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The National Association of Medical Examiners convened an expert panel to update the association's evidence-based recommendations for investigating and certifying deaths associated with opioids and other misused substances to improve death certificate and mortality data for public health surveillance. The recommendations are as follows:1. Autopsy provides the best information on a decedent's medical condition for optimal interpretation of toxicology results, circumstances surrounding death, medical history, and scene findings. The panel considers autopsy an essential component of investigating apparent overdose deaths.2. Scene investigation includes reconciling prescription information and medication counts. Investigators should note drug paraphernalia or other evidence of using intoxicating substances.3. Retain blood, urine, and vitreous humor whenever available. Blood from the iliofemoral vein is preferable to blood from more central sites.4. A toxicological panel should be comprehensive, including potent depressant, stimulant, and antidepressant medications. Detecting novel substances present in the community may require special testing.5. When death is attributed to a drug or combination of drugs (as cause or contributing factor), the certifier should list the drugs by generic name in the autopsy report and death certificate.6. The best classification for manner of death in an overdose without any apparent intent of self-harm is "accident."

Hydrogen sulfide (H2S) is a powerful toxic gas in workplace incidents, and it poses a threat to colleagues or family members involved in rescues, leading to a "domino effect" of multiple deaths. In this report, we describe three incidents in which 10 people died, and we present the results of the analyses performed in different incidents, including paper pulp pit, sewer, and sewage well. We provide the macroscopic and morphological findings of ten victims, which include conjunctival hemorrhage, corneal erosion, pulmonary edema, and pulmonary hemorrhage. Additionally, we observed large amounts of waste paper pulp or black sludge in the upper and lower respiratory tracts or upper and lower gastrointestinal tracts of six victims. Furthermore, we conducted a toxicological examination of the victims' blood sulfide using an alkylation extraction approach combined with gas chromatography/mass spectrometry. The sulfide concentrations in the 10 victims ranged from 0.06 to 6.72 mg/L. [ABSTRACT FROM AUTHOR]

The American College of Medical Toxicology and the National Association of Medical Examiners convened an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance. The panel finds the following: 1. A complete autopsy is necessary for optimal interpretation of toxicology results, which must also be considered in the context of the circumstances surrounding death, medical history, and scene findings. 2. A complete scene investigation extends to reconciliation of prescription information and pill counts. 3. Blood, urine, and vitreous humor, when available, should be retained in all cases. Blood from the femoral vein is preferable to blood from other sites. 4. A toxicological panel should be comprehensive and include opioid and benzodiazepine analytes, as well as other potent depressant, stimulant, and anti-depressant medications. 5. Interpretation of postmortem opioid concentrations requires correlation with medical history, scene investigation, and autopsy findings. 6. If death is attributed to any drug or combination of drugs (whether as cause or contributing factor), the certifier should list all the responsible substances by generic name in the autopsy report and on the death certificate. 7. The best classification for manner of death in deaths due to the misuse or abuse of opioids without any apparent intent of self-harm is "accident." Reserve "undetermined" as the manner for the rare cases in which evidence exists to support more than one possible determination.

Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.

Background: There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status., Objectives: To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda., Methodology: Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood., Results: Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively., Conclusion: There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

