Characteristics and dose-effect relationship of clinical gamma-hydroxybutyrate intoxication: A case series

Gamma-Hydroxybutyrate (GHB) overdoses cause respiratory depression, coma, or even death. Symptoms and severity of poisoning depend on blood-concentrations and individual factors such as tolerance. A retrospective case study was conducted, evaluating GHB intoxication cases. GHB-concentrations in blood and urine were determined by gas chromatography-mass spectrometry (GC-MS) along with, in part, via enzymatic assay. GHB-concentrations, demographic data, and additional drug use, as well as specific clinical information, were evaluated. The correlation between GHB-levels in blood and associated symptoms were examined. In total, 75 cases originating from the Emergency Departments (EDs) of Hamburg and surrounding hospitals were included. Fifty-four of the patients (72%) were male. The mean GHB-concentration in blood was 248 mg/L (range 21.5–1418 mg/L). Out of the group with detailed clinical information (n = 18), the comatose group (n = 10/18) showed a mean of 244 mg/L (range 136–403 mg/L), which was higher than that of the somnolent and awake patients. Of the comatose collective, 70% (n = 7) showed co-use of one or more substances, with the additional use of cocaine being the most frequently detected (n = 5). In conclusion, a moderate dose-effect relationship was observed, although, there was some overlap in dosage concentration levels of GHB in awake and comatose patients. In GHB-intoxication cases, co-use was common as were clinical effects such as acidosis, hypotension, and impact on the heart rate. Timely analytical determination of the GHB-concentration in blood could support correct diagnosis of the cause of unconsciousness.     

A marriage made in heaven: the functioning of patriarchy and nostalgia in Boer soek ’n vrou

This article explores the functioning of patriarchy and nostalgia in a South African reality television series, Boer soek ’n vrou. A hermeneutical analysis is used to unpack visual and verbal narratives that depict romantic relationships and an idealised future. Concepts such as nostalgic appropriation, benevolent patriarchy and the courtship narrative are explored to illustrate the latent patriarchal agenda which is conveyed to the audience. Interactions between the two genders not only naturalise but also reaffirm gender stereotypes. Throughout the series, female contestants are relegated to the sphere of domesticity whereas male farmers are shown as active social agents. Footage that sentimentalises the farmers’ feelings is also used to regenerate Afrikaner masculinity, arguably as a direct result of the perceived loss of male authority. This ‘renegotiated’ image of a white, heterosexual man is indistinguishable from the historical, patriarchal portrayal of men. In the series, patriarchy and nostalgia collaborate to create a cultural product that can be commercially marketed. The colonial gaze is employed to depict farms as picturesque spaces where benevolent patriarchal power relations are enforced. selective erasure, however, distorts reality and exploitative power relations remain hidden from the audience.     

Investigations on the cause of death in a polytoxicomanic patient treated with wires and intermaxillary fixation for a chronic, infected mandibular fracture

The case of a 36-year-old male and former patient is presented who died for initially unknown reasons, with intermaxillary wire fixation for the treatment of an infected mandibular fracture still in place. The combined investigation of forensic experts and maxillofacial surgeons excluded aspiration and asphyxia as cause of death. Evidence was found for lethal methadone concentrations after intravenous drug abuse and a broncho pneumonia. Despite the clear evidence of a fatal intoxication in this case, caution must be exercised when dealing with individuals carrying intermaxillary fixation.     

Suicidal monointoxication with flunitrazepam. Further comment on coloration phenomena of the upper gastrointestinal tract

Fatal monointoxications with benzodiazepines, for instance with a suicidal intention, are exceptional findings. We report the autopsy case of an 82-year-old woman who died due to a suicidal monointoxication with Rohypnol 1 mg film tablets (therapeutical agent: flunitrazepam). 0.065 mg/L flunitrazepam and 0.34 mg/L 7-aminoflunitrazepam were detected in a postmortem heart blood sample and toxicological analysis revealed the metabolite 7-aminoflunitrazepam in gastric contents, too. At external examination, a bluish-turquoise coloration was seen around the woman's right nostril and within the oral cavity. At autopsy, similar coloration phenomena were seen on the mucosa of the distal esophagus and the stomach. Formerly, bluish stains on mouth and nostrils were considered indicative of intoxications with organophosphates such as parathion (E 605). More recently, case reports accumulate where an intoxication with Rohypnol 1 film tablets (containing the coloring agent indigocarmine in its core) have to be considered as a potential differential diagnosis of such coloration phenomena.     

