Ioannis Papoutsis

• National and Kapodistrian University of Athens

Abstract Text: Introduction: Road Traffic Accidents (RTA) are among the top five causes of all-cause mortality globally.1 Motorcycle accidents, specifically, have grown to become a significant problem worldwide.2 Various protective measures, mainly the use of a helmet, have been proposed to reduce fatal outcomes of motorcycle accidents.3 Most victi...

In recent years, there has been increasing interest on the use of alternative biological materials in forensic toxicology. Vitreous humor is one of them, which, due to the closed cavity it is contained, has a low degree of contamination and high purity that makes it ideal for use in post-mortem specimens. The aim of this study was to investigate th...

The purpose of this study was to examine the prevalence and characteristics (victims’ profiles, circumstances surrounding the incidents, and methods employed) of complex and complicated suicides over a 12-year period in the broader area of Athens, Greece. A retrospective analysis of 5,568 autopsy cases performed at the Department of Forensic Medici...

Purpose Τhe aim of the present study was to investigate the use of vitreous humor as an alternative biological material in forensic toxicology for the determination of quetiapine, 7-hydroxy-quetiapine, and nor-quetiapine. The distribution of these substances in vitreous humor was studied by determining and correlating their concentrations in vitreo...

Purpose Cannabidiol (CBD) products are widely used for pain relief, sleep improvement, management of seizures etc. Although the concentrations of Δ ⁹ -tetrahydrocannabinol (Δ ⁹ -THC) in these products are low (≤0.3% w/w), it is important to investigate if its presence and/or that of its metabolite 11-nor-carboxy-Δ ⁹ -THC, is traceable in plasma and...

Background and Objectives: Fetal growth abnormalities increase the risk of negative perinatal and long-term outcomes. Bisphenol A (BPA) is a ubiquitous endocrine-disrupting chemical to which humans may be exposed in a number of ways, such as from the environment, via various consumer products, and through the individual’s diet. Since the compound p...

Aim The aim of the present study was to investigate the use of vitreous humor as an alternative biological matrix in Forensic Toxicology for the determination of quetiapine and its metabolites, 7-hydroxy-quetiapine and nor-quetiapine. The distribution of these substances in vitreous humor was studied, by correlating their concentrations in vitreous...

Purpose: Serum and urinary bisphenol A (BPA) concentrations have been associated negatively with the number of retrieved oocytes after in vitro fertilization (IVF). The impact of BPA upon women with polycystic ovary syndrome (PCOS) and women with tubal factor infertility (TFI), following IVF, was investigated. To this purpose, associations among s...

Introduction. Ground-level falls have emerged as one of the major causes of unintentional fatal injury in several developed countries. As older age is accompanied by deterioration on various systems and abilities of the human body, the elderly are known to be particularly vulnerable to fatal ground-level falls. Methods. Forty-three cases of fatal a...

Driving under the influence of alcohol and/or psychoactive substances increases the risk of severe, even fatal motor vehicle accidents. The aim of this descriptive study was to present the impact of alcohol and/or psychoactive substances on fatal road traffic accidents (RTAs) during the period 2011-2017. For this purpose, the toxicological investig...

Purpose Fentanyl analogues are popular in recent years among drug addicts and have been related to many overdoses and deaths worldwide. Furanylfentanyl, ocfentanil, acetylfentanyl and butyrfentanyl are among the most common of these drugs. Methods for the determination of furanylfentanyl and ocfentanil by gas chromatography–mass spectrometry (GC–MS...

Antihistamines are used widely in clinical practice to alleviate symptoms associated with allergic reactions, or to treat insomnia and motion sickness. The wide use of these drugs, in some cases without prescription, as well as their interactions with other drugs and alcohol that enhance their sedative adverse effects, led to the necessity for a pr...

Purpose Diphenidine is a potent synthetic dissociative anesthetic drug that has recently emerged in drug markets of Europe, Japan and America. The aim of this review is to summarize the current knowledge about this drug concerning its chemistry, synthesis, prevalence, pharmacology, toxicology and metabolism, as well as its legal status. Analytical...