Abstract: The sharp increase in drug-related deaths has tempted medical examiner/coroner offices to perform external examinations with comprehensive toxicology testing instead of performing a standard autopsy. Compounding the problem of an increasing workload has been the decrease in available forensic pathologists. Opting for external examinations on suspected drug-related fatalities, however, is antithetical to current best practices. The purpose of this study was to review case files, autopsy reports, and toxicologic results of all deaths that were autopsied at the authors' facility and decide whether significant disease processes or injuries that would supersede the results of toxicologic testing and external examination findings alone were being missed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Most of the on-site approaches for inferring of the post-mortem interval are still based on observative data from the direct body inspection, whereas, objective and quantitative analyses, such as potassium in the vitreous humor, are require laboratory instrumentation and skilled personnel. The present paper presents a simple and low cost analytical method suitable for use at the crime scene for inferring the time since death. The method uses a microfluidic paper-based device (μPAD) for the determination of ammonium in the vitreous humor (VH) based on the selective interaction between the ammonium and the Nessler's reagent. The color change was measured in terms of "RGB distance" by using a simple and free smartphone application. The optimized device showed a limit of detection of 0.4 mmol L−1, with between days precision less than 9.3% expressed as relative standard deviation, and accuracy between days from 94.5% to 104.5%. The selectivity of the Nessler's reaction was tested towards the main vitreous humor compounds, and no significant interferences were found. This paper-based analytical device was successfully used for the determination of ammonium ion in VH samples from forensic autopsies. The results obtained with the proposed method, although for a limited number of cases (n = 25), showed a close correlation with the data obtained with an instrumental analysis based on capillary electrophoresis. Moreover, in order to make the evaluation of results as simple as possible, a direct correlation between the color intensity, expressed as RGB distance, and the post-mortem interval was studied and a significant correlation was found (R2 > 0.78). In conclusion, the present preliminary study showes that the proposed device could be an additional tool to the traditional methods for a more accurate, although still presumptive, estimation of the time of death directly at the crime scene. Image 1 • A simple and low cost analytical method suitable for use at the crime scene for inferring the time since death is presented. • The device uses the microfluidic paper-based technology and the selectivity of the Nessler's reagent towards ammonium ion. • A concordance between the results obtained with the proposed procedure and those using CE-UV is proved. • The proposed procedure showed significant advantages for thanatochemical analysis at the crime scene. [ABSTRACT FROM AUTHOR]

Hanging is one of the most common methods of committing suicide all around the world. This is retrospective study conducted between June 2014 to December 2016, which included 50 cases of Hanging which were autopsied in Mortuary of Government Medical College associated Hospital, Ambikapur, Sarguja, Chhattisgarh during this period. Out of 50 cases of Hanging, 26 (52%) cases were males and 24 (48%) cases were females. Maximum number of victims 16 (32%) were in the age group of 21-30 years. Maximum 48 (96%) cases occurred in closed place and least number of cases occurred in open place 02 (4%). Cyanosis was seen in 46 (92%) of cases and face congestion seen in 24 (48%) cases. Ligature mark present above the level of thyroid cartilage in maximum number of cases 48 (96%). Fracture of hyoid bone present in 1 (2%) case. Aim of the study was to find out incidence, trends and patterns of hanging in Chhattisgarh. [ABSTRACT FROM AUTHOR]

Introduction: The motor vehicle crash (MVC) constitutes an important challenge for forensic pathology in order to identify the manner and cause of death. Our study focuses on a fatal accident during a rally race corresponding to MVC sub-category., Materials and Method: Postmortem computed tomography (PMCT) was performed before the conventional autopsy. Autoptic and PMCT data were compared. Data collection allowed analyzing biomechanical dynamics of the incident and post-traumatic injuries through qualitative-statistics and solicitation quantitative indices., Results: Photo and circumstantial evidence analysis showed a wrong installation of double shoulder belt system of head and neck support (HANS) collar. PMTC clearly highlighted multiple and bilateral fractures involving roof and base of skull; a displaced fracture of the right acetabulum was also encountered. Autopsy confirmed PMCT data and revealed a brainstem laceration. AIS (Abbreviated Injury Scale) achieved a maximum score in consideration of fatal injuries., Discussion: The injuries analysis resulting from photographic surveys examination, conventional autopsy, and PMCT has led us to confirm a fatal front collision with a tree trunk. Head trauma represents a major injury in the present case. In this case, head injuries, related to whiplash trauma, are a consequence of a double shoulder belt system (HANS collar component) wrong installation., Conclusion: MVC and especially high-speed motor racing represent an important death cause. There was, for this reason, a marked development of cars and occupants' safety systems, such as HANS collar. PMCT improves the diagnostic performance of conventional autopsy and increases forensic medical knowledge related to traumatic injuries.

