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AIMS: The purpose of this study is to evaluate the accuracy and validity of the determination of cause of death (COD) and manner of death (MOD) at the completion of the forensic autopsy prosection. METHODS: We analysed 952 autopsy cases conducted from 2019 to 2020 and compared every patients COD, other significant contributing factors to death (OSC), and MOD after prosection to their COD, OSC and MOD after completion of the final autopsy report. RESULTS: We found that 83% of cases (790 patients) did not have an unexpected change and 17% of cases (162 patients) exhibited a true change in their final diagnosis; the relationship between age and changes in COD and MOD was significant. CONCLUSIONS: Our findings indicate that in the majority of forensic autopsy cases, medical professionals can reasonably complete death certification after the autopsy prosection. In addition to improving the accuracy of COD and MOD, advances in this field will enhance timely decedent affairs management, timely investigations of crimes and timely closure to families who have lost loved ones. We recommend implementing combined interventional education and consultation with expert pathologists, and a well-followed structured method of death classification as the best course of practice.

BackgroundIschemic cardiomyopathy is the leading cause of heart failure (HF). Most patients do not undergo coronary assessment after HF diagnosis. There are no randomized clinical trials of coronary assessment after HF diagnosis.MethodsUsing an electronic health record cohort of all individuals with HF within the San Francisco Health Network from 2001 to 2019, we identified factors associated with coronary assessment. Then, we studied the association of coronary assessment within 30 days of HF diagnosis with all-cause mortality and a composite of mortality and emergent angiography using a target trial emulation observational comparative-effectiveness approach. Target trial emulation is an approach to causal inference based on creating a hypothetical randomized clinical trial protocol and using observational data to emulate the protocol. We used propensity scores for covariate adjustment. We used national death records to improve the ascertainment of mortality and included falsification end points for the cause of death.ResultsAmong 14 829 individuals with HF (median, 62 years old; 5855 [40%] women), 3987 (26.9%) ever completed coronary assessment, with 2467/13 301 (18.5%) with unknown coronary artery disease status at HF diagnosis assessed. Women, older individuals, and people without stable housing were less likely to complete coronary assessment. Among 5972 eligible persons of whom 627 underwent early elective coronary assessment, coronary assessment was associated with lower mortality (hazard ratio, 0.84 [95% CI, 0.72-0.97]; P=0.025), reduced risk of the composite outcome (hazard ratio, 0.86 [95% CI, 0.73-1.00]), higher rates of revascularization (odds ratio, 7.6 [95% CI, 5.4-10.6]), and higher use of medical therapy (odds ratio, 2.5 [95% CI, 1.7-3.6]), but not the falsification end points.ConclusionsIn a safety-net population, disparities in coronary assessment after HF diagnosis are not fully explained by coronary artery disease risk factors. Early coronary assessment is associated with improved HF outcomes possibly related to higher rates of revascularization and guideline-directed medical therapy but with low certainty that this finding is not attributable to unmeasured confounding.

BACKGROUND: Hypoinflammatory and hyperinflammatory phenotypes have been identified in both Acute Respiratory Distress Syndrome (ARDS) and sepsis. Attributable mortality of ARDS in each phenotype of sepsis is yet to be determined. We aimed to estimate the population attributable fraction of death from ARDS (PAFARDS) in hypoinflammatory and hyperinflammatory sepsis, and to determine the primary cause of death within each phenotype. METHODS: We studied 1737 patients with sepsis from two prospective cohorts. Patients were previously assigned to the hyperinflammatory or hypoinflammatory phenotype using latent class analysis. The PAFARDS in patients with sepsis was estimated separately in the hypo and hyperinflammatory phenotypes. Organ dysfunction, severe comorbidities, and withdrawal of life support were abstracted from the medical record in a subset of patients from the EARLI cohort who died (n = 130/179). Primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. RESULTS: The PAFARDS was 19% (95%CI 10,28%) in hypoinflammatory sepsis and, 14% (95%CI 6,20%) in hyperinflammatory sepsis. Cause of death differed between the two phenotypes (p

Introduction Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system. Materials and Methods A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e. mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue. Results Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%). Conclusion The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners. [ABSTRACT FROM AUTHOR]

Introduction Suicidal ideation and attempts are considered to be graduated risks for suicide, yet they remain under studied. Suicide is among the leading causes of death in the U.S. for all individuals between the ages of 10 and 64 years. Suicide is a critical problem in the U.S. Military. The U.S. Army suicide rates surpassed civilian rates in 2008 and continue to climb steadily; with U.S. Army soldiers at more than twice the risk than U.S. civilians, and enlisted personnel at more than twice the risk of officers. Suicidal ideation and attempts are routinely reported within U.S. Army brigades using suicide-related serious incident reports (SR-SIRs). These reports could form a useful source of information for prevention planning, but to date there have been no efforts to summary these reports. This paper analyzes SR-SIRs among enlisted personnel for a 4-year period for 1 Army brigade, to test the usefulness of this information and to explore whether risk factors for attempts compared to ideation can be identified. Materials and Methods This report analyzes 130 de-identified reports of suicidal ideation (n  = 102) and suicide attempts (n  = 28) reported as SR-SIRs from August 2018 to June 2022 among enlisted personnel in an airborne infantry brigade combat team (BCT) outside the continental U.S. Analysis of de-identified data was not considered research by brigade and university human subject/IRB authorities. Fourteen soldier characteristics and context factors were examined to determine if they differentiate the two types of incidents, suicidal ideations and suicide attempts. Results Unit location and alcohol use at the time of the incident were strongly associated with suicide attempts compared to ideation. Attempts occurred disproportionately during off duty hours, and attempters were more likely to have had prior contact with behavioral health services than ideators; however, these differences did not attain conventional statistical significance. Conclusions The study can help inform unit-specific suicide prevention and intervention strategies. Off duty hours and alcohol use are risk factors for attempts, particularly among soldiers who have sought behavioral health care. Plans to engage and support soldiers who have sought behavioral health care during off duty hours, and information regarding the risks of alcohol use, could meaningfully reduce their risk. This is the first known attempt to examine active duty U.S. Army brigade combat team SR-SIRs, and they are a potentially valuable source of health and mental health-related information. [ABSTRACT FROM AUTHOR]