Antihistamines are excreted into breast milk in small amounts; however, there are no adequate published studies or data concerning their effects on newborns and safety during breastfeeding. Thus, the development of sensitive and specific methodologies for the determination of antihistamines in breast milk is critical. A simple and sensitive GC–MS m...

A simple, rapid, sensitive and accurate gas chromatography–mass spectrometric method was developed and validated for the simultaneous determination of hydroxyzine and cetirizine in whole blood. Solid-phase extraction procedure using Bond Elut LRC Certify II columns was used for the isolation of hydroxyzine and cetirizine from 1 mL whole blood follo...

PurposeOcfentanil and carfentanil are two potent synthetic opioids that are analogues of fentanyl and are actively involved in the recent fentanyl crisis. The aim of this review is to provide all the available information on these two fentanyl analogues. Methods All reviewed information was gathered through a detailed search of PubMed and the World...

The fentanyls are a family of drugs that have caused hundreds of deaths in Europe and the United States. They first appeared in the United States in the late 1970s; they were sold as heroin to unsuspecting users. Furanylfentanyl is a potent synthetic drug, an analogue of fentanyl that belongs to the above family. It has no proven medical use, but i...

Loperamide is a phenylpiperidine derivative and an opioid agonist that was launched by Janssen Pharmaceutica in 1973. It was initially classified in the United States as a Schedule II drug and was transferred to Schedule V in 1977; it has not been listed as a controlled substance since 1982. Loperamide is used for the symptomatic treatment of diarr...

Calcium channel blockers (CCBs) have a narrow therapeutic index, and their intake in excess is associated with a critical clinical presentation of sustained hypotension and non-cardiogenic pulmonary edema, which are difficult to treat. Unfortunately, available means of treatment fail to resuscitate a significant number of patients poisoned by CCBs,...

U-47700 is a synthetic opioid analgesic and a potent, short acting structural isomer of the earlier opioid AH-7921 that has recently invaded the drug arena in Europe and the Unites States. Although the drug was synthesized and patented in the 1970s, it was first identified in October 2014, as a powder sample that was seized by Swedish Customs. Swed...

Fonazepam (desmethylflunitrazepam) and nifoxipam (3-hydroxy-desmethylflunitrazepam) are benzodiazepine derivatives and active metabolites of flunitrazepam. They recently invaded the drug arena as substances of abuse and alerted the forensic community after being seized in powder and tablet forms in Europe between 2014 and 2016. A review of all the...

Antihistamines are a class of drugs that inhibits the action of histamine and are used to alleviate symptoms associated with allergic reactions, but some of them can cause side effects, the most unpleasant and dangerous of which are the sedative effects that may hinder important psychological functions and impair skilled performance. These side eff...

Fenethylline is a theophylline derivative of amphetamine having stimulant effects similar to those of other amphetamine type derivatives. Fenethylline was used as medicament for hyperactivity disorders in children, narcolepsy and depression, but it has also been used as a drug of abuse under the common name of "captagon". Unlike other drugs of abus...

Acetylfentanyl is a potent synthetic opioid analgesic that has been increasingly available in America, Europe, Japan, China, and Australia during the last years. It has no approved medical or veterinary use, but it is used illicitly around the world as a substitute of its controlled precursor, fentanyl, as well as of heroin or other related substan...

“Flakka” is the street name for the synthetic cathinone α-pyrrolidinopentiophenone (α-PVP). Although it was developed by Boehringer Ingelheim as a central nervous system stimulant and pressor agent in the 1960s, it entered in the drug arena at an accelerated rate during the last 4 years causing intoxications, fatal or not. α-PVP is abused in Europe...

