Profiles in Toxicology

Toxicology Unit of the Forensic Science Laboratory (FSL), Mauritius

Mauritius is an island of 1 864 km2, located 2 000 km east of the mainland African coast and 855 km from Madagascar. It has a population of 1.2 million, and an economy based on agriculture, exports, financial services and tourism.

In Mauritius, the Forensic Science Laboratory (FSL) was established in the 1950s and is the sole provider of forensic and advisory services to law enforcement agencies. It is also becoming an increasingly prominent forensic service provider in the region.

The Toxicology Unit has always been an essential part of the FSL. In its early years, the Unit dealt with limited resources to provide the required service. Alcohol level determination in blood and urine was performed by distillation and titration methods. Only a few samples per day could be analyzed. Analysis of drugs and poisons in body fluids was performed by liquid-liquid extraction followed by thin layer chromatography on laboratory prepared plates. Reference standards were scarce, with some provided by the UNODC. Color tests were used to identify poisons such as cyanide, metaldehyde and paraquat. Carbon monoxide (CO) levels in blood were analyzed by micro diffusion in a Conway cell. Ultraviolet-visible spectroscopy was the only instrument used for identification of poisons and drugs.

The introduction of Mauritius’ Drunk Driving Law in the 1990s brought new challenges – and new resources. A new headspace gas chromatography coupled to flame ionization detection (HS-GC-FID) instrument was acquired, allowing Mr. AK Jackaria (now a retired FSL director) to develop a modern, semi-automatic method for determination of alcohol levels in biological fluids. This increased throughput to 20 samples per day.

Further developments in the 21st century included the addition of a gas chromatograph coupled to a nitrogen phosphorus detector (GC-NPD) for screening, as well as liquid chromatographs coupled to tandem mass spectrometry or high resolution mass spectrometry (LC-MS/MS and LC-HRMS).

In 2000, the FSL left the umbrella of the Police Medical and Scientific Division to become an autonomous body under the Prime Minister’s Office. The laboratory has developed its quality management system, gaining its ISO 17025 accreditation in 2011. It is now participating in the International Collaborative Exercise (ICE) for biological samples organized by the UNODC. FSL was the winner of the Innovation and Improvement Award in 2015 and the Public Services Excellence Bronze Award Winner in 2018.

The current Director of FSL, Mrs. GM Madhub-Dassyne, has a commitment to modernizing the Toxicology Unit. The emergence of New Psychoactive Substances (NPS) has led to the purchase of mass spectrometers coupled to liquid chromatgraphs. NPS analysis and novel compound identification is still one of the main challenges facing the Toxicology Unit, together with turnaround time and backlogs. To meet this tall order, new tools such as in silico methods for predicting metabolism and mass fragmentation, and with multi-stage fragmentation (MSn), are used for structural elucidation of unknown compounds. About 40 NPS have been encountered in seized material analyzed by the FSL over the last 5 years.

The FSL Toxicology Unit, which treats about 1 800 cases per year, is now expanding its services to include drugged driving, workplace drug testing, drug facilitated crimes, hemp product analysis and even clinical (hospital) toxicology. Equine (racehorse) doping might also come under its purview. Furthermore, the Unit aims to achieve designated status for the analysis of chemical warfare agents by the Organisation for the Prohibition of Chemical Weapons (OPCW). With its 50 employees, the FSL thus covers a great deal of ground in toxicological applications!

Gedifew Nigatu Beza, M.Sc.

Gedifew Nigatu Beza, M.Sc. is the chairman of the Forensic Toxicology Laboratory of Saint Paul’s Hospital Millennium Medical College (Addis Ababa, Ethiopia), and a forensic toxicology lecturer in the Department of Forensic Medicine and Toxicology at the same institution. He obtained a B.Sc. in applied chemistry from Arba Minch University (Ethiopia), where he acquired his first research experience in evaluating the effectiveness of the University Wastewater Stabilization Pond (AMUWSP) as a treatment plant by evaluating the important physico-chemical parameters of wastewater quality. He received his first master’s degree in analytical chemistry from the University of Hawassa (Ethiopia). His research dealt with residue level analysis of organochlorine pesticides (OCPs) using GC-MS and toxicological risk assessment on humans at different exposure levels. More recently, he earned an Erasmus Mundus Master’s in Forensic Sciences at the University of Lincoln, United Kingdom (coordinating institution) and two other consortium European institutions: the University of Cordoba (Spain) and the Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM, Lisbon, Portugal). In the past, Mr. Beza served as a lecturer of analytical chemistry at Arba Minch University, where he has also been head of the Department of Chemistry, coordinating the undergraduate and graduate programs.