ABSTRACT Hepatitis A is a vaccine‐preventable disease that typically causes mild illness. Hepatitis A outbreaks associated with person‐to‐person transmission have been widespread in the United States since 2016. We used public‐use US Multiple Cause of Death data to compare characteristics and listed comorbidities among decedents with hepatitis A‐listed deaths during non‐outbreak (2011–2015) and outbreak (2017–2021) periods and assessed the median age at death among decedents with and without hepatitis A‐listed deaths during the outbreak period. From the non‐outbreak period to the outbreak period, hepatitis A‐listed deaths more than doubled (from 369 to 801), while the hepatitis A‐listed age‐adjusted mortality rate increased 150% (p < 0.001). When compared with the non‐outbreak period, hepatitis A‐listed decedents during the outbreak period were more frequently male, aged 18–49 years, non‐Hispanic White, died in an inpatient setting, and had hepatitis A listed as their underlying cause of death. The median age at death for hepatitis A‐listed decedents was significantly younger during the outbreak period overall and among females (62 and 66 years, respectively) compared with the non‐outbreak period (64 and 72 years, respectively, p < 0.001). During the outbreak period, median age at death for hepatitis A‐listed decedents was 14 years younger than decedents without hepatitis A listed. Compared with the general US population, decedents with hepatitis A listed on the death certificate died at younger ages during 2017–2021. Efforts are needed to improve hepatitis A vaccination coverage among adults recommended for hepatitis A vaccination to prevent additional premature hepatitis A deaths. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to analyse the trends in Takayasu arteritis (TAK) in Japan during three recent decades based on autopsy reports. Methods: We extracted TAK cases from the Japanese Pathological Autopsy Reports published during three decades (1991–2000, 2001–10, and 2011–20) and compared the data for the number of cases, age, gender, malignant tumour complication rate, and cause of death. Results: 322 TAK cases were reported during the 30 years. They represented 0.04–0.06% of the total autopsies, with little variation among the three decades. The peak age at autopsy increased: from the 60s for 1991–2010 to the 70s for 2011–20. The malignant tumour complication rate increased to 12.2%, 18.5%, and 22.7% during the three decades. However, about half of those cases had no metastases, and malignant tumours were rarely directly involved in a TAK patient's death. TAK-associated cardiovascular lesions accounted for most deaths. Conclusions: Although the age at TAK onset showed little change during the 30 years, the age at autopsy has increased, suggesting that the long-term prognosis has improved. Although the malignant tumour complication rate increased with age, the most common causes of death were cardiovascular lesions. [ABSTRACT FROM AUTHOR]

The Pliocene lacustrine infill of Camp dels Ninots maar (Girona, Spain) hosts an exceptional record of complete articulated skeletons. Here we present the taphonomical description of 22 fossil water frogs recovered from the Pit 7/8 of Can Argilera Sector. Description of their skeletal taphonomy is done on the basis of their distribution, completeness, articulation and limb position, and by establishing comparisons with the late Miocene site of Libros (Spain). Microscopic examination shows no evidence of digestion and absence of weathering. Mass mortality or any environmental stress-induced factors cannot be ruled out, but natural death seems to be the most probable. Limited time of decay prior burial seems to be the main pattern explaining the relatively high degree of articulation and completeness. Floatation is not to be disregard for some more (proximally) disarticulated specimens. Taphonomical patterns document two types of sub-environments inside a cool and deep lake, suggesting a more complex depositional scenario for Camp dels Ninots than the ones described in others similar Konservat-Lagerstätten. [ABSTRACT FROM AUTHOR]

Introduction Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. Materials and Methods This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. Results There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38–31.07 seconds; 6 months: median 36.33, interquartile range 31.59–55.22 seconds; 12 months: median 49.50, interquartile range 41.75–60.75 seconds; 24 months: median 38.79, interquartile range 30.20–53.08 seconds; P  < .0001, P  < .0001, P  = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50–10.00; 6 months: median 8.00/10, interquartile range 6.75–9.00; 12 months: median 8.00/10, interquartile range 6.75–9.25; P  < .0001, P  < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50–10.00; 24 months: 10.00/10, interquartile range 9.00–10.00; P =.125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. Conclusions This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency. [ABSTRACT FROM AUTHOR]

Background: Children of immigrants often have excess mortality rates, in contrast to the low mortality typically exhibited by their parents' generation. However, prior research has studied children of immigrants who were selected for migration, thereby rendering it difficult to isolate the intergenerational impact of migration on adult mortality. Methods: We use semiparametric survival analysis to carry out a total population cohort study estimating all-cause and cause-specific mortality among all adult men and women from age of 17 years among all men and women born in 1953-1972 and resident in Finland in 1970-2020. We compare children of forced migrants from ceded Karelia, an area of Finland that was ceded to Russia during the Second World War, with the children of parents born in present-day Finland. Results: Children with two parents who were forced migrants have higher mortality than children with two parents born in Northern, Southern, and Western Finland, but similar or lower mortality than the subpopulation of children whose parents were born in the more comparable areas of Eastern Finland. For women and men, a mortality advantage is largest for external causes and persists after controlling for socioeconomic factors. Conclusion: Our findings suggest that forced migration can have a beneficial impact on the mortality of later generations, at least in the case where forced migrants are able to move to contextually similar locations that offer opportunities for rapid integration and social mobility. The findings also highlight the importance of making appropriate comparisons when evaluating the impact of forced migration. [ABSTRACT FROM AUTHOR]

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Understanding the underlying causes of maternal death across all regions of the world is essential to inform policies and resource allocation to reduce the mortality burden. However, in many countries there exists very little data on the causes of maternal death, and data that do exist do not capture the entire population at risk. In this article, we present a Bayesian hierarchical multinomial model to estimate maternal cause of death distributions globally, regionally, and for all countries worldwide. The framework combines data from various sources to inform estimates, including data from civil registration and vital systems, smaller‐scale surveys and studies, and high‐quality data from confidential enquiries and surveillance systems. The framework accounts for varying data quality and coverage, and allows for situations where one or more causes of death are missing. We illustrate the results of the model on three case‐study countries that have different data availability situations. [ABSTRACT FROM AUTHOR]

INTRODUCTION The occurrence of maternal mortality is a significant indicator of a country's economic progress. The current study seeks to examine the causes of maternal deaths in a tertiary care hospital. OBJECTIVES To gather data and insights about the factors and issues contributing to maternal mortality in a tertiary care hospital in an urban setting, identify any potentially avoidable factors, and utilize the findings to prevent future maternal deaths. METHODS This was a 4 years retrospective study. The medical records of all maternal deaths occurring over a period of 4 years between January 2019 and November 2022 were reviewed and correlated with causes of death. RESULTS MMR in our study was 466.2/1 lakh live birth, most of the deaths(36.3%) were in the age group of 23-27 years, 61.3% cases were from rural areas, major immediate cause of death being sepsis (22.5%), major antecedent cause of death found was hypertensive disorders(27.4%), 44.8% of deaths were between 24 hours- <7 days of admission. CONCLUSION A significant number of the deaths that have been observed could be prevented, indicating a large scope for improvement. [ABSTRACT FROM AUTHOR]

