Acebutolol is a β1-selective adrenergic receptor antagonist with moderate membrane-stabilizing activity and intrinsic sympathomimetic activity; accordingly, the drug is indicated in hypertension, ...angina pectoris, and arrhythmia. However, acebutolol’s beta-blocking properties also extend the QRS and QTc intervals, and may predispose the patient to ventricular tachydysrhythmia. Here, we report autopsy and toxicological findings on a fatal case of acebutolol self-poisoning in a 70-year-old woman. Toxicological analyses of post-mortem samples (using a liquid chromatography high-resolution mass spectrometry (LC-HR-MS) method) highlighted high concentrations of acebutolol and its metabolite diacetolol in femoral blood (92.8 mg/L and 21.2 mg/L, respectively) and other matrices (cardiac blood, urine, bile, and gastric contents). A molecular networking approach provided useful information on acebutolol’s metabolism and revealed the existence of an unknown phase II metabolite of acebutolol. Molecular networking also facilitated visualization of the complex LC-HR-MS/MS datasets and the sample-to-sample comparisons that confirmed massive acebutolol intoxication by ingestion.
Intro
Evidence of breath after birth is one of the main forensic issues in suspected neonaticide. Hydrostatic test (HT) and pathological examination are currently used to assess it, but they are not ...entirely reliable or immediately available.
Objective
To determine the performance of postmortem computed tomography (PMCT) to assess neonatal breath in suspected neonaticide, by comparing lung CT attenuation values between live birth and stillbirth cases, in correlation with HT and pathology.
Method
Cases of suspected neonaticides who underwent a PMCT and complete forensic autopsy with an HT were retrospectively selected from the databases of four French Forensic Medicine Departments. The diagnosis of vitality (i.e., stillbirth or live birth) was based on the pathological examination and/or a combination of arguments, including HT result. Lung density on CT was measured in Hounsfield units (HU) by ROIs drawn in both pulmonary parenchymas.
Results
Eleven patients were included, six live birth and five stillbirth cases. The result of HT was concordant with pathological examination when available (seven cases). Mean lung densities in live birth cases (− 173 HU − 255; − 91 CI 95%) were significantly lower than in stillbirth cases (40 HU 28; 52 CI 95%) (
p
< 0.05), with a very high degree of interobserver reproducibility (ICC = 0.998 (CI 95% 0.991–0.999;
p
< 0.001).
Conclusion
PMCT and especially lung CT attenuation measurement is a reliable and easy-to-use method for assessing neonatal breath in suspected neonaticides.
The published version of this article unfortunately contained a mistake. In Figure 1 on the molecular network of acebutololol, two molecular structures are not displayed (“acebutolol glucuronide “and ...“impurity J”). The Figure is corrected here.
The primary objective of the present study was to evaluate the frequency of positive tests for alcohol and drugs during roadside testing or after road accidents among drivers in the Brittany region ...of France. The study’s secondary objective was to describe the blood concentrations of the substances found during these tests, in order to provide a scientific basis for the establishment or modification of legislative threshold values for road injuries prevention. We performed a cross-sectional study of a database compiled by Rennes University Hospital’s toxicology laboratory in the Brittany region of France between 2010 and 2018. Driver’s age, sex, and test status (positive or negative), and blood levels of ethanol, 9-tetrahydrocannabinol (THC), methylene dioxymethamphetamine (MDMA), amphetamine, benzoylecgonine and 6-monoacetylmorphine (6-MAM) were collected. Twelve thousand four hundred and ninety-seven drivers (males: 86.1%; median (range) age: 29 (15–94)) have provided roadside blood samples, giving a total of 25,998 test results. Among the 10,996 drivers with at least one positive test, the median blood concentrations of ethanol, THC, MDMA, amphetamine, benzoylecgonine, and 6-MAM were respectively 1.82 g/L, 2.41 ng/mL, 138.4 ng/mL, 67.7 ng/mL, 173.3 ng/mL, and 0.97 ng/mL. 1159 (10.54%) of the 10,996 drivers tested positive for two or more substances, and 151 (1.4%) tested positive for three or more substances. With the exception of heroin, the currently recommended threshold values appear to be appropriate for road injuries prevention with regard to the concentrations observed in offenders.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Health units in prisons Bouvet, Renaud; Dumont, Christine
Soins; la revue de référence infirmière,
2022 Nov-Dec, Volume:
67, Issue:
870-871
Journal Article
Peer reviewed
Since the publication of the law of 18 January 1994, health care for detainees has been entrusted to public health establishments, and no longer to the prison administration. This is a real step ...forward insofar as individuals placed in the hands of justice now benefit from care provided by health professionals, who officiate within health units in prisons. Today, these professionals work in particular to promote preventive and health promotion actions, thereby helping to restore the detainee's place as a subject with a view to reintegrating him or her into the community.