• In Italy, recent regulation has updated the post-mortem body disposition. • Body donation is admitted for study, training and scientific research purposes. • Unsolved issues concern the grantees of teaching and training activities. • The Italian College of Anatomists has made constructive criticisms to the law. • Suggestions are provided to manage the donation process and use of the body. In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors' scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations. [ABSTRACT FROM AUTHOR]

Introduction: This paper presents digital educational material in forensic odontology, including dental identification after multiple fatalities and dental age estimation from different age groups. Material and method: Electronic patient records consisting of intraoral scans of the dentition, digital radiographs, photographs and written dental records were collected. Exercises in age estimations contained digital radiographs and photographs of ground tooth sections, with digital measuring tools and tables according to age groups. The teaching material was organised as a module in an electronic Learning Management System with external links to all relevant teaching material. Results: For the identification exercises, intraoral scans and the latest digital radiographs simulated the postmortem examination of the deceased. For comparison, all other radiographs, photographs and dental records were available as antemortem material. The exercise was to match postmortem findings with the antemortem records using the Interpol standard and reconciliation. Age assessment of children used designated tables to grade tooth development on digital radiographs. For adults, non-destructive methods, digital radiographs, photographs and measuring tools were used. Discussion: The teaching concept was hybrid, but it can easily be adapted as a fully digital exercise. The instructions and written material can be translated into different languages. The level of difficulty in the exercises can be adjusted according to the participant's level of knowledge. Conclusion: The educational material embraces the new possibilities for digitalisation and intraoral scanning. This might be a valuable tool for motivating and engaging the students in their participation and understanding of the subject. [ABSTRACT FROM AUTHOR]

Introduction: This survey of Canadian pathology residents was designed to quantify the number of autopsies Canadian residents aim to complete during residency training, to better understand the perception of residents about access and quality of autopsy skills education. In addition, the interest of current pathology residents in autopsy and forensic pathology as a future career was also assessed., Methods: A web-based survey was sent to all Canadian pathology residents. This survey consisted of 19 questions on institution, level of training, intention to complete the American Board of Pathology examination, number of autopsies completed, perception of quality/access to autopsy skills education, interest, and factors contributing to autopsy and forensic pathology., Results: Eighty two (26%) of a possible 310 residents (12/47 general pathology, 70/263 anatomical pathology) across all Canadian institutions offering anatomical or general pathology programs (16/16 institutions) participated in the survey. Eighty-three percent of the respondents rated autopsy education as either very important or important. Fifty-five percent of the respondents intended to either challenge the American Board of Pathology examination or wanted the option to do so in the future, whereas only 47% of the participants agreed that all residents who wish to challenge the examination will easily be able to complete 50 autopsies during residency. Only 18% of the respondents were interested in performing autopsies as a major part of their career, and a combined 52% were only interested in performing autopsies to secure a desired position or felt that having to do autopsies would be a job deterrent. The quality of autopsy teaching received and the number of autopsies performed was identified as the most significant factors affecting interest in performing autopsies as part of a future career. A combined 68% of the respondents felt that the job market in forensic pathology in Canada was either good (better than most subspecialties) or very good (more jobs than graduating fellows). Seventy-one percent (12/17) of postgraduate year 5 respondents reported having completed 50 or more autopsies at the time of survey completion. Eleven percent of the respondents did not agree that all residents who document having completed an autopsy at their institution will have participated in all 8 essential autopsy tasks. Twenty four (29%) of the 82 respondents provided detailed narrative comments., Discussion: Most Canadian pathology residents believe that autopsy education is an important component of residency training. Limited access to quality autopsy teaching seems to be an important factor in resident interest in forensic pathology as a future career, despite a perceived good job market in comparison with most other subspecialties., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The article presents a commentary on the role of phosphatidylethanol in assessing postmortem ethanol intake in autopsies. The author highlights the use of the ethanol compound as a biomarker in determining alcohol consumption in an autopsied person's brain and serum blood level. The author also offers the detailed information on the research conducted on the effectiveness of phosphatidylethanol in autopsies.