Autopsy of infants can provide vital information about the cause of death and contributes to the detection of diagnostic errors, especially in a low- or middle-income country. To observe the clinicopathological agreement in neonatal deaths in neonatal intensive care units (NICU) and comment on the additional information retrieved by autopsy. A retrospective observational study was conducted in the NICU from January 2020 to December 2022. Neonatal deaths were analyzed, and clinical details and autopsy findings were collected. Both clinical and pathological diagnoses were classified according to the Goldman classification. Twenty-two newborn infants were enrolled. The mean gestational age was 33.5 (±4.38) weeks, and the median birth weight was 1510 (1005–2100) g. There was complete concordance between clinical and pathological diagnosis in 11 (50%) cases. Major diagnostic errors occurred in 41% of cases. Respiratory system disorders (lung infections, airway anomalies) accounted for six (54%) cases of missed diagnosis. Our study showed that the diagnosis was revised after autopsy in about one-third of cases, and newer findings were identified in one-fifth of cases. [ABSTRACT FROM AUTHOR]

Aims: One half of Norwegians die in nursing homes, where death certificates (DCs) are completed by two types of physicians: in-house physicians or physicians on call. The aims of this study were to examine differences in the quality of DCs due to type of physician and to uncover possible implications of errors for the public statistics. Methods: DCs from the year 2013 from nursing homes in the catchment area of Akershus University Hospital were examined with regard to logical deficiencies, garbage code diagnoses and type of certifying physician. In one third of cases, the registered causes of death were compared to information in the medical records. Results: A total of 873 DCs from 24 nursing homes were evaluated. Physicians on call certified 46% of all deaths. Logical deficiencies were found in 34% of all DCs and were more common in DCs from physicians on call. Garbage code diagnoses were used in every third DC, with 'sudden death' or 'cause of death unknown' preferred by physicians on call and 'unspecified pneumonia' preferred by in-house physicians. Comparisons against medical records uncovered missing information in 49% and 35% of DCs from physicians on call and in-house physicians, respectively. A dementia diagnosis was frequently overlooked by both physician types. Garbage code diagnoses were more common in DCs with missing information from medical records. Conclusions: Error rates in DCs in nursing homes in Norway are high. The results raise concerns about the validity of public cause of death statistics. [ABSTRACT FROM AUTHOR]

Background: Malaria contributes substantially to the persistent burden of child deaths in sub-Saharan Africa. Accurate and comprehensive malaria mortality data are crucial to monitor the progress in reducing malaria incidence and mortality. Verbal Autopsy (VA) ascertains the cause of death despite its limitations leading to misclassification errors. Minimally Invasive Tissue Sampling (MITS) is being conducted in some settings as an alternative to Complete Diagnostic Autopsy (CDA). The present study examines the validity of malaria-related deaths comparing VA diagnoses with those obtained through MITS and/or CDA. Methods: A comprehensive literature search for original studies in English language using Ovid MEDLINE, Ovid Embase, CINAHL via EBSCO, Scopus, The Cochrane Library via Wiley, Google Scholar and searching the MITS Surveillance Alliance papers was carried out. The reference period was January 1, 1990–March 31, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted. Results: Among 71 articles identified in the databases, 21 matched the eligibility criteria. Qualitative syntheses showed that malaria Cause Specific Mortality Fractions (CSMFs) across various studies ranged from 2 to 31%. Plasmodium falciparum was mostly responsible for these deaths and the most common complications were anaemia and cerebral malaria. The sensitivity and specificity of the VA validation studies ranged from 18.4% to 33% and from 86.6% to 97%, respectively, and there was a high level of misclassification for both InSilico and Expert Algorithm VA for malaria compared to MITS. The overall concordance rates between MITS and CDA diagnoses ranged from 68 to 90%, with the highest concordance seen in deaths due to infectious diseases and malignant tumours. Clinical data increased diagnostic coincidence between MITS blind to clinical data and the gold standard CDA by 11%. Conclusions: The comprehensive review finds that MITS demonstrated better accuracy compared to VA in diagnosing malaria-attributed deaths, particularly in hospital settings. The high specificity of malaria in VA diagnosis suggests population-based estimates of the proportion of deaths due to malaria are broadly plausible. [ABSTRACT FROM AUTHOR]

Background Advancements in access to antiretroviral therapy (ART) and human immunodeficiency virus (HIV) care have led to a decline in AIDS-related deaths among people with HIV (PWH) in Switzerland. However, data on the ongoing changes in causes of death among PWH over the past 15 years are scarce. Methods We investigated all reported deaths in the Swiss HIV Cohort Study between 2005 and 2022. Causes of death were categorized using the Coding Causes of Death in HIV protocol. The statistical analysis included demographic stratification to identify time trends and logistic regression models to determine associated factors for the underlying cause of death. Results In total, 1630 deaths were reported, with 23.7% of individuals assigned female sex at birth. These deaths included 147 (9.0%) HIV/AIDS-related deaths, 373 (22.9%) due to non-AIDS, non-hepatic cancers, 166 (10.2%) liver-related deaths, and 158 (9.7%) cardiovascular-related deaths. The median age at death (interquartile range) increased from 45.0 (40.0–53.0) years in 2005–2007 to 61.0 (56.0–69.5) years in 2020–2022. HIV/AIDS- and liver-related deaths decreased, whereas deaths from non-AIDS, non-hepatic cancers increased and cardiovascular-related deaths remained relatively stable. Conclusions The proportionally decreasing HIV/AIDS and liver-related deaths showcase the effectiveness of ART, comprehensive HIV patient care, and interventions targeting hepatitis C virus coinfection. Future research should focus on managing cancer and cardiovascular-related conditions as the new leading causes of death among PWH. Comprehensive healthcare strategies focusing on non–AIDS-related comorbid conditions, cancer management, and sustaining liver and cardiovascular health are needed to bridge the ongoing health disparities between PWH and the general population. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has been called the deadliest disease event in history. In this study, we compared the cause-specific mortality rate of the Spanish flu (1918–1920) with that of COVID-19 (2020–2022) in the Netherlands. During the periods of exposure, about 50 000 people died of COVID-19 and 32 000 people of the Spanish flu. In absolute numbers, COVID-19 seems to be deadlier than Spanish flu. However, the crude mortality rates for COVID-19 and Spanish flu were 287 and 486 per 100 000 inhabitants, respectively. Comparing age-standardized mortality rates, there would have been 28 COVID-19– and 194 Spanish flu–related deaths in 1918–1920, or 214 Spanish flu– and 98 COVID-19–related deaths in 2020–2022 per 100 000 inhabitants per year. Thus, taking the population differences into account, the Spanish flu would have been deadlier than COVID-19. [ABSTRACT FROM AUTHOR]

