Intentional overdose of glargine insulin: Determination of the parent compound in postmortem blood by LC-HRMS

Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21^A-Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine was always absent or below the limit of quantitation. In this study, we present a case of suicide of a young nurse by injection of insulin glargine in which the parent molecule was found at a toxic concentration in blood. The determination and the discrimination of insulin glargine from human insulin and other synthetic analogs in the blood specimen were performed by liquid chromatography coupled to high-resolution mass spectrometry (Waters XEVO G2-XS QToF) and extraction after precipitation in the presence of bovine insulin (internal standard), with a mixture of acetonitrile/methanol +1% formic acid followed by purification on solid phase extraction cartridges C18. Glargine insulin tested highly positive in the blood with a concentration of 1.06 mg/L. Due to the difficulty in obtaining a M1 pure standard, the metabolite could not be dosed. This unique presence of the parent molecule, reported for the first time, can be explained by inter-individual variability in the rate of conversion to metabolite. Intravenous injection versus subcutaneous injection can also explain the presence of insulin glargine. Finally, the dose injected may have been so high that saturation of the proteolytic enzymes responsible for conversion to M1 should have occurred.     

‘it was better during the war’: narratives of everyday violence in a Palestinian refugee camp

The distinction between what is commonly regarded as the routine of impoverishment and what is acknowledged and remarked upon as violence is increasingly being questioned in scholarship and public policy circles. Interrogating the distinction between routine and remarkable not only reveals the habits and relationships constituting everyday life as the site of violence, but also foregrounds questions of gender. Given that the everyday is shaped by a given community's norms regarding the gendered division of labour that produces and reproduces the conditions of the everyday, in what ways is violence as well as its experience gendered? This article examines this question in the particular context of Palestinian camp refugees’ lived experience of forced displacement in Lebanon. It explores the ways in which the violence used against Palestinian camp refugees draws on norms regarding masculinity and femininity shared by the refugees as well as their Lebanese oppressors. It also examines the ways in which Palestinian camp refugees’ everyday experience of impoverishment as well as the acknowledged violence of forced displacement, subjection to Lebanese military intelligence control, and participation in the armed struggle for national liberation are constituted by and constitutive of unequal subject positions of gender, class and citizenship.     

Primer composition and memory effect of weapons--some trends from a systematic approach in casework

Since 2008, our laboratory has adopted a systematic approach to the examination of gunshot residues (GSR) in casework by analysing, whenever possible, the inorganic composition present in ammunition (cartridge cases and unused ammunition). By compiling the results of these analyses in a database, it is possible to observe some trends during the period of interest: on the one hand, the prevalence of primers containing lead, barium and antimony is about 50%, and even as high as 70% when including lead-barium-antimony based primers also containing tin; on the other hand, the prevalence of non-toxic primers is for the time being very low. Still using the same approach, test firings were performed with recovered weapons and litigious ammunition whenever possible in order to estimate the influence of the well known "memory effect" of the weapons on the GSR analysis results. The first results show a quite strong memory effect for the .22 and the .32 caliber, unlike the .38 caliber. This is probably due to a high prevalence of lead-barium-antimony based primers for the latter caliber.     

Evaluation of the Role of Toxicological Data in Discriminating Between H2S Femoral Blood Concentration Secondary to Lethal poisoning and Endogenous H2S Putrefactive Production

Hydrogen sulfide is a colorless gas and has a strong odor of rotten eggs. It is absorbed by the upper respiratory tract mucosa, and it causes histotoxic hypoxemia and respiratory depression by exerting an inhibitory effect on cytochrome oxidase. To evaluate the role of toxicological data in distinguishing between the H₂S blood concentration secondary to lethal poisoning and the endogenous H₂S produced during putrefaction, we compared the postmortem H₂S concentrations of six fatal H₂S poisoning cases (8.7–28.6 mg/L) with the postmortem concentrations of endogenous H₂S of 12 subjects who died from other causes (traffic‐related deaths) (2.2–32.7 mg/L). These results will be of interest to the forensic community as it underlines the importance of considering circumstantial evidence along with the toxicological and pathological findings in the identification of H₂S lethal poisoning.