Fatal poisoning due to ingestion of boiled oleander leaf extract

Nerium oleander is an ornamental evergreen shrub belonging to the family Apocynaceae. The Apocynaceae family includes the attractive evergreen shrub known as oleander. The cardiotoxic glycoside, oleandrin, is present in all portions of the common oleander plant. Oleander consumption can result in deadly situations accidentally or as a suicide attempt. After consuming kettle-boiled oleander leaf extract as part of a suicide attempt, an 80-year-old man was discovered comatose in his home and taken to our emergency room. The patient's heart rate was 30 beats per minute, and he had hypotension. Arterial blood gas analysis revealed remarkable metabolic acidosis and hyperkalemia (K: 7.7 mEq/L). An electrocardiogram showed a wide QRS wave, similar to a sine curve. The patient collapsed following cardiac arrest soon after hospital arrival. Veno-arterial extracorporeal membrane oxygenation was initiated; however, the patient eventually died. The serum level of oleandrin at hospital arrival, subsequently measured by LC–MS/MS, was found to be 33.4 ng/mL, far above the levels reported in previous fatal cases.     

Democratisation and the prospects for participatory regionalism in Southeast Asia

This article explores the impact of democratic transitions in Southeast Asia on regional co-operation, and the relationship between this process and the development of a non-official regionalism. Until now, regionalism in Southeast Asia has been essentially elite-centred and politically illiberal. The emergence of the Association of Southeast Asian Nations was founded upon the common desire of its members, which had by then retreated significantly from their postcolonial experiments in liberal democracy, to ensure regime survival. This orientation was further institutionalised by asean 's doctrine of non-interference, which helped to shield its members from outside pressures towards democratisation. But with democratisation in the Philippines, Thailand and more recently Indonesia, the asean model of elite-centric regional socialisation has been challenged. The civil society in the region demands greater openness in Southeast Asian regionalism. The article proposes a conceptual framework for analysing the relationship between democratisation and regionalism, with the key argument being that the displacement of traditional patterns of regional elite socialisation has been offset by potential gains such as advances in regional conflict management, transparency and rule-based interactions. But the realisation of a more 'participatory regionalism' in Southeast Asia faces a number of barriers, including obstacles to further democratisation, the continued salience of the non-interference doctrine and the diminished space for civil society in the wake of the 11 September terrorist attacks.     

Death From Butane Inhalation Abuse in Teenagers: Two New Case Studies and Review of the Literature

The ready availability of butane makes butane abuse frequent. Fatalities are rare. This study presents two cases of death by butane overdose. The postmortem analyses were carried out using headspace gas chromatography–mass spectrometry. It revealed femoral blood butane concentrations of 18 and 22 mg/L, respectively, as well as specific combinations of adjuvants in each victim. In one of the victims, brain and fatty tissue also contained butane, pointing to chronic consumption. The originality of this study is to show that the identification of specific combinations of adjuvants can be helpful for identifying the brand of deodorant used. Also, sampling the skin and mucosa can help identify the method of drug delivery. The histological examination documented both the direct toxic effect of the gas on the respiratory mucosa and signs of chronic abuse. Volatile substance intoxications should be systematically considered in case of sudden death in a teenager.     

Achievements and challenges of energy poverty alleviation policies: Evidence from the select states in India

Indian energy sector has undergone a tremendous transformation with consistent government policy interventions since 2000. Against this backdrop, we examine the extent to which energy poverty has decreased due to the expansion of energy services and the significant determinants of energy poverty in select six states in India. Overall, results reveal that absolute multidimensional energy poverty has substantially decreased across all states examined in the study as well as across all income and social groups between 2015 and 2018. Specifically, acute multidimensional energy poverty has reduced by an average of 30% between 2015 and 2018 in six states. At the same time, dependency on biomass remains more or less the same between 2015 and 2018. Results also show that inequality in the access to energy across income and social groups exists, and education is negatively related to energy poverty. Energy poverty has declined by a similar percentage among most employment groups, except for people practicing cattle rearing. Finally, culture is a significant determinant of energy poverty as households with the elderly and more land owned have higher energy poverty, probably due to the easy access to biomass and preference of such households to use it.     

Ideas,identity, and institution‐building: From the ‘ASEAN way’ to the ‘Asia‐Pacific way'?

Abstract

This article examines the extent to which the development of multilateral institutions in the Asia‐Pacific region may be viewed as an exercise in identity‐building. It argues that institution‐building in this region is more of a ‘process‐orientated’ phenomenon, rather than simply being an outcome of structural changes in the international system (such as the decline of American hegemony). The process combines universal principles of multilateralism with some of the relatively distinct modes of socialization prevailing in the region. Crucial to the process have been the adaptation of four ideas: ‘cooperative security’, ‘open regionalism’, ‘soft regionalism’, and ‘flexible consensus’. The construction of a regional identity, which may be termed the ‘Asia‐Pacific Way’ has also been facilitated by the avoidance of institutional grand designs and the adoption of a consensual and cautious approach extrapolated from the ‘ASEAN Way’. The final section of the article examines the limitations and dangers of the Asia‐Pacific Way. It concludes with the assertion that while the Asia‐Pacific Way is an over‐generalised, instrumental, and pragmatic approach to regional cooperation, and there remain significant barriers to the development of a collective regional identity that is constitutive of the interests of the actors, it has helped introduce the concept and practice of multilateralism into a previously sceptical region and might have ‘bought’ enough time and space for regional actors to adapt to the demands of multilateralism.     

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.