Objective: To compare the prognostic differences between non-small cell lung cancer (NSCLC) patients with mild and severe checkpoint inhibitor-associated pneumonitis (CIP), and explore the causes of death and prognostic risk factors in NSCLC patients with severe CIP. Methods: A retrospective study of a cohort of 116 patients with unresectable stage III or IV NSCLC with any grade CIP from April 2016 to August 2022 were conducted. To analyze the clinical characteristics of patients with different CIP grades, patients were divided into mild CIP group (grade 1-2, n=49) and severe CIP group (grade 3-5, n=67) according to the grade of CIP. To explore the OSrelated risk factors in the severe CIP group, the patients were divided into a good prognosis (GP) group (≥ median OS, n=30) and a poor prognosis (PP) group (< median OS, n=37) based on whether their overall survival (OS) were greater than median OS. Baseline clinical and laboratory data were collected for analysis. Results: The median OS of all NSCLC patients combined with CIP was 11.4 months (95%CI, 8.070-16.100), The median OS for mild CIP and severe CIP was 22.1 months and 4.4 months respectively (HR=3.076, 95%CI, 1.904-4.970, P<0.0001). The results showed that the most common cause of death among severe CIP patients in the PP group was CIP and the most common cause in the GP group was tumor. The univariate regression analysis showed that suspension of antitumor therapy was a risk factor for poor prognosis (OR=3.598, 95%CI, 1.307-9.905, p=0.013). The multivariate logistic regression analysis showed that suspension of anti-tumor therapy (OR=4.24, 95%CI, 1.067-16.915, p=0.040) and elevated KL-6 (OR=1.002, 95%CI, 1.001-1.002, p<0.001) were independent risk factors for poor prognosis. Conclusion: In conclusion, patients with severe CIP had a poor prognosis, especially those with elevated KL-6, and the main cause of death is immune checkpoint inhibitor-associated pneumonitis complicated with infection. In addition, anti-tumor therapy for severe CIP patients should be resumed in time and should not be delayed for too long. [ABSTRACT FROM AUTHOR]

Background: Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study. Methods: 1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants. Results: 577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality). Conclusion: This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine whether the post-mortem computed tomography (PMCT) findings are able to correlate well with the cause of death on conventional autopsy. Materials and methods: From January 2008 until September 2016, total of 60 bodies underwent PMCT scans in the radiology department, followed by conventional autopsies conducted in the forensic department. The radiological findings were interpreted, which were then correlated with the cause of death based on conventional post-mortem autopsy and/or pathological diagnosis. Results: The PMCT findings correlated well with the conventional autopsies. In 28 cases (46.7%), the cause of death was diagnosable based on PMCT alone, in nine cases (15%) the cause was suggestive but required additional information, and in 23 cases (38.3%) the cause was not diagnosable based on PMCT alone. Diagnosable cases included those involving gunshot wounds, sharp and blunt injuries, and lung infections. Causes that could not be diagnosed through PMCT alone included acute myocardial infarction, burns, asphyxiation, drug intoxication and septicemia. Conclusion: PMCT proves to be a valuable and excellent tool for documenting and illustrating bone fractures, abnormal air and fluid accumulation compared to soft tissue injuries, which are better detected in autopsies. However, PMCT alone cannot replace conventional autopsy, which remain the gold standard for establishing the cause of death. Nevertheless, PMCT can serve as useful adjunct in forensic investigations. [ABSTRACT FROM AUTHOR]

During the last years, the detection of different causes of death based on postmortem imaging findings became more and more relevant. Especially postmortem computed tomography (PMCT) as a non-invasive, relatively cheap, and fast technique is progressively used as an important imaging tool for supporting autopsies. Additionally, previous works showed that deep learning applications yielded robust results for in vivo medical imaging interpretation. In this work, we propose a pipeline to identify fatal cerebral haemorrhage on three-dimensional PMCT data. We retrospectively selected 81 PMCT cases from the database of our institute, whereby 36 cases suffered from a fatal cerebral haemorrhage as confirmed by autopsy. The remaining 45 cases were considered as neurologically healthy. Based on these datasets, six machine learning classifiers (k-nearest neighbour, Gaussian naive Bayes, logistic regression, decision tree, linear discriminant analysis, and support vector machine) were executed and two deep learning models, namely a convolutional neural network (CNN) and a densely connected convolutional network (DenseNet), were trained. For all algorithms, 80% of the data was randomly selected for training and 20% for validation purposes and a five-fold cross-validation was executed. The best-performing classification algorithm for fatal cerebral haemorrhage was the artificial neural network CNN, which resulted in an accuracy of 0.94 for all folds. In the future, artificial neural network algorithms may be applied by forensic pathologists as a helpful computer-assisted diagnostics tool supporting PMCT-based evaluation of cause of death. [ABSTRACT FROM AUTHOR]

Background: Duchenne muscular dystrophy (DMD) is a neuromuscular disorder with progressive decline of pulmonary function increasing the risk of early mortality. The aim of this study was to explore the respiratory-related comorbidities, and the effect of these comorbidities and treatments on life expectancy and causes of death. Methods: All male patients living in Sweden with DMD, born and deceased 1970–2019, were included. Data regarding causes of death were collected from the Cause of Death Registry and cross-checked with the medical records along with diagnostics and relevant clinical features. Results: Hundred and twenty nine patients were included with a median lifespan of 24.3 years. Acute respiratory failure accounted for 63.3% of respiratory-related causes of death. 70.1% suffered at least one pneumonia, with first episode at a median age of 17.8 years. Hypoventilation was found in 73.0% with onset at 18.1 years. 60.5% had their first pneumonia before established hypoventilation. Age at onset of hypoventilation showed a strong correlation with age at first pneumonia. First pneumonia and scoliosis non-treated with scoliosis surgery increased the risk of dying of respiratory-related causes. In 10% of the patients, first pneumonia resulted in acute tracheostomy or early death. Patients treated with assisted ventilation had higher life expectancy compared to untreated patients. Conclusions: Our results highlight the importance of identifying subclinical hypoventilation in a timely manner and the importance of an active treatment regime upon clinical signs of pneumonia. [ABSTRACT FROM AUTHOR]

Background. The analysis, interpretation and storage of information is entrusted to the individual expert, who bases his judgments on the knowledge resulting from the experience. The aim of this experimental study is to analyse and introduce a new line of research applicable to forensic pathology, based on the use of artificial intelligence techniques as a possible tool for data collection and analysis. Methods. The sample analysed is represented by judicial autopsies performed at the University of Catanzaro from 01/01/2020 to 31/12/2021. For each case were performed: study of medical records; autopsy; histological examinations; toxicological analysis of blood samples. Continuous variables were presented as means ± standard deviations, and categorical variables were expressed as percentages. A random forest regression model was conducted, as a machine learning approach, to estimate the importance of individual solid organ weight variables in predicting cause of death. Conclusions. This study aimed to evaluate autopsy data to aid in the description and study of forensic cases, using a machine learning approach. To date, this study appears to be the first to evaluate the weight of organs in predicting a cause of death. Artificial intelligence techniques are an optimal solution in solving forensic dilemmas. The results of this study demonstrate that routine data can be submitted using machine learning techniques in order to identify key elements of procedures that provide more information in relation to the prediction of cause of death. [ABSTRACT FROM AUTHOR]