Abstract
In its promotion of an autonomy model of decision-making in medical matters, French law, after making patients' consent to medical procedures compulsory by case law then by legislation, ...established the primacy of the expression of patients' wishes. Lawmakers followed the principle of shared medical decision-making and, for situations in which subjects are not fit to express their wishes, created mechanisms to represent their wishes as expressed previously. Examination of comparable legal provisions in other countries raises questions about the pertinence of the French model, which has not fully incorporated the concept of decision-making capacity but limited itself to a binary appreciation of fitness to express one's wishes.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, PRFLJ, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract
Increasing a soldier's perception, action and survival abilities responds to an operational need justified by the evolution of the battlefield. The available or conceivable means are ...multiple, including invasive techniques involving the soldier's mind and body. This field of intervention places the medical officer at the centre of the debate, as a guarantor of the soldier's aptitude for combat, and as a possible actor of the soldier's enhancement. The conditions of consent and medical necessity seem overwhelmed by the challenges of using a technique of enhancement in this context. Consent indeed appears necessary, but insufficient to justify its implementation, and the requirement of medical necessity seems obsolete, as the normal/pathological dichotomy that structures the medical thought is outdated, the goal being to reach a "supranormality". Moreover, the decision-making process creates a tension concerning the articulation of the aim of medical practice with the operational objectives.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, PRFLJ, SAZU, UILJ, UKNU, UL, UM, UPUK
Si la responsabilité pénale demeure personnelle, la jurisprudence récente tend à élargir les hypothèses d’engagement de la responsabilité pénale du médecin en matière de délits non intentionnels. La ...question concerne singulièrement le psychiatre, du fait d’actes commis par son patient, sur le fondement des articles 221-6 ou 222-19 du code pénal. L’appréciation jurisprudentielle de la faute et de son lien de causalité avec le dommage ne fait toutefois pas peser sur le psychiatre une obligation de résultat, dans la mesure où seuls les manquements professionnels graves, manifestement non conformes aux règles de l’art médical, se voient sanctionnés.
If the criminal liability remains personal, recent case law has tended to broaden the hypotheses for the doctor's criminal liability in the case of unintentional offenses. The question particularly concerns the psychiatrist, because of acts committed by his patient, on the basis of articles 221-6 or 222-19 of the French penal code. However, judicial assessment of the fault and its causal link with the damage does not impose on the psychiatrist an obligation of result, insofar as only serious professional misconduct, manifestly not in accordance with the rules of medical art, are sanctioned.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Litigation concerning hepatitis B vaccination provides a good illustration of the difficulties courts encounter when deciding on compensation claims in which scientific uncertainty, whether ...real or perceived, is present. Despite the difference in approach to vaccination - an obligation in France and a recommendation in Germany -, their vaccine coverage is comparable, as are their regimes of compensation for damage attributed to vaccination, whether on the basis of producer liability or national solidarity. Confronted with scientific uncertainty, German and French courts choose to make use of presumptions to establish legal causality that is not contingent on scientific causality. German and French case law diverge however, with regard to their relationship to scientific criteria of causality, the volume of court cases, and consideration of claims, highlighting what seems to be a distinctive situation in France.
Full text
Available for:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, PRFLJ, SAZU, UILJ, UKNU, UL, UM, UPUK
PDF