A simple liquid chromatography mass spectrometric method with direct urine injection analysis was developed and validated for the identification and quantification of gammahydroxybutyric acid (GHB), gamma-butyrolactone (GBL), 1,4-butanediol (1,4-BD), methylenedioxyn- methylamphetamine (MDMA), 3,4-methylenedioxy-amphetamine (MDA), 3,4-methylenedioxy...

AH-7921 is a structurally unique synthetic opioid analgesic that has recently entered the drug arena in Europe, the USA, and Japan. Although it was synthesized and patented in the mid-1970s, it was first identified in a seized sample purchased via the Internet in July 2012 and formally brought to the attention of the European Union early warning sy...

The potential deleterious effects of extractables/leachables in pharmaceutical products led the USP, EP and JP to require extractable and toxicity testing of container/closure systems. To that, a HS-GC/FID method was developed and validated for the determination of hexane as potential extractable residue from pharmaceutical container closure system...

In a number of forensic toxicological cases, Δ9-tetrahydrocannabinol (THC) and its metabolite 11-carboxy-delta-9-tetrahydrocannabinol (THCA) are frequently considered as contributor factors to the event. To that, a liquid chromatographic mass spectrometric method is described for the identification and quantitation of THC and its metabolite THCA in...

A simple gas chromatographic method with mass spectrometry detection was developed and validated for the determination of lacosamide in human plasma. Lacosamide and the internal standard, levetiracetam-d6, were extracted from 200 μL plasma, by a solid-phase extraction through HF Bond Elut C18 columns, and derivatized using N-methyl-N-tert-butyldime...

The potential deleterious effects of extractables/leachables in pharmaceutical products and the need to preserve product safety throughout its shelf life have led the three major pharmacopoeias (USP, EP, JP) to require extractable and toxicity testing of container/closure systems. To that, a HPLC/UV method was developed and validated for the detect...

A sensitive and accurate gas chromatography-mass spectrometric method was developed and validated for the simultaneous determination of levetiracetam and lamotrigine in whole blood. A solid-phase extraction (SPE) procedure using HF Bond Elut C18 columns followed by derivatization using N-methyl-N-tert-butyldimethylsilyl-trifluoroacetamide (MTBSTFA)...

Introduction: Perforator flaps whether in a free or pedicled form are essential in leg reconstruction, requiring meticulous dissection based on a detailed understanding of vascular topographic anatomy. Numerous investigators have addressed this issue. However, the directionality of their fascial exit has not been greatly discussed in the literatur...

Risperidone has been widely used in the treatment of schizophrenia. From toxicological point of view, risperidone appears to be involved in a number of clinical cases related to abnormal use or overdosage. Although a number of articles report the determinationof this drug in biological fluids, until today no study has been conducted to address the...

Abstract Substituted phenethylamines are a class of designer drugs that have recently emerged in the drug abuse market. Such substances remain legal to use, possess, and supply until these compounds become classified as scheduled. 2C-I-NBOMe or 25I-NBOMe is the N-benzyl-derivative of the iodo-substituted dimethoxy-phenethylamine (2C-I) that appeare...

5-(2-aminopropyl)indole (5-IT) is a new psychoactive substance, a 'legal high', that recently invaded the drug arena in Europe and has already led to numerous intoxications and fatalities. Knowledge upon its pharmacology and toxicity is non-existent or restricted; the only available information involves very few published scientific articles, offic...

The stability of drugs in biological specimens is a major concern during the evaluation of the toxicological results. The stability of morphine, codeine, and 6-acetyl-morphine in blood was studied after different sampling conditions: (i) in glass, polypropylene or polystyrene tubes, (ii) with addition of dipotassium ethylene diamine tetraacetic aci...

Substituted phenethylamines are a class of designer drugs that hold a significant position in the drug abuse market. The most important substances within this class appear to be 4-bromo-2,5-dimethoxyphenethylamine (2C-B) and its novel derivative 2-(4-bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25B-NBOMe). Intoxications related to 2C-B...