Simple Summary: Bird mortality resulting from collisions and electrocutions with overhead lines (such as power lines and phone lines) has contributed to the decline of various avian species globally. Specifically, overhead line collisions pose a significant threat to the conservation of the Canarian houbara bustard (Chlamydotis undulata fuertaventurae), an endangered subspecies endemic to the Canary Islands. This study focuses on postmortem findings from Canarian houbara bustards that collided with overhead lines. We describe the necropsy findings of Canarian houbara bustards found dead near overhead lines, and we investigated, using a forensic approach, whether the animal survived the initial trauma. The mortality of birds resulting from collisions and electrocutions with overhead lines, such as power lines and phone lines, among others, has been implicated in the decline of various avian species globally. Specifically, overhead line collisions pose a significant threat to the conservation of the Canarian houbara bustard (Chlamydotis undulata fuertaventurae), an endangered subspecies endemic to the Canary Islands. This study centers on the postmortem findings of Canarian houbara bustards that have collided with overhead lines, providing insights into the post-collision outcomes for these birds. A complete standardized necropsy of nine Canarian houbara bustards revealed that trauma was the cause of death in all cases. The most notable gross lesions associated with trauma included bone fractures, soft tissue lacerations, hemorrhages, luxations, and hemocoelom. The inguinal area, chest, and wings were the body regions more frequently affected. A histopathology, immunohistochemistry, and entomology analysis confirmed that numerous birds survived the initial trauma. We concluded that when a houbara bustard collides with an overhead line, it frequently survives the initial trauma, with a survival time ranging from minutes to hours. The histopathology, immunohistochemistry, or entomologic analysis may be helpful to approximate the timing interval between trauma and death. [ABSTRACT FROM AUTHOR]

Introduction: The present study is an epidemiological study of the fatal cases of COVID-19 positive by Reverse Transcriptase Polymerase Chain Reaction in a tertiary care centre in West Bengal. The trace, track and treat mode of investigation has helped in the control and timely intervention in the disease pathogenesis. Objective: to analyse the epidemiological characteristics of COVID-19 related deaths in tertiary centre in Eastern India and comprehended the pattern of deaths due to COVID-19. This will help in understanding the gaps between infection and deaths. Methods: It was a cross sectional analytical study. The Medical certification of cause of death was studied and data was tabulated. We collected deaths due to COVID-19 in a tertiary set up in Eastern India from March'2020 to September'2020. Results: A total of sixty-one deaths were studied. Among the deaths with COVID-19, mild type accounted for the most followed by the severe type. The median age was 65 years50% of the deaths were distributed in 60-80 years age group. Additionally, the male to female ratio was 3:1. % of patients had underlying comorbidities. It was noted more amongst males. Most of the underlying diseases were hypertension, Diabetes Mellitus, cardiovascular diseases. Conclusion: COVID-19 posed a greater threat to the elderly people and men with fatal consequences. [ABSTRACT FROM AUTHOR]

Background: Mortality statistics serve as a crucial component in community health planning systems. The causes of death can vary across different geographical areas due to factors such as indigenous culture and lifestyle. This study aimed to investigate the mortality trends and their causes from 2015 to 2019 in Hamedan province, located in the west of Iran.Methods: This cross-sectional study examined all deaths (43,515 individuals) in Hamedan province from 2015 to 2019. Death data, including demographics and the underlying cause of death, were extracted from the mortality system of the Hamedan Health Center. Data collection utilized a checklist corresponding to the International Death Certificate issued by the WHO. Data analysis was performed using SPSS ver. 26.Results: In 2019, the average monthly death rate was the highest compared to previous years (766.3±39.1), while this number for 2015 was 682.2±37.7. In 2019, U codes (for Emerging diseases) were used for Covid-19. The mean age of deceased females (73.3±18.2) was higher than that of deceased males (67.0±20.6), showing a significant difference (P

Objectives: Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020. Methods: Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020. Results: The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths. Conclusions: Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

Abstract Background Malaria contributes substantially to the persistent burden of child deaths in sub-Saharan Africa. Accurate and comprehensive malaria mortality data are crucial to monitor the progress in reducing malaria incidence and mortality. Verbal Autopsy (VA) ascertains the cause of death despite its limitations leading to misclassification errors. Minimally Invasive Tissue Sampling (MITS) is being conducted in some settings as an alternative to Complete Diagnostic Autopsy (CDA). The present study examines the validity of malaria-related deaths comparing VA diagnoses with those obtained through MITS and/or CDA. Methods A comprehensive literature search for original studies in English language using Ovid MEDLINE, Ovid Embase, CINAHL via EBSCO, Scopus, The Cochrane Library via Wiley, Google Scholar and searching the MITS Surveillance Alliance papers was carried out. The reference period was January 1, 1990–March 31, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted. Results Among 71 articles identified in the databases, 21 matched the eligibility criteria. Qualitative syntheses showed that malaria Cause Specific Mortality Fractions (CSMFs) across various studies ranged from 2 to 31%. Plasmodium falciparum was mostly responsible for these deaths and the most common complications were anaemia and cerebral malaria. The sensitivity and specificity of the VA validation studies ranged from 18.4% to 33% and from 86.6% to 97%, respectively, and there was a high level of misclassification for both InSilico and Expert Algorithm VA for malaria compared to MITS. The overall concordance rates between MITS and CDA diagnoses ranged from 68 to 90%, with the highest concordance seen in deaths due to infectious diseases and malignant tumours. Clinical data increased diagnostic coincidence between MITS blind to clinical data and the gold standard CDA by 11%. Conclusions The comprehensive review finds that MITS demonstrated better accuracy compared to VA in diagnosing malaria-attributed deaths, particularly in hospital settings. The high specificity of malaria in VA diagnosis suggests population-based estimates of the proportion of deaths due to malaria are broadly plausible.

Abstract Background Although 70% of Japanese individuals wish to die at home, the in-hospital death rate in Japan is 71%. The in-hospital death rate is more than 80% in dialysis patients, most of whom are hemodialysis patients. Few reports exist on the relationship between place and cause of death in peritoneal dialysis (PD) patients. Methods We conducted a retrospective study of PD patients who died between January 2008 and June 2022 at three facilities. Results Ninety-four patients died, 71% in hospital, 25% at home, and 4% in elderly care facilities. The in-hospital death rates were 67%, 74%, and 71% (P = 0.90) in the three facilities. Of the 67 in-hospital deaths, infection was the most common cause of death (30%), followed by sudden cardiac death (SCD) (15%), senility/cachexia (15%), heart failure (12%), and malignancy (9%). In the out-of-hospital deaths, there were no cases of infection, and SCD accounted for the majority (59%), followed by senility/cachexia (11%), heart failure (7%), stroke (4%), and malignancy (4%). Limiting to SCD, patients who died outside the hospital were significantly younger and had a higher prevalence of ischemic heart disease than those who died in hospital. Conclusions The in-hospital death rate for PD patients was lower than that previously reported for dialysis patients and similar to that of the Japanese population. Based on the place and cause of death in PD patients, to further increase the death rate at home, which many PD patients would have preferred, it may be necessary to prevent infectious diseases, strengthen interventions for patients at high risk of SCD, and shift to home care for patients with senility/cachexia and malignancies.

