No abstract

Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5-76 h of taking ibogaine. The clinical and postmortem evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular, and/or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the uninformed use of ethnopharmacological forms of ibogaine.

Context In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years. Objective To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings. Design We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths). Results Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription–polymerase chain reaction positive for influenza. Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, >30) was noted in 72% of adult and adolescent cases. Conclusions The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics. Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Upper Cretaceous rocks described and correlated in this report are the Steele Shale, Mesa verde Group (consisting of the Rock River l!'ormation (new name), Haystack Mountains)formation (new name), Allen Ridge Formation, Pine Ridge Sandstone, and Almond Formation), Lewis Shale, E'ox Hills Formation, Medieine Bow ll..,ormation, and the lower part of the Ferris Formation. '.rhe lower Tertiary rocks described consist of the upper part of the Ferris ll..,ormation of Paleocene age and the overlying Hanna ll..,ormation of late Paleocene and Eocene age. 'l'he oldest unit Jnvestigated, the Steele Shale, consists of 2,300-8,800 feet of dark-gray marine shale that contains limestone concretions, beds of bentonite as much as '5 feet thick, and• thin layers of siltstone ami very fine grained sandstone. It becomes sandy upward nnd grades into the overlying Mesaverde Group. 'The Mesaverde Group, in the Rawlins-Medicine Bow area, consists of the following formations, from oldest to youngest: Haystack Mountains Formation, Allen Ridge Formation, Pine Ridge Sandstone, and Almond Formation. The Haystack Mountains Formation comprises a sequence of mostly shallow-water marine sandstone and shale that thins southwestwardly across southcentral 'Vyoming from 2,550 to 850 feet. It contains three persistent ridge-forming sandstone members interpreted as beach and barrier-bar deposits. The oldest member, Tapers Ranch Sandstone (new name) , is 270 feet thick •and forms the base of the formation. The second member, O'Brien :Spring Sandstone (new name) is 220 feet thick and lies 1,350 feet below the top of the formation. The Hatfield Sandstone Member, as much as 167 feet thick, lies 450 feet •below the top. Nonmarine sandstone, shale, and carbonaceous beds largely mal{e up the Allen Ridge Formation, but some sandstone and shale of brackish-water and marine origin are included. The Allen Ridge is conformable with the underlying Haystack Mountains Formation. It is as much as 1,500 feet thick. It intertongues with the Rock River Formation, and in the Laramie Basin area, it is replaced by that formation. Dlsconformably overlying the Allen Ridge Formation is the Pine Ridge Sandstone, a white t

No abstract

This Viewpoint emphasizes the importance of accurate, detailed documentation of cause of death, underlying medical disease, and contributing comorbidities to allow public health agencies to track and manage the coronavirus disease 2019 (COVID-19) pandemic based on timely and accurate classifications.

All deaths due to descent from height that underwent autopsy at the Manhattan Office of Chief Medical Examiner of New York City over a two year period (1997–1999) were reviewed. The scene and autopsy findings, psychiatric history, and toxicology results were examined. There were 120 deaths: 77 suicides, 36 accidents, 5 undertermined, and 2 homicides. Psychiatric illness was reported in 86% of suicides. The toxicological detection of psychiatric medications supports the high percentage of psychiatric disease in the suicide group. In the accidental group, the detection of ethanol and illicit drugs was higher (36%) than expected from the case investigation and similar to the suicide group (29%). Accidental falls by women made up fewer than 3% of all manners. Due to the variation in the extent of injuries, it is unwise to attempt to conclude how high a person descended based on the autopsy findings. Descents into water commonly have minimal findings on external examination with marked internal injuries. The methods of investigation and criteria for death certification using the study results are discussed.