Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity.

ABSTRACT: The incidence of suicide by intentional nitrite ingestion has increased since 2017. Limited options exist for commercial laboratory analysis for nitrite/nitrate. This study investigates the use of urine dipsticks for screening at autopsy for potential toxicity with sodium nitrite and, less commonly, alkyl nitrite. Archived samples of blood, urine, vitreous fluid, and gastric contents from 4 sodium nitrite/nitrate cases, 3 alkyl nitrite cases, and 4 control cases were tested using dipsticks. A rapid, strong positive result for nitrite was in the vitreous fluid of all 4-sodium nitrite/nitrate cases, along with 2 positive urine and 1 positive gastric. The 2 alkyl nitrite inhalation toxicity cases had no positive results. One alkyl nitrite ingestion case had a positive urine. The 4 controls had negative urine: equivocal results in 2 vitreous, and 1 positive gastric. Urine dipsticks are a useful adjunct to laboratory testing for nitrite toxicity and provide a rapid, cost-effective tableside result that may guide the need for further testing. Vitreous fluid and urine appear to be the most reliable specimens, although testing of gastric liquid may be useful to corroborate oral ingestion. Dipsticks may not be a reliable adjunct for testing for alkyl nitrite toxicity via inhalation route, likely due to the much lower nitrite concentration compared to nitrite ingestion cases.

Neck Hemorrhage: Fact or Artifact?-A Retrospective Analysis of Patterns of Postmortem Anterior Neck Muscle Hemorrhages From Hypostasis Versus Strangulation.

ABSTRACT: Distinguishing artifactual postmortem hypostatic hemorrhages from injury is key to accurately diagnosing strangulation. Despite being a well-known phenomenon, the literature is limited. This retrospective case-control analysis characterizes anterior neck musculature hemorrhage patterns associated with postmortem artifact versus strangulation by comparing incidental neck hemorrhages noted on 20 autopsy reports from 2020 to 2021 to 10 strangulation controls from 2015 to 2021 in Northern Nevada. Cases were analyzed for body position and location/severity of musculature involvement. For artifact cases, 50.0% were prone, 40.0% supine, and 10.0% side-lying. A total of 55.6% of artifact cases and controls demonstrated neck hemorrhage laterality. A total of 80.0% of the prone cases versus 77.8% of supine had diffuse hemorrhage versus focal. A total of 63.2% of artifact cases involved the sternocleidomastoid versus 70.0% controls (P = 1.000), 26.3% involved soft tissues versus 20.0% (P = 1.000), 9.1% the sternohyoid versus 40.0% (P = 0.149), 27.3% the sternothyroid versus 60.0% (P = 0.198), 9.1% the thyrohyoid versus 10.0% (P = 1.000), 18.2% the omohyoid versus 30.0% (P = 0.635), and 10.0% the tongue versus 50.0% (P = 0.026). Despite the limitations, this study demonstrated that while prone positioning is a contributing factor to the development of anterior neck hemorrhages, there are other factors than postmortem hypostasis.

From Kiyoshi Shiga to Present-Day Shigella Vaccines: A Historical Narrative Review.

We are at an exciting moment in time with the advancement of many vaccines, including a shigella vaccine for the world. It is instructive to look at the long road that some vaccines have traveled to recognize the remarkable accomplishments of those who were pioneers, appreciate the evolution of scientific and applied technology, and inform the future history of a vaccine that would have great potential for global health. To achieve this valuable retrospective, a narrative historical literature review was undertaken utilizing PubMed and Embase databases with relevant search terms. Retrieved articles were reviewed and information was organized into historical themes, landmark discoveries, and important vaccine development parallels. The literature reviewed was synthesized into major eras of shigella vaccine development from pathogen discovery and first attempts to empirical approaches of killed whole-cell and live-attenuated approaches, and a modern era that applied recombinant DNA engineering and structural vaccinology. The history of shigella vaccine development has largely followed the evolutionary path of vaccine development over the last 120 years, but with important lessons learned that should be considered as we embark on the future chapters of bringing to the world a safe and effective vaccine for global health.

Kratom-Associated Fatalities in Northern Nevada-What Mitragynine Level Is Fatal?

ABSTRACT: Mitragyna speciosa, commonly known as the kratom tree, has been utilized in Southeast Asia for centuries for its opioid-like effects. Kratom has been available in the United States for the past decade and has grown increasingly popular despite a lack of clinical research to determine its safety. With its widespread use, there have been an increasing number of fatalities. This study aims to establish a potential lethal range for mitragynine, the active compound in kratom, by investigating the toxicology reports of 35 deaths in Northern Nevada between 2015 and 2020. Mitragynine concentrations ranged from 8.7 to 1800 ng/mL (n = 27) in cases with drug toxicity as the cause of death; in 1 case, the sole intoxicant was mitragynine with a blood concentration of 950 ng/mL. In cases with nonmitragynine causes of death, the concentration was 110 to 980 ng/mL (n = 8). There was no statistically significant difference in blood concentrations between cases where mitragynine was not listed as a cause of death (mean, 315 ± 297.2 ng/mL) and cases in which mitragynine contributed to death (mean, 269.4 ± 382.5 ng/mL; P < 0.201). A literature review is also presented.