Abstract Background Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study. Methods 1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants. Results 577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality). Conclusion This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.

This study investigated the relationship between the cause of death stated on a post-mortem (medical) examination report and the subsequent cause of death given in a finding by a legal or judicial coroner (non-medical). A review of causes of death provided by forensic pathologists in their reports found the majority of cases (89%) were given in the traditional death certificate format, but were transformed to a sentence format in just over two thirds of coronial findings (68.5%). There was no evidence that converting the format of the cause of death statements caused a delay in finalizing the case. Of note, the post-mortem examination report provided an indefinite cause of death in 3.8% of cases and around a quarter (25.3%) of these were converted to a definite cause of death in the coronial finding (for example, by removing the word 'probable'). Where the post-mortem examination did not determine a cause of death (5.2% of cases), most remained undetermined in the coronial finding. It is suggested that pathologists could work with coroners to ensure the cause of death provided on post-mortem examination reports are in the preferred style for their jurisdiction. [ABSTRACT FROM AUTHOR]

Abstract Background Comprehending the toxic effects of substances co-detected in bodily fluids presents a formidable challenge. The combined toxic effect of carbon monoxide and methamphetamine remains a rarely discussed issue within the realm of scholarly literature. The main objective of this research is to delve into the potential intricacies of death mechanisms, unraveling the profound impact of both CO and methamphetamine on the heart. Case presentation The cause and mechanism of death of a young man with toxic levels of CO–Hb and low-dose methamphetamine in his bloodstream were discussed in conjunction with the literature in this study. Methamphetamine levels of 30 ng/mL (0.03 mg/L) and 25.8% CO–Hb were detected in the blood of a 25-year-old individual who was found dead and without any disease. Conclusions Although the amounts of methamphetamine and CO–Hb in the blood were not in the deadly range, it was determined that death occurred as a result of the combined action of these substances. In the present case, it was considered that death occurred as a result due to the combined cardiac effect of methamphetamine and CO, before the lethal blood CO level was reached.

Abstract Background Although one’s socioeconomic status affects health outcomes, limited research explored how South Korea’s National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality. Methods Based on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002–2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality. Results The SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10–1.15] for men and 1.18 [1.15–1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types. Conclusion This nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level. Trial registration This study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975).

Abstract Background Existing knowledge on healthcare use and costs in the last months of life is often limited to one patient group (i.e., cancer patients) and one level of healthcare (i.e., secondary care). Consequently, decision-makers lack knowledge in order to make informed decisions about the allocation of healthcare resources for all patients. Our aim is to elaborate the understanding of resource use and costs in the last six months of life by describing healthcare use and costs for all causes of death and by all levels of formal care. Method Using five national registers, we gained access to patient-level data for all individuals who died in Norway between 2009 and 2013. We described healthcare use and costs for all levels of formal care—namely primary, secondary, and home- and community-based care —in the last six months of life, both in total and differentiated across three time periods (6-4 months, 3-2 months, and 1-month before death). Our analysis covers all causes of death categorized in ten ICD-10 categories. Results During their last six months of life, individuals used an average of healthcare resources equivalent to €46,000, ranging from €32,000 (Injuries) to €64,000 (Diseases of the nervous system and sense organs). In terms of care level, 63% of healthcare resources were used in home- and community-based care (i.e., in-home nursing, practical assistance, or nursing home care), 35% in secondary care (mostly hospital care), and 2% in primary care (i.e., general practitioners). The amount and level of care varied by cause of death and by time to death. The proportion of home- and community-based care which individuals received during their last six months of life varied from 38% for cancer patients to 92% for individuals dying with mental diseases. The shorter the time to death, the more resources were needed: nearly 40% of all end-of-life healthcare costs were expended in the last month of life across all causes of death. The composition of care also differed depending on age. Individuals aged 80 years and older used more home- and community-based care (77%) than individuals dying at younger ages (40%) and less secondary care (old: 21% versus young: 57%). Conclusions Our analysis provides valuable evidence on how much healthcare individuals receive in their last six months of life and the associated costs, broken down by level of care and cause of death. Healthcare use and costs varied considerably by cause of death, but were generally higher the closer a person was to death. Our findings enable decision-makers to make more informed resource-allocation decisions and healthcare planners to better anticipate future healthcare needs.

Abstract Background Common marmosets (Callithrix jacchus) are widely used as primate experimental models in biomedical research. Duodenal dilation with chronic vomiting in captive common marmosets is a recently described life-threatening syndrome that is problematic for health control. However, the pathogenesis and cause of death are not fully understood. Case presentation We report two novel necropsy cases in which captive common marmosets were histopathologically diagnosed with gastric emphysema (GE) and pneumatosis intestinalis (PI). Marmoset duodenal dilation syndrome was confirmed in each case by clinical observation of chronic vomiting and by gross necropsy findings showing a dilated, gas-filled and fluid-filled descending duodenum that adhered to the ascending colon. A diagnosis of GE and PI was made on the basis of the bubble-like morphology of the gastric and intestinal mucosa, with histological examination revealing numerous vacuoles diffused throughout the lamina propria mucosae and submucosa. Immunostaining for prospero homeobox 1 and CD31 distinguished gas cysts from blood and lymph vessels. The presence of hepatic portal venous gas in case 1 and possible secondary bacteremia-related septic shock in case 2 were suggested to be acute life-threatening abdominal processes resulting from gastric emphysema and pneumatosis intestinalis. Conclusions In both cases, the gross and histopathological findings of gas cysts in the GI tract walls matched the features of human GE and PI. These findings contribute to clarifying the cause of death in captive marmosets that have died of gastrointestinal diseases.

Introduction: Death due to Road Traffic Accidents (RTA) is one of the leading causes of mortality and morbidity in a developing country like India. As there is a paucity of literature on the nature and type of injuries in RTAs in the locality of Upper Assam, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted to address the magnitude of the problem. Aim: To analyse different types of skull fractures and causes of death among two-wheeler RTAs at tertiary care Hospital in Northeast India. Materials and Methods: The present cross-sectional study was conducted in the mortuary of Assam Medical College, Dibrugarh, Assam, India, for a period of one year from August 2020 to July 2021. The records of all RTA cases involving two-wheeler motorcycles brought for postmortem examination during this period were studied for parameters including age, gender distribution, cause of death, type of skull fracture, intracranial haemorrhage, and time of occurrence, and analysed using descriptive statistics. R esults: There were 532 fatal RTA cases recorded, out of which 292 involved two-wheelers (54.89%). Males (87.67%) outnumbered females (12.33%). The most affected age group was between 21-30 years with a total of 98 cases (33.56%), followed by 31-40 years with 68 cases (23.29%). Skull fracture was present in 103 cases (35.27%). Fissured fracture was the most common type seen in 64 cases (62.14%) followed by depressed fracture in 19 (18.45%). The most common single bone fracture was of the Temporal bone in 44 cases (42.72%), followed by frontal bone in 18 (17.48%). Coma was the most common cause of death, seen in 214 cases (73.29%), followed by haemorrhagic shock in 42 (14.38%). Subdural Haemorrhage (SDH) alone was the most common intracranial haemorrhage found in 159 cases (74.30%), followed by Extradural Haemorrhage (EDH) alone in 7 cases (3.27%). C onclusion: Injuries to the skull and brain are the leading cause of death in RTAs. Adequate measures should be taken to prevent mortality and morbidity, achievable through strict enforcement of road safety measures, awareness among the people, and improving road infrastructure along with emergency medical services.