Introduction: Modern forensic investigations increasingly revert to 3D imaging techniques, such as computed tomography, magnetic resonance imaging, and 3D surface imaging. Findings are therefore often based on 3D data sets; however, this information is commonly reported and communicated within 2D imagery. The use of interactive 3D PDFs is already established in the scientific community but has yet to be implemented in the field of forensic medicine., Methods and Materials: Three example cases were chosen to serve as exemplary data for the most commonly applied imaging techniques in postmortem imaging. 3D surface models were created from postmortem magnetic resonance imaging (PMMR), postmortem computed tomography (PMCT), and 3D surface imaging data sets., Results: PMMR revealed a space-occupying subdural hemorrhage that led to ipsilateral compression of the brain tissue of the right hemisphere. PMCT displayed a defect in the skull on the left side of the temporal bone. 3D surface imaging data displayed a patterned discoloration on the inside of the left forearm., Discussion: Interactive 3D PDFs offer the possibility to communicate 3D information to the reader while maintaining all the benefits of a regular 2D PDF. With Adobe Acrobat, the reader can interactively navigate through 3D data sets and create sufficient depth cues to generate a realistic 3D perception of the data., Conclusion: The interactive 3D PDF is a useful extension of standard 2D PDFs and has the potential to communicate 3D data to the reader in a more complete, more comprehensible, and less subjective manner than 2D PDFs.

I In this in vitro study, i [5] I in the USA evaluated the cytotoxic effects of amikacin on equine chondrocytes, synoviocytes, and bone marrow and adipose- derived mesenchymal stem cells (MSC). i Chondrocytes, synovial cells, and adipose and bone marrow derived MSC were harvested post-mortem from three horses with no evidence of osteoarthritis. Cell metabolism/viability was assessed by colorimetric MTT assay, and cell proliferation was assessed by live cell imaging. Amikacin at clinically applied doses induces rapid, pronounced cell death of equine joint cells and so amikacin doses currently used intra-articularly should be reconsidered. [Extracted from the article]

The authors discuss a report on the 79 autopsy registers of the Grant Medical College and J.J. Hospital and their effort in retrieving lost data. Topics mentioned include the pioneering work of P.V. Gharpure (1896-1967) of the Pathology Department, preservation of records from 1872 of post-mortems done by several teachers, and the Framji Dinshaw Petit laboratory for scientific and medical research built in 1891.

Background: Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known., Objectives: The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2)., Review Methods: Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis., Results: Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable., Limitations: A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions., Conclusions: LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care., Funding: The National Institute for Health Research Health Technology Assessment programme., Competing Interests: No competing interests were declared.

Vasant Ramji Khanolkar was the first Indian pathologist and a pioneering researcher who was at the forefront of the diverse fields of cancer research, blood group genetics, epidemiology and leprosy research, etc. in the mid-twentieth century. All his cutting-edge research took place after he joined Tata Memorial Hospital, Bombay (now Mumbai), as Director of Laboratories. There is little evidence of his research in the first 17 years of his career in India, at J.J. Hospital and K.E.M. Hospital, Bombay. We tried to address this gap by attempting to obtain information on Khanolkar's papers from PubMed, prior to his having joined Tata Memorial Hospital. We evaluated the abstracts of the presentations that he made at the meetings of the Teaching Pathologists Association, Bombay. Finally, we extracted from the autopsy registers at the two hospitals, any useful information about the autopsies that he had performed. Khanolkar performed preliminary laboratory research in anaemia as well as some experimental pathology in his stint at K.E.M. Hospital. Further, surprisingly, histology was not performed on most autopsies at J.J. Hospital for the period that he was Professor, but was done at K.E.M. Hospital. Why Khanolkar was a late bloomer and did not perform much research or publish in the first two institutions that he was Professor at, remains a mystery. [ABSTRACT FROM AUTHOR]

Fourth, the Letter raises a number of additional issues: The Letter states that "The National Association of Medical Examiners has in place a procedure for providing contact information for surveys such as this in order to make sure that the sampling is complete and unbiased. To be clear, our paper calls for a long-overdue discussion about what information should and should not be used in forensic pathology decisions, and a collective recognition that cognitive bias occurs in forensic pathology decision-making - as it can in any decision-making task. In the second set of data from our experimental study, the research question was whether forensic pathology decisions were biased by nonmedical and irrelevant contextual information in general, I not i race specifically. Remember that our paper presents the first data to examine bias in forensic pathology decision-making, and as we clearly stated, "Our two data sets are the first step in examining biases in postmortem decision-making, and they do not answer all the questions.". [Extracted from the article]