In addition to his leadership of the Forensic Toxicology Laboratory, he is also a volunteer Doping Control Officer (DCO) for the Ethiopian National Antidoping Office. He is also actively participating in establishing a poison control centre in Ethiopia with the collaboration of Public Health England.

Throughout his career, Mr. Beza has built experience with LC-MS/MS and GC-MS instrumentation for toxicological applications. He has developed an LC-MS/MS analytical method for multidetermination of drugs of abuse and their metabolites from human hair, as well as a GC-MS method for analysis of organochlorine pesticides. His teaching and research experiences in the fields of analytical chemistry and forensic sciences have helped him to build teamwork and leadership abilities.

The Forensic Toxicology Laboratory of Saint Paul’s Hospital Millennium Medical College is a nascent service, analysing cases from the whole country. Mr. Beza is committed to establishing a well-accredited forensic toxicology laboratory for Ethiopia. The end goal is to have a toxicology laboratory which would be used for postmortem examination, doping control, driving under the influence of alcohol and drugs, as well as drug-facilitated sexual assault cases. It would also serve as the poison control centre for the country and carry out toxicology research.

Currently, testing is mostly done using thin layer chromatography (TLC) and colorimetric tests. Alcohol and common drugs of abuse (cocaine, cannabis, amphetamine, diazepam & metabolites, to name a few) are analysed in postmortem examinations and drug-facilitated sexual assault cases. Given its early development stage, an important part of the work is developing standard operating procedures (SOP) and following appropriate chain of custody. Interpretation of postmortem toxicology results is another important part of the task, and Mr. Beza has presented seminars on this topic as well as on analysis procedures.

In the upcoming years, Mr. Beza plans to develop and validate further sensitive and selective analytical methods for drugs of abuse and their biomarkers (metabolites) in different biological and environmental matrices. Optimization of fast and simple sample preparation techniques in toxicology—as well as analysis of drugs of abuse in wastewater to estimate the extent of drug (ab)use by the community—is also an important goal. Mr. Beza intends for statistics and chemometrics to play a key role in these advanced forensic science and forensic toxicology projects, to help serve justice in his society.

Publications in preparation:

• Multidetermination of drugs of abuse in human hair using restricted access supramolecular solvent combined with LC-MS/MS
• Survey of obsolete pesticide dumpsites in Southern Nations Nationalities & People Regional State (SNNPRS) of Ethiopia
• A residue level analysis of organochlorine pesticides in SNNPRS of Ethiopia using GC-MS and their toxicological risk evaluation from selected sites

Pr. Sanae Achour

Pr. Sanae Achour is the head of the Pharmacology – Toxicology Laboratory Department at the University Hospital “CHU Hassan II” in Fez and the director of the Biomedical and Translational Research Laboratory at the University Sidi Mohamed Ben Abdellah (USMBA). After obtaining her medical degree in 2004, she specialized in toxicology in Morocco's Poison Control and Pharmacovigilance Centre, with further training at the Limoges and Angers university hospitals. In 2015, she obtained her PhD in medical sciences from the Ibn Tofail University (Kenitra, Morocco) with a thesis entitled, “Poisoning in children in Morocco: analysis of the situation since 1980 and strategy to reduce mortality”. She is currently the president of the Moroccan Society of Clinical and Analytical Toxicology (SMTCA, www.smtca.ma).

Pr. Achour has participated extensively in teamwork on poisoning events, such as the International Consensus Group on the Terminology of the Clinical Consequences of Scorpion Bite and a randomized controlled trial against placebo of an equine antivenom F(ab’)2 for envenomation’s scorpion treatment. As the director of the Pharmacology – Toxicology Laboratory Department at CHU Hassan II, she has developed and validated clinical and analytical toxicology methods.