Background: Although one's socioeconomic status affects health outcomes, limited research explored how South Korea's National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality. Methods: Based on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002–2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality. Results: The SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10–1.15] for men and 1.18 [1.15–1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types. Conclusion: This nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level. Trial registration: This study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975). [ABSTRACT FROM AUTHOR]

Background: Common marmosets (Callithrix jacchus) are widely used as primate experimental models in biomedical research. Duodenal dilation with chronic vomiting in captive common marmosets is a recently described life-threatening syndrome that is problematic for health control. However, the pathogenesis and cause of death are not fully understood. Case presentation: We report two novel necropsy cases in which captive common marmosets were histopathologically diagnosed with gastric emphysema (GE) and pneumatosis intestinalis (PI). Marmoset duodenal dilation syndrome was confirmed in each case by clinical observation of chronic vomiting and by gross necropsy findings showing a dilated, gas-filled and fluid-filled descending duodenum that adhered to the ascending colon. A diagnosis of GE and PI was made on the basis of the bubble-like morphology of the gastric and intestinal mucosa, with histological examination revealing numerous vacuoles diffused throughout the lamina propria mucosae and submucosa. Immunostaining for prospero homeobox 1 and CD31 distinguished gas cysts from blood and lymph vessels. The presence of hepatic portal venous gas in case 1 and possible secondary bacteremia-related septic shock in case 2 were suggested to be acute life-threatening abdominal processes resulting from gastric emphysema and pneumatosis intestinalis. Conclusions: In both cases, the gross and histopathological findings of gas cysts in the GI tract walls matched the features of human GE and PI. These findings contribute to clarifying the cause of death in captive marmosets that have died of gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

Background: Comprehending the toxic effects of substances co-detected in bodily fluids presents a formidable challenge. The combined toxic effect of carbon monoxide and methamphetamine remains a rarely discussed issue within the realm of scholarly literature. The main objective of this research is to delve into the potential intricacies of death mechanisms, unraveling the profound impact of both CO and methamphetamine on the heart. Case presentation: The cause and mechanism of death of a young man with toxic levels of CO–Hb and low-dose methamphetamine in his bloodstream were discussed in conjunction with the literature in this study. Methamphetamine levels of 30 ng/mL (0.03 mg/L) and 25.8% CO–Hb were detected in the blood of a 25-year-old individual who was found dead and without any disease. Conclusions: Although the amounts of methamphetamine and CO–Hb in the blood were not in the deadly range, it was determined that death occurred as a result of the combined action of these substances. In the present case, it was considered that death occurred as a result due to the combined cardiac effect of methamphetamine and CO, before the lethal blood CO level was reached. [ABSTRACT FROM AUTHOR]

Gastric volvulus is a rare cause of gastric obstruction, due to the rotation of the stomach by more than 180°. It is a rare but life-threatening medical emergency that is considered difficult to diagnose at the initial clinical presentation. Forensic pathologists may be presented with gastric volvulus in several ways, for instance, as a cause of sudden and unexpected death or in the context of suspected clinical errors. The post-mortem examination of gastric volvulus may be challenging, due to the specific technical issues it presents and the various mechanisms by which volvulus may cause death. We therefore present five cases of gastric volvulus that in combination represent almost the entire spectrum of presentations and post-mortem findings, to discuss how gastric volvulus may come to the attention of a forensic pathologist, the approach and findings at post-mortem examination (including post-mortem CT), and the variety of mechanisms by which gastric volvulus may result in death. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate changes over time in cause of death and making end-of-life decisions in preterm infants. Methods: A follow-back survey was conducted of all preterm infants who died between September 2016 and December 2017 in Flanders and Brussels, Belgium. Cause of death was obtained from the death certificate and information on end-of-life decisions (ELDs) through an anonymous questionnaire of the certifying physician. Results were compared with a previous study performed between August 1999 and July 2000. Results: In the cohort 1999-2000 and 2016-2017, respectively, 150 and 135 deaths were included. A significantly higher proportion of infants born before 26 weeks of gestation was found in the 2016-2017 cohort (53% vs. 24% in 1999-2000, p < 0.001). Extreme immaturity (<26 weeks) remained the most prevalent cause with a significant increase in the 2016-2017 cohort (48% vs. 28% in 1999-2000, p < 0.001). The overall prevalence of ELDs was similar across study periods (61%). Non-treatment decisions remained the most common ELD (36% and 37%). Conclusion: Infants born at the limits of viability have become more prevalent among infant deaths, possibly due to a change in attitude towards periviable births. Neither the process of making ELDs nor the cause of death has changed over time. [ABSTRACT FROM AUTHOR]

