Ľuboš Nižnanský

Background/Objectives: Hanging is the most common method of suicide in most countries worldwide. It is characterized by high lethality, technical simplicity, and typical autopsy findings. Autopsy plays a crucial role in determining the cause and mechanism of death. While external injuries are relatively consistent, internal findings show considerable variability in the literature. The aim of this prospective study was to analyze 660 cases of suicidal hanging over a ten-year period, focusing on the occurrence of forensically relevant internal autopsy findings. Methods: The study was conducted at the Department of Forensic Medicine in Bratislava between 2015 and 2024. All cases underwent standardized complete autopsy, including histology, toxicology, and analysis of death circumstances. Recently reported thoracic aortic adventitial hemorrhages described in 2024 were evaluated only in a targeted subset of cases examined between July and December 2024. Statistical evaluation was performed using the chi-square test to identify associations between internal findings and suspension type, knot location, age, sex, and body weight. Results: The argent line was present in 61.1% of cases, most frequently with posterior knot placement and complete suspension. Neck muscle hemorrhages occurred in 53.8%, predominantly at the periosteal-clavicular attachment of the sternocleidomastoid muscle, with higher incidence in complete and anterior suspension. Amussat’s sign was observed in 10.2% of cases, and Etienne-Martin’s sign in 1.1%. Fractures of the laryngo-hyoid complex were present in 49.7%, mainly in cases with complete suspension and posterior knot location. Cervical spine injuries were detected in 2.6%, predominantly in older males and with anterior knot placement. Simon’s hemorrhages occurred in 35.2%, mainly in younger individuals and complete suspension. Hemorrhages in the intestinal wall were detected in 7.4%, and rectal hemorrhages in 1.1% of cases. In the targeted 2024 subset, no thoracic aortic adventitial hemorrhages were identified. Conclusions: The findings suggest the forensic relevance of several internal findings associated with hanging, while emphasizing that the results were obtained using a uniform and consistently applied autopsy protocol. They also indicate the need for further research, particularly regarding recently reported adventitial hemorrhages of the thoracic aorta, which were assessed only in a limited subset of cases during the final months of the study and were not identified in our material.

Propafenone (PPF) belongs to the class 1C antiarrhythmics and can cause electrocardiogram-associated adverse/toxic effects. Cases of PPF intoxication are rarely investigated. We developed a novel and selective GC-MS/MS method for the determination of PPF and its tissue distribution in an intentional fatal poisoning case, which is applicable to PPF quantification in the range of therapeutic to lethal concentrations in complex post-mortem samples. A simple and effective sample pretreatment was applied to all analyzed samples. PPF was determined without the need for dilution, even in highly complex samples containing a wide range of analyte concentrations. Quantification was performed using the standard addition method, developed and validated according to the ICH M10 guidelines. The obtained results indicated that the PPF concentration in the serum from blood taken while alive, before therapy, was the highest ever reported in the literature. Despite the intensive therapy after the patients’ admission, the PPF concentrations in the lungs, spleen, femoral blood and cardiac blood were fatal or abnormally high. On the other hand, the concentrations in the liver and skeletal muscle were lower or approximately the same as observed in cases with therapeutic doses. To the best of our knowledge, the distribution of PPF has not been investigated in fatal intoxication cases and can be helpful in clinical or forensic toxicology.

Biologically active taxanes, present in small- to medium-sized evergreen conifers of various Taxus species, are widely used for their antioxidant, antimicrobial and anti-inflammatory effects, but mostly for their antitumour effects used in the treatment of solid tumours of the breast, ovary, lung, bladder, prostate, oesophagus and melanoma. More of the substances found in Taxus plant extracts have medical potential. Therefore, at the beginning of this review, we describe the methods of isolation, identification and determination of taxanes in different plant parts. One of the most important taxanes is paclitaxel, for which we summarize the pharmacokinetic parameters of its different formulations. We also describe toxicological risks during clinical therapy such as hypersensitivity, neurotoxicity, gastrointestinal, cardiovascular, haematological, skin and renal toxicity and toxicity to the respiratory system. Since the effect of the drug-form PTX is enhanced by various Taxus spp. extracts, we summarize published clinical intoxications and all fatal poisonings for the Taxus baccata plant. This showed that, despite their significant use in anticancer treatment, attention should also be focused on the risk of fatal intoxication due to ingestion of extracts from these plants, which are commonly found in our surroundings.

Ahyahuasca is a term commonly used to describe a decoction prepared by cooking the bark or crushed stems of the liana Banisteriopsis caapi (contains β-carbolines) alone or in combination with other plants, most commonly leaves of the shrub Psychotria viridis (contains N,N-dimethyltryptamine-DMT). More than 100 different plants can serve as sources of β-carbolines and DMT, which are the active alkaloids of this decoction, and therefore it is important to know the most accurate composition of the decoction, especially when studying the pharmacology of this plant. The aim was to summarize the latest sensitive methods used in the analysis of the composition of the beverage itself and the analysis of various biological matrices. We compared pharmacokinetic parameters in all of the studies where decoction of ayahuasca was administered and where its composition was known, whereby minimal adverse effects were observed. The therapeutic benefit of this plant is still unclear in the scientific literature, and side effects occur probably on the basis of pre-existing psychiatric disorder. We also described toxicological risks and clinical benefits of ayahuasca intake, which meant that the concentrations of active alkaloids in the decoction or in the organism, often not determined in publications, were required for sufficient evaluation of its effect on the organism. We did not find any post-mortem study, in which the toxicological examination of biological materials together with the autopsy findings would suggest potential lethality of this plant.

Glutamate decarboxylase (GAD) catalyses decarboxylation of glutamate to gamma-aminobutyrate (GABA) in a metabolic pathway connected to citrate cycle and known as GABA shunt. The gene (gad) was disrupted in Trichoderma atroviride CCM F-534 and viable mutants were characterized. Two of them were found to arise by homologous recombination and were devoid of both GAD activity and GABA. Mutants grew slower as compared to the wild type (F534). In the submerged culture, mutants developed less CO₂ and consumed less O₂ than the F534 without changing their respiratory quotients. Hyphae of mutants were more ramified than those of F534. Their ramification, in contrast to F534, was not increased by cyclosporin A, a drug causing hyphae ramification of several fungi and which is a calcineurin/cyclophilin inhibitor, or by FK506. Rapamycin, which is a cyclophilin but not calcineurin inhibitor, had a different effect on hyphae ramification in F534 and mutants. To examine the presence of GABA receptors in the fungus the effect of mammalian GABA-receptor modulators, such as bicuculline, gabapentin or carbamazepine on fungal morphology were investigated. Conidia of mutants germinated in a multipolar manner more frequently (up to 80 %) than those of F534. This trait was modified with cyclosporine A, FK506 and GABA receptor modulators in a different manner. Transport of chlorides, an intimate feature of GABA-regulated receptors/channels in animal cells, was measured in vegetative mycelia by means ³⁶Cl⁻ uptake. It was significantly reduced in gad mutants. The results suggest that T. atroviride possesses a signalling pathway that involves GABA, putative GABA receptor(s), calcineurin, target of rapamycin and chloride transporter(s) to regulate physiological functions.