Hernández del Rincón, Juan Pedro

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Hernández del Rincón, Juan Pedro

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Hernández del Rincón, Juan Pedro

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Universidad de Murcia. Departamento de Ciencias Sociosanitarias

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Open Access
Diagnostic application of postmortem cardiac troponin I pericardial fluid/serum ratio in sudden cardiac death
(MDPI, 2021-03-30) Valverde-Vázquez, María del Rocio; Noguera Velasco, José Antonio; Hernández del Rincón, Juan Pedro; Hernández Romero, Diana; Osuna Carrillo-Albornoz, Eduardo Javier; Pérez Cárceles, María Dolores; Ciencias Sociosanitarias
In approximately 5% of unexpected deaths, establishing a conclusive diagnosis exclusively on the basis of anatomo-pathological findings in a classic autopsy is difficult. Postmortem biomarkers have been actively investigated as complementary indicators to help to reach valid conclusions about the circumstances of death. Several studies propose either the pericardial fluid or peripheral veins as a location for troponin determination, but the optimum sampling site is still a matter of debate. Our objective was to evaluate the association between the ratio of troponin values in the pericardial fluid and serum (determined postmortem) and the diagnosis of acute myocardial infarction (AMI) in the context of sudden cardiac death. We included 175 forensic cases. Two groups were established: AMI deaths (48; 27.4%) and the control group (127; 72.6%). The cardiac Troponin I (cTnI) values in the pericardial fluid and the troponin ratio were found to be associated with the cause of death. Univariate regression analyses showed that both age and the cTnI ratio were significantly associated with the diagnosis of AMI death. In a multivariate analysis, adjusting for confounding factors, the age and cTnI ratio were independent predictors of death from myocardial infarction. We performed a receiver operating characteristic (ROC) curve for the cTnI ratio for AMI death and selected a cut-off point. Our biomarker was found to be a valuable and highly effective tool for use in the forensic field as a complementary method to facilitate diagnosis in nonconclusive autopsies.
Open Access
Identification of Benzodiazepine Use Based on Dried Blood Stains Analysis
(MDPI, 2024-06-17) Fernández López, Lucía; Rodríguez, Sandra; Cánovas Cabanes, Alberto; Teruel Fernández, Francisco Javier; Almela Rojo, Pilar; Hernández del Rincón, Juan Pedro; Navarro Zaragoza, Javier; Falcón Romero, María; Farmacología
Biological matrices are typically used in forensic toxicological or pharmacological analysis: mainly blood, vitreous humor or urine. However, there are many cases in which crimes are a consequence of drug intoxication or drug abuse and they are not closed because over the months or years the samples become altered or decomposed. A dried blood stains test (DBS-MS) has recently been proposed to be used in drug toxicology when blood is found at a crime scene. This test could help an investigator to reveal what a person had consumed before the perpetration of the crime. In order to check the possibilities of this test, we analyzed several dried blood stains located on a cotton fabric. Therefore, the aim of this study was to determine if the analysis of a dried blood spot located on a cotton fabric could be an alternate source of obtaining toxicological results, particularly regarding benzodiazepines. We splashed blood stains on cotton fabric with different concentrations of the following benzodiazepines: alprazolam, bromazepam, clonazepam, diazepam and lorazepam, which were dried for 96 h and subsequently quantified by high-performance liquid chromatography coupled mass spectrometry (HPLC-MS). Our results show that it is possible to identify several benzodiazepines contained in a cotton fabric blood stain; consequently, this method may add
Open Access
Causes of death and survival in alcoholic cirrhosis patients undergoing liver transplantation: influence of the patient’s clinical variables and transplant outcome complications
(MDPI, 2021-05-27) Bolarín, J. M.; Minguela, A.; Muro, Manuel; Hernández del Rincón, Juan Pedro; Legaz Pérez, Isabel; Luna Maldonado, Aurelio; Pérez Cárceles, María Dolores; Ciencias Sociosanitarias
Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.
Open Access
Genetics of hypertrophic cardiomyopathy: A review of current state.
(Wiley, 2017-03-21) Pérez Sánchez, Inmaculada; Gimeno, Juan Ramón; Hernández del Rincón, Juan Pedro; Sabater Molina, María; Ciencias Sociosanitarias
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease. HCM is a highly complex and heterogeneous disease regarding not only the number of associated mutations but also the severity of phenotype, symptom burden, and the risk of complications, such as heart failure and sudden death. The penetrance is incomplete and it is age and gender dependent. It is accepted as a disease of the sarcomere. Sixty percent of HCM cases carry mutations in 1 of 8 sarcomere protein genes, mainly non-sense MYBPC3 and missense MYH7 variants. Young patients with severe phenotype and other clinical features are included in proposed scores for prediction of high positive genetic result. The number of genes reported as disease-causing has increased in the last few years, in some cases without robust evidence. Currently available in silico tools are not always useful for differentiation between benign and deleterious variants. There is enough information on genotypephenotype correlations to start understanding the mechanisms of the disease. Genetic and environmental modifiers have been explored with some interesting insights from miRNA studies with potential as biomarkers and therapeutic agents. There is an additional value of genetic testing in HCM for prognosis. Knowledge about genetics and functional studies are the basis of near future therapies.
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Aplicación de análisis bioquímicos y de difracción de rayos X al cálculo de la data de restos óseos / Juan Pedro Hernández del Rincón ; directores Aurelio Luna Maldonado, Carmen Pérez Sirvent, María Dolores Pérez Cárceles.
(Murcia : Universidad de Murcia, Departamento de Ciencias Sociosanitarias. Unidad Docente de medicina Legal y Forense,, 2001) Hernández del Rincón, Juan Pedro
Open Access
Carbamazepine overdose after psychiatric conditions: A case study for Postmortem Analysis in Human Bone
(2022-06-13) Fernández López, Lucía; Mancini, Rosanna; Rottolo, Maria Concetta; Navarro Zaragoza, Javier; Hernández del Rincón, Juan Pedro; Falcón Romero, María; Farmacología
Carbamazepine is the main option used as a preventive medication to treat bipolar disorder when there is no response to lithium. Carbamazepine toxicity is defined as serum levels greater than 12 μg/mL, with severe toxicity occurring over 40 μg/mL, reduced to 30 μg/mL when combined with pharmacological treatment, i.e., benzodiazepines or antidepressants. For these reasons, it is necessary to find a validated tool to determine carbamazepine levels in an autopsy to rule out suicide or to know if the death was a consequence of an adverse drug reaction (ADR), especially when only bones can be accessed. We have validated a tool to detect and quantify drug concentration in bone. Our results showed a peak for carbamazepine at minute 12 and a mass fragment of 193 m/z. This case study is the first time in the literature that carbamazepine has been detected and quantified in bone. These results demonstrate that carbamazepine can be detected in bone tissue from forensic cases, but almost more importantly, that the method proposed is valid, reliable, and trustworthy.