The studies of thymic structure were performed predominantly in cohorts of younger individuals. Here, we established a cohort of body donors whose age at the time of death ranged from 57 to 103 to study the relationship between thymic structure and factors that, in the younger subjects, have shown to affect the organ's anatomy, including the presence of the organ's capsule, its weight, size of the left and right lobes, and a transverse diameter. We explored the relationships between these thymic parameters and the subjects' age, sex, and cause of death (COD), asking how the thymus in the elderly differed from the organ's macro-anatomy in a broader and younger human population, and whether age, sex, COD, and BMI could influence the thymic parameters in the elderly. Our analyses revealed that the thymic size but not thymic weight in the KYCOM cohort differed significantly from the younger individuals. The size of the thymus in males progressively decreased, but in females, the size of the right lobe increased. The encapsulated thymus was detected with a higher frequency in females than males. We found no associations between thymic parameters and the person's COD, age, or sex. However, the person's BMI was associated with thymic weight, suggesting that obesity may influence the aging of the immune system. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is an important public health problem worldwide, accounting for an estimated 6–20% of total mortality. A significant proportion of SCD is caused by inherited heart disease, especially among the young. An autopsy is crucial to establish a diagnosis of inherited heart disease, allowing for subsequent identification of family members who require cardiac evaluation. Autopsy of cases of unexplained sudden death in the young is recommended by both the European Society of Cardiology and the American Heart Association. Overall autopsy rates, however, have been declining in many countries across the globe, and there is a lack of skilled trained pathologists able to carry out full autopsies. Recent studies show that not all cases of sudden death in the young are autopsied, likely due to financial, administrative, and organizational limitations as well as awareness among police, legal authorities, and physicians. Consequently, diagnoses of inherited heart disease are likely missed, along with the opportunity for treatment and prevention among surviving relatives. This article reviews the evidence for the role of autopsy in sudden death, how the cardiologist should interpret the autopsy-record, and how this can be integrated and implemented in clinical practice. Finally, we identify areas for future research along with potential for healthcare reform aimed at increasing autopsy awareness and ultimately reducing mortality from SCD. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Intensive Care Unit (PICU) represents a specialized healthcare setting dedicated to providing critical care for infants, children, and adolescents facing severe and lifethreatening medical conditions. The rate of pediatric mortality in the Pediatric Intensive Care Unit (PICU) varies worldwide, reflecting the diverse healthcare landscapes and socioeconomic factors influencing pediatric critical care outcomes. The objective of this study was to describe the pattern of admission and outcome of patients who received intensive care. The objective of this study was to describe the pattern of admission and outcome of patients who received intensive care. Patients and methods: A retrospective study in which records of admissions (from 1st of January 2019 to 31 December 2023) were obtained from the PICU patient's file in Al Zahraa Teaching, Najaf, Iraq. Data used from the records included age, sex, residency, address, source of admission, diagnosis, duration of stay in the unit, need for intubation and mechanical ventilation, and patient outcome. Results: A total number of 1501 patients were admitted to the PICU during the study period. The patients were referred mainly from the Emergency Room 47% followed by the neonatal intensive care unit 21%. The case fatality rate was 54.1%. the main cause of death was RDS, sepsis, meningitis, and congenital heart diseases (29.2, 8.5, 6.6, and 6.6% respectively). 47.9% of PICU deaths occurred in patients admitted from the ER followed by NICU 24.2%. (P value 0.043, OR 1.082, 95% CI 1.002-1.168). The mean age of dead PICU patients was 15.697±32.79 months versus 23.301±39.91 months for discharged outcome (P value 0.000). Hospital stay length mean for PICU dead patients was 5.1±3.8 days versus 6.173±3.8 days for discharged patients (P value 0.000). That means the smaller age patients carry a higher risk of death in PICU, also the situation with fewer hospital stays days. Conclusions: This study showed the case fatality rate was high (54.7%.). The most common causes of admission and death were RDS (22.7% and 29.2% respectively). The highest percentage of death occurs in the infant age group (78.1%). Neither gender nor residency represents a risk factor for PICU patient's death but endotracheal intubation does. The fewer days of hospital stay carry a higher risk factor for death. [ABSTRACT FROM AUTHOR]

Background: Childhood cancer survivors are at increased risk of late mortality (death =5 years after diagnosis) from cancer recurrence and treatment-related late effects. The authors conducted a systematic review and meta-analysis to provide comprehensive estimates of late mortality risk among survivors internationally and to investigate differences in risk across world regions. Methods: Health sciences databases were searched for cohort studies comprised of 5-year childhood cancer survivors in which the risk of mortality was evaluated across multiple cancer types. Eligible studies assessed all-cause mortality risk in survivors relative to the general population using the standardized mortality ratio (SMR). The absolute excess risk (AER) was assessed as a secondary measure to examine excess deaths. Cause-specific mortality risk was also assessed, if reported. SMRs from nonoverlapping cohorts were combined in subgroup meta-analysis, and the effect of world region was tested in univariate meta-regression. Results: Nineteen studies were included, and cohort sizes ranged from 314 to 77,423 survivors. Throughout survivorship, SMRs for all-cause mortality generally declined, whereas AERs increased after 15-20 years from diagnosis in several cohorts. All-cause SMRs were significantly lower overall in North American studies than in European studies (relative SMR, 0.63; 95% confidence interval, 0.49-0.80). SMRs for subsequent malignant neoplasms and for cardiovascular, respiratory, and external causes did not vary significantly between world regions. Conclusions: The current findings suggest that late mortality risk may differ significantly between world regions, but these conclusions are based on a limited number of studies with considerable heterogeneity. Reasons for regional differences remain unclear but may be better elucidated through future analyses of individual-level data. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study examines maternal mortality among Brazilian indigenous women from 2015 to 2021, contrasting their causes of death with non‐indigenous women.An observational study utilizing Ministry of Health data analyzed maternal deaths' characteristics, comparing indigenous and non‐indigenous groups based on death certificates and live‐birth records. Variables included age, region, location, time, and cause of death. Maternal mortality ratios (MMR) were calculated with linear regression and outliers identified with Grubbs test. Prevalence ratios compared MMR and causes of death.Between 2015 to 2021, Brazil recorded 13 023 maternal deaths. Among these, with 205 among indigenous women (1.60% of total). Indigenous women had higher MMR (115.14/100 000), than non‐ indigenous women (66.92/100 000), consistently across years. Hemorrhagic causes notably contributed to the indigenous women's elevated MMR.Indigenous Brazilian women face elevated maternal mortality rates across all causes, primarily due to hemorrhage, contrasting wih national trends. [ABSTRACT FROM AUTHOR]

The current study focused on the associations between the cause of a loved one's death, mourner's emotional distress, mourner's ongoing relationship with the deceased, and posttraumatic growth (PTG). The sample comprised 91 Israeli mourners following death due to traffic accident, military service, or prolonged illness. Participants completed questionnaires assessing psychological distress, ongoing relationship with the deceased, and PTG. Findings showed that in traffic-accident deaths, mourners reported higher psychological distress and preoccupation with the deceased compared to that reported by the other mourner groups. Moreover, psychological distress mediated the association between the cause of death and PTG. The findings emphasize the differences between the mourner groups. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction(AMI) is one of the most common causes of sudden cardiac death, but the accurate AMI identification biomarkers are still lacking. Recently, lipidomics shed new light on the exploration of AMI biomarkers. In this study, lipid molecules were examined in rat myocardial tissue based on Liquid chromatography-tandem mass spectrometry (LC-MS/MS) lipidomics to screen for metabolic markers for the identification of AMI. Results showed that 70 lipid molecules with different expressions identified by distinguishing between the sham group and the AMI 5 min group, 275 differentially expressed lipid molecules identified by distinguishing between the sham group and the AMI 4 hour group. And 257 differentially expressed lipid molecules identified by distinguishing between the AMI 5 min group and the AMI 4 hour group. Comprehensive analysis shows that PC (18:0_18:1)+HCOO and PC (16:0_18:2)+HCOO exhibited more significant changes. Two lipid molecules were applied to build AMI-identification models, the accuracy rate reached 77.8% and R2 = 0.539. [ABSTRACT FROM AUTHOR]