The Pharmacology – Toxicology Laboratory at CHU Hassan II is located in Fez (Morocco). This north-eastern city is often considered the cultural capital of the country, and is famous for the fortified medina of Fez El Bali, with medieval Merinide architecture, lively souks and old-fashioned atmosphere. The laboratory was created in September 2009 to service the entire Fez-Meknes region. Its main goal is to perform toxicological analyses to guide the clinician in his or her diagnostic approach, therapeutic approach and assessment of prognosis of acute and chronic poisoning cases. The laboratory is also involved in drug dependence cases and therapeutic monitoring. The aim of the Therapeutic Pharmacological Monitoring program is to decrease the incidence of therapeutic failures and prevent the onset of unwanted effects of diverse medications, such as antibiotics (gentamicin, amikacin and vancomycin), antiepileptic (valproic acid, phenobarbital, carbamazepine) immunosuppressants (ciclosporin, tacrolimus) and methotrexate. In addition to its full time staff of biologists, toxicologists, chemists and laboratory technicians and its academic staff (hospital practitioners, full professors), the laboratory welcomes PhD candidates and medical students.

The Biomedical and Translational Research Laboratory of Sidi Mohamed Ben Abdellah University (USMBA), also in Fez, carries out research related to toxicology and environmental health. Amongst the more than 50 active projects are:

• Risk of nephrotoxicity linked to the use of plants and mixtures in traditional Moroccan pharmacopoeia;
• Assessment of heavy metals exposure among the tanners of Fez city;
• Detection of lead poisoning by artisanal manufacturers of Khôl in the old medina of Fez and in children in the Fez-Boulemane region;
• Assessment and prevention of health risks linked to the use of pesticides in the professional environment (Moroccan farmers).

Related and recent publications:

• Touiti, N., Achour, S., Iken, I., Chebaibi, M. and Houssaini, T. S. (2019). Nephrotoxicity associated with herbal medicine use, experience from Morroco. Toxicologie Analytique et Clinique, 31, 145-152. https://doi.org/10.1016/j.toxac.2019.04.001
• Bouftini, S., Bahhou, J., Lelièvre, B., de la Barca, J. C., Turcant, A., Diquet, B. et al. (2015). Screening for childhood lead poisoning in the industrial region of Fez, Morocco. Archives of environmental contamination and toxicology, 68, 442-450. https://doi.org/10.1007/s00244-014-0108-5
• Achour, S., Iken, I., Abidi, K., Dumont, X., Messouak, O., Belhcen, F. et al. (2019). Dépistage du saturnisme chez une famille travaillant dans la fabrication artisanale du Khôl. Toxicologie Analytique et Clinique, 31, S46. https://doi.org/10.1016/j.toxac.2019.03.063

Dr. Ellen Mwenesongole

Dr. Ellen Mwenesongole is a Forensic Science Lecturer at Botswana International University of Science & Technology (BIUST), where she has been involved in developing undergraduate and postgraduate forensic science courses as well as establishing a Forensic Chemistry research group. Dr. Mwenesongole holds a PhD in Forensic Science from Anglia Ruskin University (Cambridge, UK), and has also worked in toxicology, pharmaceutical and doping control laboratories.

Profiled as one of the Royal Society of Chemistry’s ‘175 Faces of Chemistry’, her research interests are in chemical profiling of illicit drugs as well as the extraction and detection of prohibited and controlled substances (including illicit drugs) from various matrices such as waste water, using mass spectrometric techniques. Drug abuse has contributed to detrimental social, health and economic implications in Southern Africa. Current research projects undertaken by the Forensic Chemistry Research Group at BIUST include chemical profiling of nyaope (a mixture of mainly heroin and cannabis) and methamphetamine (“Tik”) and waste water based epidemiology, targeting commonly used illicit drugs.

Aside from linking samples seized from different areas through their chemical profile, which in turn can be used to establish drug trafficking and distribution patterns, the research also aims to identify the cutting agents and adulterants used when making a mixture of nyaope. These are thought to include bicarbonate of soda, pool cleaner, teething powder, rat poison, lidocaine, acetaminophen, caffeine, methaqualone and antiretroviral drugs.

Waste water based epidemiology is based on detecting drugs of abuse in waste water with the aim of estimating community drug usage. This is in order to obtain near real-time information on the types and levels of drugs being used by communities in Botswana. The research projects, undertaken by masters and PhD students, are done in collaboration with the South African Police Service and Anglia Ruskin University (UK).

