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 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 less then 0.201). A literature review is also presented.
  Diagnosis of the underlying cause of sudden unexpected death in a previously healthy individual remains one of the important challenges in forensic practice. Ischemic heart disease is the most common cause of sudden death. The current study aims to investigate the incidence and pathology of sudden ischemic cardiac death in Egypt. All cases of sudden cardiac death (SCD) examined by different forensic departments throughout Egypt during the period of January 2010 through December 2014 were included. Cases underwent complete autopsy examination including a thorough gross and microscopic examination of the heart and great blood vessels. Of 535 cases of SCD diagnosed during the period of the study, coronary atherosclerosis was the principle finding in 420 (78.5%) cases. The highest numbers of deaths were reported in fifth and sixth decades with male preference. Other causes of SCD included myocarditis, cardiomyopathies, valvular heart disease, and hypertensive heart disease (7.8%, 4.1%, 4.1%, and 2.8%, respectivsion, ischemic heart disease is the leading cause of SCD in Egypt.
  The Accreditation Council for Graduate Medical Education Milestones offer a framework for competency-based assessment of forensic pathology fellows. The initial forensic pathology-specific milestones (Milestones 1.0) were developed in 2014. Although a great foundation, this first iteration of the milestones was somewhat convoluted and exhibited areas of discrepancy. A Forensic Pathology Milestone 2.0 Working Group of 12 volunteers, with various levels of forensic pathology expertise representing a broad array of institutions across the United States, sought to reduce milestone complexity and modify the cross-specialty "harmonized" milestones to ensure they fit within the context of forensic pathology training. The group also created a supplemental guide to provide additional clarification for each milestone. Overall, 5 specialty-specific subcompetencies were drafted, and the language in the 14 harmonized subcompetencies was adjusted to reflect the unique population of patients and multidisciplinary medicolety and modify the cross-specialty "harmonized" milestones to ensure they fit within the context of forensic pathology training. The group also created a supplemental guide to provide additional clarification for each milestone. Overall, 5 specialty-specific subcompetencies were drafted, and the language in the 14 harmonized subcompetencies was adjusted to reflect the unique population of patients and multidisciplinary medicolegal systems inherent to forensic pathology. Once the initial development was complete, the Milestones 2.0 draft was made available for review by the greater forensic pathology community, with the aim of creating a shared mental model for forensic pathology education and the trajectory of the field. Additional changes were made based on the survey results and Milestones 2.0 will be implemented during the 2021-2022 academic year.
  Immediate medical device adverse event (MDAE) reporting indications of Korea include death, life-threatening, hospitalization (initial or prolonged), disability or permanent damage, and congenital malformation or abnormalities. With the advent of new codes from the International Medical Device Regulators Forum, a study was undertaken to explore the applicability of health impact codes as immediate MDAE reporting indications in the Republic of Korea.
 
  This domestic cross-sectional survey study was conducted for members from Medical Device Safety Information Monitoring Center in November 2019. For the annex F (health impact) codes defining health impact of an MDAE, we checked whether each code matched with the current indication and asked experts whether they agreed with each code as an indication of immediate reporting. Consensus was reached when ≥70% of experts agreed.
 
  A total of 28 experts from 19 centers responded to the survey. Of a total of 64 codes, 29 matched with the current indication. However, in an expert survey, 17 of 29 codes were not agreed for immediate reporting and 5 codes were found to be unmatched codes. For these 5 codes, experts agreed that they would need reporting immediately. Finally, only 17 codes achieved consensus for immediate reporting.
 
  There is a discrepancy between the code matched to the current immediate MDAE reporting indication and experts' consensus.  https://www.selleckchem.com/products/selonsertib-gs-4997.html  Sufficient discussion and agreement would be needed to apply health impact codes for immediate reporting.
 There is a discrepancy between the code matched to the current immediate MDAE reporting indication and experts' consensus. Sufficient discussion and agreement would be needed to apply health impact codes for immediate reporting.
  Both social and medical factors can negatively affect health outcomes, especially in vulnerable populations. To address these 2 types of factors in a postdischarge population, 2 nonprofit organizations collaborated to combine their novel decision support programs and address the question Could combined programs have greater potential for improved health outcomes?
 
  HomeMeds, a social health program in which trained social services staff make home visits to vulnerable clients, was combined with MedSafety Scan, a medical health, clinical decision support tool. Data captured in the home visits were entered into the HomeMeds and MedSafety Scan programs to detect those patients at the greatest risk of adverse health outcomes because of medications.
 
  Patients (n = 108; mean age, 77 years; multiple comorbidities and LACE+ (length of stay, acuity, comorbidities, emergency department visits [hospital index]; score >29) received a postdischarge home visit by trained social services staff. The number of drugs reported as being taken was 10.