Fatal intoxication with 1,4-butanediol: Case report and comprehensive review of the literature

A fatal case of 1,4-butanediol (1,4-BD) oral ingestion is reported here, in which a 51-year-old man was found dead in his bed. According to the police report, the deceased was a known drug user. A glass bottle labeled (and later confirmed to be) “Butandiol 1,4” (1,4-BD) was found in the kitchen. Furthermore, the deceased's friend stated that he consumed 1,4-BD on a regular basis. The autopsy and histological examination of postmortem parenchymatous organ specimens did not revealed a clear cause of death. Chemical-toxicological investigations revealed gammahydroxybutyrat (GHB) in body fluids and tissues in the following quantities: femoral blood 390 mg/L, heart blood 420 mg/L, cerebrospinal fluid 420 mg/L, vitreous humor 640 mg/L, urine 1600 mg/L, and head hair 26.7 ng/mg. In addition, 1,4-BD was qualitatively detected in the head hair, urine, stomach contents, and the bottle. No other substances, including alcohol, were detected at pharmacologically relevant concentrations. 1,4-BD is known as precursor substance that is converted in vivo into GHB. In the synoptic assessment of toxicological findings, the police investigations and having excluded other causes of death, a lethal GHB-intoxication following ingestion of 1,4-BD, can be assumed in this case. Fatal intoxications with 1,4-BD have seldom been reported due to a very rapid conversion to GHB and, among other things, non-specific symptoms after ingestion. This case report aims to give an overview to the published of fatal 1,4-BD-intoxications and to discuss the problems associated with detection of 1,4-BD in (postmortem) specimens.     

Utilising an Ubuntu-Centred Communication Management Framework to Analyse CSR Messages on SNSS

ABSTRACT

This article is the result of qualitative research conducted on the corporate social responsibility (CSR) communication disseminated by two financial institutions, FNB and Capitec, on their social networking sites (SNSs). The research employed a phenomenological research paradigm to explore the interactions between the financial institutions and their stakeholders on Facebook and Twitter. Collected data were analysed by means of interpretative discourse analysis as well as two computer-aided qualitative data analysis software programmes, Leximancer and Centim. The authors categorised the financial institutions’ CSR communication in themes and coded it according to a newly formulated theoretical framework of Ubuntu-centred communication practices on SNSs. It was found that FNB's CSR communication was based on Ubuntu values whereas Capitec's CSR communication did not exhibit key characteristics, such as the inclusion of narratives and archetypes, sound conflict resolution strategies, and the presentation of mutually beneficial solutions to societal issues. Based on the findings, it is proposed that organisation-stakeholder interactions can be facilitated when organisations disseminate CSR messages and constructively engage with stakeholders on SNSs. Moreover, culturally-specific communication management strategies, such as Ubuntu-centred communication, should be infused in holistic communication models to foster participatory online communities which are characterised by dialogue, mutual trust and reciprocity.     

How Litigants in Dutch Courtrooms Come to Trust Judges: The Role of Perceived Procedural Justice,Outcome Favorability,and Other Sociolegal Moderators

This paper examines the hypothesis that litigants' perceived procedural justice is positively associated with their trust in judges. We argue that although this association might seem quite robust, it can vary across contexts. In particular, we suggest that the nature and magnitude of the association between procedural justice and trust in judges depends on outcome concerns, and other sociolegal moderators such as outcome importance and prior court experience. We tested our predictions in three different types of law cases among 483 litigants at court hearings of the district court of the Mid‐Netherlands. As predicted, our results indicate that perceived procedural justice was positively associated with trust in judges when outcomes were relatively favorable, and that this association was even stronger when outcomes were relatively unfavorable. The courtroom context studied here enabled us to explore how other sociolegal variables moderated these relationships.     

Judicial and Litigant Perceptions in Dutch Court Cases: Perceptions of Outcome Importance Overlap,Perceptions of Procedural Justice Diverge

Social Justice Research - The current paper aims to provide insight into judges’ perceptions of how fairly they treat litigants and how important case outcomes are to litigants, and whether...     

3 case examples of intravital maggot infestations

The authors report on three cases of myiasis which rarely occurs in the civilized world. Poor social conditions, old age, alcoholism, diabetes and vascular occlusive disease were predisposing co-factors. All three victims showed large necrotizing skin ulcerations, but in no case a generalized infection had developed. Therefore the probable benefit from the maggot infestation concerning these ulcerating skin lesions is discussed. For centuries clinicians have observed that maggots provide debridement of necrotic wounds particularly in Military Medicine. With the advent of antibiotics their therapeutic use declined. Recently "biosurgery" (syn. maggot or larval therapy) again became a promising tool for therapy of infected, necrotizing skin-ulcerations. Besides wound debridement marked anti-microbial activity and secretion of proteolytic enzymes could be detected. Maggot debridement is an valuable and cost-effective treatment option for patients with nonhealing wounds.