveux, il n’est pas possible, avec les ongles, d’établir un calendrier rétrospectif par segmentation et dans ces conditions une période d’exposition un peu fine.</div><div>À partir de l’expérience des auteurs, les différentes étapes de l’analyse des cheveux (ou des ongles) et de l’interprétation finale seront passées en revue, allant du cas simple, presque académique, impliquant la doxylamine aux situations les plus complexes (cheveux mal prélevés, cheveux prélevés longtemps après les faits, traitements cosmétiques, migration le long de la mèche avec plusieurs segments positifs, absence de toute donnée dans la littérature) impliquant l’alprazolam, le zo","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages S26-S27"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amine Larabi , Pamela Dugues , Isabelle Etting , Marie Bellouard , João Matias , Alberto Salomone , Sevag Chenorhokian , Gregory Pfau , Jean-Claude Alvarez
{"title":"Cut-offs: Do we need to move forward?","authors":"Amine Larabi , Pamela Dugues , Isabelle Etting , Marie Bellouard , João Matias , Alberto Salomone , Sevag Chenorhokian , Gregory Pfau , Jean-Claude Alvarez","doi":"10.1016/j.toxac.2025.01.058","DOIUrl":"10.1016/j.toxac.2025.01.058","url":null,"abstract":"<div><h3>Aim</h3><div>This study draws on findings from the European Union Drugs Agency (EUDA) project on hair testing initiated in 2023, and incorporates insights gained from the author's 12 years of expertise in hair analysis. The conference aims to assess the current proposed cut-off values in the field of international hair testing era and to address the challenges of applying these thresholds across different exposure scenarios, including regular, occasional, and single drug use.</div></div><div><h3>Method</h3><div>A total of 100 drug users were recruited in France as part of the EUDA project. Participants provided consent, completed an online questionnaire, and submitted hair sample segmented into proximal (0–6<!--> <!-->cm) and distal (6–12<!--> <!-->cm) sections. Samples were decontaminated, extracted and analyzed by LC-MS/MS and LC-HRMS to screen for traditional drugs of abuse (DoA) and new psychoactive substances (NPS). The questionnaire focused on substance use timelines (<<!--> <!-->1<!--> <!-->month, <<!--> <!-->6<!--> <!-->months, ><!--> <!-->6–12<!--> <!-->months, or never) and frequency (days of use within the past month). Self-reported data were compared with hair concentrations using thresholds (LOQ: 1<!--> <!-->pg/mg) and Society of Hair Testing (SoHT) cut-offs. The presence of metabolites was also considered. Occasional or regular use were categorized based on hair concentrations, applying international guidelines, the interquartile range approach, or insights from scientific literature.</div></div><div><h3>Results</h3><div>Cocaine interpretation is presented as an example. Among 78 participants self-reporting cocaine use in the past 12 months, all tested positive using the LOQ approach, but 46% (36 participants) were classified as negative under the SoHT cut-off (500<!--> <!-->pg/mg for cocaine). Cocaine concentrations for these 36 participants ranged from 6 to 495<!--> <!-->pg/mg (median: 146<!--> <!-->pg/mg; mean: 186<!--> <!-->pg/mg; 1st quartile: 70<!--> <!-->pg/mg; 3rd quartile: 302<!--> <!-->pg/mg). Two up to 5 metabolites (benzoylecgonine BZE, norcocaine NC, OH-cocaine, anhydroecgonine methyl ester AEME, cocaethylene CE) were detected in 86% (31 participants) while only one metabolite alongside cocaine was detected in the 5 remaining participants (4 with BZE, 1 with AEME). Additionally, 18 participants who reported never using cocaine had concentrations below 500<!--> <!-->pg/mg, with up to four metabolites identified. Overall, 96% of the participants tested positive for cocaine, while only three had cocaine concentrations below 20<!--> <!-->pg/mg and no detectable metabolites.</div><div>Cocaine concentrations around 200<!--> <!-->pg/mg with at least 2 metabolites (excluding BZE/AEME combinations) are strongly indicative of active cocaine use. In contrast, concentrations below 100<!--> <!-->pg/mg, with no more than two metabolites (typically BZE/AEME and occasionally norcocaine), may point to potential externa","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Page S39"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacogenetic testing and TDM-TOX results interpretation","authors":"Haufroid Vincent","doi":"10.1016/j.toxac.2025.01.017","DOIUrl":"10.1016/j.toxac.2025.01.017","url":null,"abstract":"<div><div>Pharmacogenetics (PGx) can be defined as the study of the impact of hereditary genetic variations on the clinical response to drug treatments. In this definition, clinical response includes both therapeutic efficacy and the potential occurrence of side effects. There is therefore a potential link between PGx and therapeutic drug monitoring (TDM) as well as toxicology (forensic, clinical, occupational and/or environmental).</div><div>Following a short presentation of the French-speaking network of Pharmacogenetics (RNPGx's) updated recommendations concerning the selection of pharmacogenes of clinical interest at the present time (defined as core and secondary panels), examples of application will be presented in the context of immunosuppressive treatments in solid organ transplantation, antidepressant and antipsychotic treatments, anti-infectious treatments and anticancer treatments.</div><div>In addition to its prospective use associated to the prescription of a specific drug or its use to understand abnormal drug or toxicant behavior a posteriori, the prospects for using PGx data in a pre-emptive context will then be discussed, highlighting the main advantages of this latter approach and taking into account its main remaining obstacles such as the integration of the data into the patient's medical record and the generation of alerts when prescribing.</div></div>","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Page S16"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unsolved issues in hair testing","authors":"Robert Kronstrand","doi":"10.1016/j.toxac.2025.01.054","DOIUrl":"10.1016/j.toxac.2025.01.054","url":null,"abstract":"<div><h3>Objective</h3><div>To highlight issues still unsolved in hair analysis.