The article responds to a study on the role of restraint in fatal excited delirium syndrome, highlighting flaws in the original study's methodology and conclusions. The authors argue that the study's scope goes beyond its stated aims and that the interpretation of the literature is flawed. They question the exclusion of cases and the subjective nature of diagnoses, ultimately concluding that the study fails to provide a balanced and accurate interpretation of the subject matter. The authors emphasize the need for a comprehensive post-mortem examination by a qualified forensic pathologist in cases involving restraint-related deaths. [Extracted from the article]

Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge., Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA., Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection., Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80%, reducing it to about 1-2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35-40 VA cases annually, while medical officers at primary health centers are projected to manage 150-200 physician-certified VAs each year. The app's data collection and transmission efficiency were further improved based on feedback from user and subject area experts., Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India., (©Harleen Kaur, Stuti Tripathi, Manjeet Singh Chalga, Sudhir K Benara, Amit Dhiman, Shefali Gupta, Saritha Nair, Geetha Menon, B K Gulati, Sandeep Sharma, Saurabh Sharma. Originally published in JMIR Formative Research (https://formative.jmir.org).)

Coronary artery vasculitis is a rare pathological condition and is often a manifestation of systemic vasculitis, such as Polyarteritis Nodosa, Kawasaki Disease, Takayasu Arteritis, and Giant Cell Arteritis, with Kawasaki Disease being the most common cause in children. We present the autopsy case of a 6-year-old boy with classic Hodgkin lymphoma who died of sudden cardiac death due to thrombosis caused by vasculitis, which exclusively affected the coronary arteries and was suggestive of Kawasaki Disease. To further investigate the histological features of Kawasaki Disease across all age groups, we conducted a literature review using the search terms "Kawasaki AND vasculitis AND histopathology" and "Kawasaki vasculitis histopathology" in Scopus, Google Scholar, and PubMed, covering the period from 1967 to 2023. The inclusion criteria were as follows: coronary histology (inflammation and/or aneurysm and/or thrombosis), postmortem studies, English language, free articles, all age groups, case reports, and case series., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Postmortem heart specimens are essential for education and research on the anatomy, morphology, and pathology of congenital heart defects. However, such specimens are rarely obtained these days, and the specimens stored in formalin are inexorably deteriorating. This study aimed to develop methods to archive three-dimensional data of rare human heart specimens and to publish the data., Methods: All wax-infiltrated human postmortem heart specimens stored in the Cardiac Registry, Boston Children's Hospital were scanned using microfocus computed tomography (X-Tek HMXST225, Nikon Metrology, Inc.), and reproduced using a three-dimensional printer (Form 3B, Formlabs Inc.). The digital models were published as an interactive three-dimensional online atlas. The resolution of the three-dimensional data was evaluated., Results: The primary diagnoses in the 88 specimens included in the study include normal cardiac anatomy (11 cases), transposition of the great arteries {S,D,D} (11 cases), ventricular septal defect (10 cases), double-outlet right ventricle (9 cases), hypoplastic left heart syndrome (9 cases), and common atrioventricular canal (7 cases). Twenty-five cases (28%) underwent previous surgical or percutaneous interventions to the heart, including Mustard procedure (1 case), Senning procedure (2 cases, one was performed on a postmortem heart specimen). The median voxel size of the three-dimensional data was 40.5 um (IQR, 32.8-64.2). All intracardiac structures were precisely reproduced as digital and physical three-dimensional models., Conclusions: The methods and resultant models were considered useful for archiving and furthering the utilization of these invaluable specimens. The atlas is available at https://www.sketchfab.com/heartmodels/collections., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shuhei Toba, Takato Yamasaki, and Kentaro Umezu report financial support was provided by Japan Society for the Promotion of Science. Shuhei Toba reports financial support was provided by Uehara Memorial Foundation. The other authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)