Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences

.: ORIGINAL RESEARCH
Sentetik Kannabinoid İlişkili Ölümlerde İç Organ Patolojileri: Tek Merkezli Kesitsel Otopsi Çalışması
Internal Organ Pathologies in Synthetic Cannabinoid-Related Deaths: A Single-Centered Sectional Autopsy Study
Halil İlhan AYDOĞDUa, Hüseyin Çetin KETENCİb, Gökhan KAZINDIRc, Bülent ŞAMa
aAdli Tıp Kurumu Başkanlığı, İstanbul, Türkiye
bRecep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Adli Tıp ABD, Rize, Türkiye
cAdli Tıp Kurumu, Trabzon Grup Başkanlığı, Trabzon, Türkiye
Turkiye Klinikleri J Foren Sci Leg Med. 2022;19(2):79-84
doi: 10.5336/forensic.2021-87059
Article Language: TR
Full Text
ÖZET
 Amaç: Sentetik kannabinoidler, CB1 ve CB2 reseptörleri aracılığıyla vücutta tetrahidrokannabinolün etkisini taklit eden psikoaktif maddelerdir. Sentetik kannabinoidlerin bu ölümcül yan etkileri ile ilgili bilgiler, olgu sunumları ve geniş olgu serileri ile sınırlıdır. Çalışmamızın amacı, sentetik kannabinoid ilişkili ölümlerde kardiyovasküler ve solunum sistemi organlarının patolojileri üzerinden ölüm mekanizmasının anlaşılmasına ve madde kullanımı/bağımlılığını önleme çalışmalarına katkı sunmaktır. Gereç ve Yöntemler: 'Adli Tıp Kurumu Trabzon Adli Tıp Grup Başkanlığı' 2010-2019 yılları arasındaki 10 yıllık dönemde, ölümü sentetik kannabinoid kullanımına bağlanan olgulara ait otopsi raporları incelendi. Kan ve idrar örnekleri, AB-SCIEX 5500 QTRAP model sıvı kromatografi-kütle spektrometresi/kütle spektrometresi cihazı ile analiz edildi. Bulgular: Bu çalışmaya 22 olgu dâhil edildi. Olguların yaşları 18-50 arasında değişmekteydi. Medyan yaş 31, ortalama yaş ise 31,59±9,58 idi. Adli otopsileri yapılan olguların hiçbirinde travma bulgusu tespit edilmedi. Organların ağırlıkları -özellikle akciğer- artmış olarak bulundu. Organların makroskobik ve mikroskobik incelemesinde; 20 (%90,9) olguda akciğerde yaygın ödem tespit edildi. Akciğerlerin mikroskobik incelemesinde; 8 (%36,4) olguda intraalveoler kanama, 6 (%27,3) olguda atelektazi, 3 (%13,6) olguda pnömoni bulguları ve 2 (%9,1) olguda kalp hatası hücreleri olduğu görüldü. Sonuç: Uyutucu-uyuşturucu madde kullanımı dünya genelinde ciddi bir halk sağlığı sorunudur. Hem bu çalışmadaki hem literatürde diğer çalışmalardaki veriler ışığında, akciğer ağırlıklarında artış tespit edilmesi spesifik bir bulgu olmasa da sentetik kannabinoid ilişkili ölümlerde ciddi bir bulgu olarak tanımlanabilir.

Anahtar Kelimeler: Sentetik kannabinoid; intoksikasyon; ölüm; otopsi
ABSTRACT
 Objective: Synthetic cannabinoids are psychoactive substances that mimic the effect of tetrahydrocannabinol in the body via CB1 and CB2 receptors. Information on these fatal adverse effects of synthetic cannabinoids is limited to case reports and large case series. The aim of our study is to contribute to the elucidation of the death mechanism in synthetic cannabinoid-related deaths through the organ pathologies of the cardiovascular and respiratory system organs and to the studies on the prevention of substance use/addiction. Material and Methods: Autopsy reports of cases whose death was attributed to the use of synthetic cannabinoid in the 10-year period between 2010-2019 at the 'Council of Forensic Medicine of Trabzon Forensic Medicine Group Department' were analyzed. Blood and urine samples were analyzed via AB-SCIEX 5500 QTRAP model liquid chromatography-mass spectrometry/mass spectrometry device. Results: Twenty-two cases were included in the study. The ages of the cases ranged between 18 and 50 years. The median age was 31, and the mean age was 31.59±9.58. Trauma findings were not found in any of the cases whose forensic autopsies were conducted. The weights of the organs, in particular the lung weights, were found to be increased. In the macroscopic and microscopic examination of the organs, diffuse edema in the lungs was detected in 20 (90.9%) cases. In the microscopic examination of the lungs; Intraalveolar hemorrhage in 8 (36.4%) cases, atelectasis in 6 (27.3%) cases, pneumonia in 3 (13.6%) cases, and siderophages in 2 (9.1%) cases were observed. Conclusion: Narcotic drug use is a serious public health concern across the world. Considering the data in both this study and other studies in the literature, an increase in lung weights can be defined as a serious finding in synthetic cannabinoid-related deaths, albeit it is not a specific finding.

Keywords: Synthetic cannabinoid; intoxication; death; autopsy
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