</div></div><div><h3>Introduction</h3><div>This lecture delves into the incorporation of xenobiotics into hair, focusing on their interpretation in forensic and clinical toxicology. It addresses three pivotal questions central to hair analysis: (1) was a drug administered?, (2) how much drug was administered?, (3) when was the drug administered? These questions, while seemingly straightforward, reveal complexities due to possible external contamination, individual biological variability, and limitations in analytical methodologies.</div></div><div><h3>Results and discussion</h3><div>Determining whether a drug was truly administered or merely the result of external contamination is still a significant challenge in hair analysis. This lecture underscores the critical role of metabolites, which are formed exclusively through systemic metabolism, as markers to confirm drug intake. Such metabolites are absent in environmental sources of contamination, such as drug powders or plant material. However, some drugs, like cocaine, present unique challenges; the presence of primary metabolites like benzoylecgonine does not definitively rule out external contamination. To mitigate these issues, advanced metabolite profiling, including the detection of minor cocaine metabolites has been employed, although further research is required.</div><div>Estimating the amount of drug administered based on hair analysis remains elusive. While dose-to-concentration relationships are evident under controlled conditions, they are influenced by numerous factors, including hair pigmentation, individual metabolism, and drug properties. For example, melanin has a strong affinity for weakly basic drugs, such as amphetamines and cocaine, leading to higher drug concentrations in darker hair. Controlled studies with heroin and methamphetamine demonstrate dose-dependent increases in hair concentrations, yet the wide variability precludes dose estimations. Instead, hair concentrations may more effectively be used to categorize drug usage patterns into light, moderate, or heavy use. This approach, while less precise, provides valuable context in clinical and forensic settings. While these group-level patterns are informative, this lecture emphasizes that quantitative interpretations should always consider individual variability.</div><div>Segmental hair analysis offers temporal insights into drug administration by correlating drug incorporation with the hair growth cycle. However, an individual's hair growth rate is not known and a mean value of the hair growth rate is commonly used when performing and interpreting segmental hair analysis. Controlled studies involving single-dose administrations show that drugs can be detected in hair for months post-intake, with concentrations peaking in segments corresponding to the time of administration. However, the precision of timing decreases with longer intervals ","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Page S37"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maxime Kolmayer , Marie Gamblin , Vincent Grand , Pascal Kintz , Laura Gandemer Sabountchi
{"title":"In utero cannabis exposure and pregnancy denial: A case report on unexpected neonatal death","authors":"Maxime Kolmayer , Marie Gamblin , Vincent Grand , Pascal Kintz , Laura Gandemer Sabountchi","doi":"10.1016/j.toxac.2025.01.062","DOIUrl":"10.1016/j.toxac.2025.01.062","url":null,"abstract":"<div><h3>Aim</h3><div>Cannabis use during pregnancy is known to be associated with fetal growth reduction <span><span>[1]</span></span> and to be a risk factor in the sudden death syndrome <span><span>[2]</span></span>. This case report is about a neonatal death possibly linked to cannabis use during pregnancy.</div></div><div><h3>Method</h3><div>A 27-year-old woman was awakened by severe abdominal pain and sweating. She went to the bathroom to have a bath and felt “something coming out” of her. She reports not having heard any cry or seen any movement of the baby but she may have heard a sound like an inhalation. The mother was then brought to hospital. Investigation revealed that the mother claimed to be on hormonal contraception but was unable to provide any proof. She had not changed her lifestyle (cigarettes, alcohol) and had not noticed any changes except a slight weight gain. She had done a pregnancy test, but she told it was negative. All that information supports the possibility of pregnancy denial with unexpected delivery. The forensic autopsy conducted on the baby's remains established that the fetus was viable to full-term or near-term. No traumatic injuries, apparent malformations or macroscopic signs of any pathology that could have caused death were observed. Toxicological samples were collected: pleural and pericardial fluid, cardiac and peripheral blood, gastric contents, meconium and hair. Toxicological analyses were performed on cardiac and peripheral blood, meconium, gastric contents and hair using current methods (GC-MS, LC-MS/MS, HS-GC-FID).</div></div><div><h3>Results</h3><div>Toxicological analyses found THC-COOH in peripheral and cardiac blood at 4.4 and 5.4<!--> <!-->ng/mL, respectively. THC, 11-OH-THC, and THC-COOH were found in gastric contents at 1.8, 1.7, and 10.2<!--> <!-->ng/mL, respectively. Meconium analysis found THC, THC-COOH, 11-OH-THC and CBD at 6.3, 78, 107 and 39<!--> <!-->ng/mL respectively. Hair analysis indicated the presence of THC, CBN, and CBD at 117, 24, and 75<!--> <!-->pg/mg, respectively.</div></div><div><h3>Conclusion</h3><div>The cannabinoids concentrations determined in the gastric contents and cardiac or peripheral blood are too low to indicate cannabis ingestion and appear more likely to be secondary to diffusion from the vascular compartment. Cannabinoids THC, CBN and CBD were also detected in the infant's hair. These results collectively indicate in utero exposure to cannabis <span><span>[3]</span></span>. In pregnant women, cannabis use can result into these cannabinoids crossing the placental barrier and reaching the fetus <span><span>[4]</span></span>. Starting from the eighth month of pregnancy, these molecules can become incorporated into fetal hair <span><span>[5]</span></span>. Studies have shown a positive correlation between cannabis use during pregnancy and sudden infant death syndrome <span><span>[6]</span></span>, <span><span>[7]</span></span>, <span><span>[8]</span></span>. In ","PeriodicalId":23170,"journal":{"name":"Toxicologie Analytique et Clinique","volume":"37 1","pages":"Pages S41-S42"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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