Vitamin E (a-tocopherol, a-Toc) has been widely used as a powerful antioxidant that protects against oxidation of cellular components. It is used to treat muscular dystrophies, menstrual cycle disorders, risks of pregnancy interruption and abnormalities of gonadal function in men. It is also used frequently from athletes as nutritional supplement f...

A sensitive GC/MS method for the determination of amisulpride in whole blood was developed, optimized and validated. Sample preparation included solid-phase extraction using HF Bond Elut C18 cartridges and further derivatization with heptafluorobutyric anhydride (HFBA). The limits of detection and quantification were 3.00 and 10.0μg/L, respectively...

During the autopsy of forensic cases, when there is no suspicion of drug use or chemical exposure, biological fluids may not be obtained for toxicological analysis, while specimens of tissues may be collected and preserved in a formalin solution for histological examination. When specific questions arise after the burial, the only possible options...

A simple and rapid LC/MS method with direct injection analysis was developed and validated for the identification and quantification of ten benzodiazepines (flunitrazepam, nordiazepam, diazepam, 7-aminoflunitrazepam, flurazepam, bromazepam, midazolam, alprazolam, temazepam and oxazepam) in human urine using diazepam-d5 as internal standard (IS). Th...

Cannabis products (marijuana, hashish, cannabis oil) are the most frequently abused illegal substances worldwide. Delta-9-tetrahydrocannabinol (THC) is the main psychoactive component of Cannabis sativa plant, whereas cannabidiol (CBD) and cannabinol (CBN) are other major but no psychoactive constituents. Many studies have already been carried out...

Antidepressant drugs are widely used for the treatment of depression and other psychiatric disorders and as a result they are involved in numerous clinical and forensic cases. The aim of this study was the development, optimization and validation of a simple, specific and sensitive GC/MS method for the simultaneous determination of 11 antidepressan...

Atropine is used in the daily clinical practice for the treatment of poisonings caused by anticholinesterase pesticides, due to its sympathomimetic action. The investigation of the cause of the adverse effects that appear during atropine administration showed the necessity for the development and validation of a simple, rapid, sensitive, and specif...

Anticholinesterase pesticides are widely used, and as a result they are involved in numerous acute and even fatal poisonings. The aim of this study was the development, optimization, and validation of a simple, rapid, specific, and sensitive gas chromatography-mass spectrometry method for the determination of 11 anticholinesterase pesticides (aldic...

The potential deleterious effects of extractables/leachables in pharmaceutical products led the USP, EP, and JP to require extractable and toxicity testing of container/closure systems. To that, a headspace gas chromatography flame ionization detection method was developed and validated for the determination of 1,3-butadiene (1,3-BD) as a potential...

Sildenafil (SDL) is a phosphodiesterase type 5 inhibitor and it is approved for the treatment of erectile dysfunction and pulmonary hypertension. SDL is extensively metabolized to its pharmacologically active metabolite, desmethyl-sildenafil (DSDL). A sensitive and specific GC/MS method for the determination of SDL and DSDL in whole blood was devel...

A sensitive and specific GC/MS method for the determination of sertraline and its main metabolite desmethyl-sertraline in whole blood has been developed, optimized and validated. Sample preparation included solid-phase extraction of both analytes and their derivatization with heptafluorobutyric anhydride (HFBA). Protriptyline was used as internal s...

Tadalafil is a phosphodiesterase type 5 (PDE-5) inhibitor and it is used in the treatment of pulmonary arterial hypertension and erectile dysfunction. A sensitive and specific method is described for the determination of tadalafil in whole blood. Tadalafil and its internal standard (protriptyline) were isolated from the matrix by solid phase extrac...

Buprenorphine (BUP) is used for the maintenance of opioid-addicted pregnant women. Because BUP and its main metabolite nor-BUP are excreted into breast milk, a sensitive and specific GC/MS method has been developed, optimized and validated for their determination in breast milk. BUP-d4 was used as internal standard. The sample preparation includes...