Related publications:

• Mthembi, P.M., Mwenesongole, E.M., Cole, M.D., 2019. Chemical profiling of the street cocktail drug ‘nyaope’ in South Africa using GC–MS II: Stability studies of the cannabinoid, opiate and antiretroviral components during sample storage. Forensic Science International, 300, pp. 187–192. https://doi.org/10.1016/j.forsciint.2019.04.040
• Mthembi, P.M., Mwenesongole, E.M., Cole, M.D., 2018. Chemical profiling of the street cocktail drug ‘nyaope’ in South Africa using GC-MS I: Stability studies of components of ‘nyaope’ in organic solvents. Forensic Science International, 292, pp. 115-124. https://doi.org/10.1016/j.forsciint.2018.08.001
• Mwenesongole, E.M., Gautam, L., Hall, S.W., Waterhouse, J.W., Cole, M.D., 2013. Simultaneous detection of controlled substances in waste water. Analytical Methods, 5, pp. 3248-3254. https://doi.org/10.1039/C3AY40655E

Pr. Haciba Rezk-kallah

Professor Haciba Rezk-kallah is the head of the Pharmacology – Toxicology Department at the University Hospital of Oran, and the director of the Environmental Health Research Laboratory of University of Oran 1. She is currently the president of the National Pedagogical Committee of Toxicology, vice-president of the National Pedagogical Committee of Pharmacy and the president of the Algerian Society of Toxicology (SATOX). After obtaining her pharmacy degree in 1985, she specialized in toxicology at Algiers University. At the Catholic University of Louvain (Brussels, Belgium), her research in industrial toxicology under Prof. Lauwerys focused on measuring blood and urinary phenyl acetic acid to assess occupational exposure of workers to manganese. She further obtained a PhD in medical sciences (Oran University) with research assessing the occupational exposure to chemical substances and ergotoxicological testing. Between 2000 and 2007, Pr Rezk-kallah was the head of the Pharmacy Department, Oran Faculty of Medicine. As the head of the Pharmacology – Toxicology Department at the University Hospital of Oran since 1996 she has developed clinical toxicology and management of chemical risk in the workplace. She currently aims to develop methods for forensic applications, including postmortem toxicological investigation, human-performance testing and forensic urine drug testing.

The Pharmacology – Toxicology Department is located in the University Hospital of Oran (www.lrse-oran-dz.com). This city, nicknamed Oran the radiant (in Arabic Wahran El Bahia), is the second largest city in Algeria and an important Maghreb and Mediterranean metropolis. This coastal city has a temperate climate characterized by hot, dry summers and mild, wet winters.

The main mission of the Pharmacology – Toxicology Department is to perform clinical toxicology for the hospital, helping to diagnose, predict, manage and prevent intoxications due to drugs as well as environmental and occupational toxicants. The department comprises four units:

1. Toxicological Emergencies and Toxicovigilance Unit, which handles an average of 600 requests each year. Benzodiazepines are the most commonly involved compounds in cases of voluntary or accidental intoxications. Pesticide poisoning comes in second, with almost 100 cases per year.
2. Therapeutic Pharmacological Monitoring and Pharmacovigilance Unit, which particularly monitors immunosuppressants and antiepileptics.
3. Professional and Environmental Toxicology Unit, which performs hundreds of analyses per year to assess the levels of metals exposure in workers of oil refineries, metal recovery companies, foundries, etc. They also assess levels of pesticides exposure in products production company workers and farmers.
4. Drug Testing and Forensic Toxicology Unit, which handles on average 400 cases per year and is still being developed. Their work shows that cannabis is still the most widely used drug, and that the drug diversion phenomenon is gaining momentum. The unit has been participating to the UNODC International Collaborative Exercises (ICE) program since 2018.

In addition to the full time staff (chemists, biologists, laboratory technicians) and academic staff (hospital practitioners, assistant and full professors), the Pharmacology – Toxicology Department welcomes PhD candidates and directs research work of the Environmental Health Research Laboratory at the University of Oran 1. This “Industrial and Environmental Toxicology” team studies various topics:

• Assessment and prevention of health risks linked to the use of pesticides at home and in the professional environment;
• Addictive behaviors linked with psychoactive substances – screening, biotoxicological monitoring and prevention aspects amongst target and vulnerable populations;
• Assessment of pesticides residue levels in water and food;
• Biometrological monitoring of populations professionally exposed to metals, phytosanitary products for agricultural use and public health;
• Assessment of phthalate exposure in the general population;
• Chemical risk management in healthcare establishments;
• Health risk assessments of energy drinks amongst youth;
• Health risk assessments of passive smoking.

Related publications:

• Chefirat, B., Boukalkha, H.H., Sadji, I., Rezk-kallah, H., 2015. Energy drinks: State of knowledge and consumption among young Algerians. Cahiers de Nutrition et de Diététique, 50, pp. 47–52. https://doi.org/10.1016/j.cnd.2014.07.006