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.     

In the shadows of war and peace: making sense of violence after peace accords

This article addresses an urgent but largely sidelined issue in the study of peace processes: that high levels of violence—usually framed as ‘crime’—are often ubiquitous in societies experiencing peace processes, even after the signing of peace accords. From South Africa to El Salvador, Guatemala to Northern Ireland, rising interpersonal violence has come to characterise the ‘peace’. This violence often takes place in the context of ambitious post-conflict development efforts. The article argues that even the seemingly non-political violence after peace accords is intimately linked to war, as well as the peace process—in both the causes of violence and in the types of violence that perpetrators use. In order to conceptualise post-peace accord violence, the article presents a framework of violence based on the perpetrators of violence and the types of violence (social, economic or political) that occur. This unpacking of post-peace accord violence emphasises the interconnectedness of political and non-political violence, and stresses the importance of security for development.     

Findings in fatal cases of poisoning attributed to traditional remedies in South Africa.

An analysis of the Johannesburg forensic database over the years 1991-1995 revealed 206 cases in which a traditional remedy was either stated to be the cause of death or was found to be present in a case of poisoning with an unknown substance. The range of toxins detected was wide, with herbal materials being found in 43% of cases, and pharmaceutical or agri-chemicals in 20% and 33% respectively. Since there are as yet no standard methods for the detection of many herbal remedies or their metabolites, careful analysis, using methods such as HPLC/MS, are mandatory for the correct identification of the true cause in cases of poisoning ascribed to traditional remedies.     

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.     

Accidental fatal poisoning by Nicotiana glauca: identification of anabasine by high performance liquid chromatography/photodiode array/mass spectrometry

A method, based on reversed phase high performance liquid chromatography (HPLC) was developed for the detection and quantification of anabasine, the toxic alkaloid of Nicotiana glauca, in forensic applications. A standard solid phase extraction (SPE) method was used for the extraction of anabasine from viscera, but was optimized for the extraction of this alkaloid from plant material. The careful selection of mobile phase components allowed the direct coupling of electron impact (EI) and Z spray mass selective detector (ZMD) of the HPLC. Under these conditions, anabasine was well separated from nicotine and could be detected on the PDA (limit of detection, LOD = 250 ng/ml), TMD (LOD = 10 microg/ml) and ZMD (LOD =1 ng/ml) detectors. Three geographically isolated N. glauca trees were analyzed for alkaloid content and it was found that both the leaves and the flowers contain anabasine. The optimized HPLC method was used to analyze two viscera samples (the stomach and contents of a mother and child who putatively died from food poisoning) and a flower exhibit. Anabasine was detected in both the viscera samples, supporting the finding that these fatalities were due to the ingestion of N. glauca accidentally collected with traditional spinach (marog). The alkaloid profile of the flower exhibit submitted with the viscera samples was similar to those obtained from flowers collected from three different N. glauca trees. The results show that anabasine and/or N. glauca poisoning can easily be confirmed using the forensic methodology described.     

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.     

Identification of atractyloside by LC-ESI-MS in alleged herbal poisonings

An LC-MS screening method was developed to detect the presence of atractyloside (ATR), the toxic principle of a commonly used medicinal plant in South Africa, Callilepis laureola, in biological matrices such as body fluids and human viscera.