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.     

The Relevance of Religion for Political Office: Voter Bias Toward Candidates from Different Religious Backgrounds

Over the last several decades, Gallup data shows an increased willingness among members of the public to support presidential candidates from a wide range of religious backgrounds, though a nontrivial proportion of the public is still unwilling to vote for an Atheist, Mormon, or Muslim. What underlies this opposition? We argue that voters evaluate candidates from religious out-groups more negatively on a wide range of dimensions considered desirable for political office, and that this bias should be more pronounced among the highly religious. We show support for these arguments using a survey experiment fielded with YouGov. Atheists and Muslim candidates were perceived more negatively on a large set of traits considered desirable for political office compared to candidates from religious in-groups, and Mormon candidates fall somewhere in between. The Atheist and Muslim candidates were also perceived as less competent on a diverse set of issues.

     

Book Notes

Domestic and Foreign Finance in Modern Peru, 1850–1950. By Alfonso W. Quiroz. Oxford: Macmillan in association with St Anthony's College, 1993. Pp.xiv + 297. £45. ISBN 0 333 56565 7.

Out of the Shadows: Women, Resistance and Politics in South America. By Jo Fisher. London: Latin American Bureau, 1993. Pp.228. £17.99 and £7.99. ISBN 0 906156 78 5 and 77 7.

When the Grass is Gone: Development Intervention in African Arid Lands (Seminar Proceedings 25). Edited by P.T.W. Baxter. Uppsala: Scandinavian Institute of African Studies, 1991. Pp.214. SEK 170 (hardback). ISBN 91 71 06318.     

Identification of Crystals Forming on Porcine Articular Cartilage: A New Method for the Estimation of the Postmortem Interval

Articular cartilage was examined to determine its decomposition sequence and its potential for assessing the postmortem interval. Scanning electron microscopy of articular cartilage from buried porcine trotters showed the presence of microcrystals on the synovial surface. These orthorhombic pyramidal or “coffin”‐shaped crystals, appeared at 3 weeks (22 days) after interment and disappeared after 6 weeks. The disappearance of these crystals was linked to decompositional changes to the integrity of the synovial joint. The formation and disappearance of these crystals was associated with a pH change at the cartilage surface. Scanning electron microscopy–energy‐dispersive X‐ray (SEM‐EDX) analysis showed that the five main elements contained within these crystals were carbon, nitrogen, oxygen, magnesium, and phosphorous. Such elemental analysis suggested the crystals may be struvite (MgNH₄PO₄6(H₂O)). Bacteria cultured from the cartilage synovial surface produced struvite crystals when grown in suitable media and were identified by DNA analysis to be Comamonas sp.     

Fatal accidental hanging by a high-chair waist strap in a 2-year-old girl

High chairs are commonly used to feed children after 6 months. Related injuries are oftentime minor and rarely leading to death. We describe a case of a 2-year-old female child who used to jump alone on her high chair and also had the habit to fasten the straps by herself. Her mother found her hanging by the waist straps. A thorough investigation showed that she climbed her high chair and fastened the waist straps but not the crotch one. The girl slid down into the seat, trapping her neck in the waist straps and thus resulting in hanging. In here, we concluded that the victim's death was caused by asphyxia, itself, caused by accidental hanging. The present case is of a special interest because of the rare similar cases reported. This case suggests that a correct restraint use and a close supervision would have prevented such a fatal issue.