A large number of plants, seeds, and berries have been used for medicinal, psychotropic, or aphrodisiac purposes for a thousand years. Mandragora officinarum belongs to the family of Solanaceae and is traditionally known as an aphrodisiac and is closely associated with witchcraft. In this study we report a case of an accidental poisoning after inge...

We present a validated gas chromatography-mass spectrometry method for the determination of Δ9-tetrahydrocannabinol and 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid in bile samples. The method includes protein precipitation with acetonitrile after enzymatic hydrolysis, and solid-phase extraction followed by silylation using N,O-bis(trimethylsil...

Vardenafil (VDN) is one of the three commercially available phosphodiesterase type 5 inhibitors and it is mainly used in the treatment of erectile dysfunction. A sensitive and specific gas chromatography/mass spectrometry (GC/MS) method for the determination of VDN in blood has been developed and validated. Sample preparation included solid-phase e...

A sensitive and specific GC/MS method for the determination of buprenorphine (BPN) and its main metabolite nor-buprenorphine (nor-BPN) in blood has been developed, optimized and validated. Sample preparation includes solid-phase extraction of both analytes and their derivatization with acetic anhydride in pyridine. BPN-d4 was used as internal stand...

Anticholinergic plants contain a variety of alkaloids that are toxic if ingested. Datura innoxia belongs to the family of Solanaceae and contains two main toxic alkaloids, atropine and scopolamine. In this study we report the case series of seven individuals who were admitted to two different hospitals of Athens with an anticholinergic syndrome. Al...

Benzodiazepines are used widely in daily clinical practice, due to their multiple pharmacological actions. The frequent problems associated with the wide use of benzodiazepines, as well as the multiple incidents of poisonings, led to the necessity for the development of a precise, sensitive and rapid method for the simultaneous determination of the...

At present, no official criteria exist for drug identification using single quadrupole mass spectrometers although the European Union (EU) criteria for compound identification have been adopted. These criteria are evaluated with respect to the confirmation of cocaine and its metabolites by single quadrupole liquid chromatography/mass spectrometry (...

Methadone is a synthetic opioid used medically as a narcotic analgesic drug and its pharmacological action is similar to that of morphine. Additionally, methadone is considered as the substance of choice for maintenance treatment of opioid dependence and especially on heroin. It is an agonist of μ receptors, where opioids are acting; it has prolong...

Methadone is used extensively for the maintenance of opioid-addicted pregnant women. Because methadone and the two major metabolites, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and 2-ethyl-5-methyl-3,3-diphenylpyrroline (EMDP), are excreted into breast milk, a sensitive and specific gas chromatographic-mass spectrometric method has be...

A simple HPLC method has been validated for the determination of sildenafil and its active metabolite (N-desmethylsildenafil) in human blood, using an octadecyl silica (ODS) hypersil column. The chromatographic run time is less than 25 min using a mobile phase of 35:65 (v/v) acetonitrile-0.015 M disodium hydrogen phosphate (Na(2)HPO(4)), triethylam...

A sensitive and specific GC/MS method for the determination of methadone (MDN) and its two main metabolites, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and 2-ethyl-5-methyl-3,3-diphenylpyrroline (EMDP), in plasma samples obtained from venous and arterial umbilical cord blood and maternal blood has been developed, optimized and validat...

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their s...

The three major cannabinoids, Δ9-tetrahydrocannabinol (Δ9-THC), cannabidiol (CBD) and cannabinol (CBN) were identified and determined quantitatively using a GCD (GC–EI) instrument, in samples of illicit herbal cannabis, seized by Customs and Police authorities in two areas of Greece (Ipiros and Lakonia) during 1996. These samples were sent by the a...

The three major cannabinoids, Δ9-tetrahydrocannabinol (Δ9-THC), cannabidiol (CBD) and cannabinol (CBN) were identified and determined quantitatively using a GCD (GC–EI) instrument, in samples of illicit herbal cannabis, seized by Customs and Police authorities in two areas of Greece (Ipiros and Lakonia) during 1996. These samples were sent by the a...