Argyrophilic grain disease is common in older adults and may be a risk factor for suicide:a study of Japanese forensic autopsy cases

Background Neuropathological diagnosis of argyrophilic grain disease(AGD)is currently based primarily on the combination of argyrophilic grain(AG)visualized using Gallyas-Braak silver staining,phosphorylated tau-positive pretangles,coiled bodies,and ballooned neuron detection.Although AGD is common in patients with dementia and/or prominent psychiatric symptoms,whether it is a distinct neurological disease entity or a by-product of the aging process remains unclear.Methods In 1449 serial forensic autopsy cases>40 years old(823 males and 525 females,aged 40-101 years,mean age 70.0±14.1 years),we examined the frequency and comorbid pathology of AGD cases and investigated the clini-cal appearance by comparing those with non-AGD cases using the propensity score.Results Of the 1449 cases,we detected 342 AGD cases(23.6%;mean age 79.7 years;177 males and 165 females).The AGD frequency and stage increased with age(P<0.001).Among AGD cases,80(23.4%)patients had dementia,and 51(15.2%)had a history of psychiatric hospital visits.The frequency of suicide and history of psychiatric disorders were significantly higher in AGD cases than in AGD-negative cases,matched for age,sex,and comorbidity pathol-ogy,with a relative risk of suicide of 1.72(1.30-2.26).The frequency of suicide was significantly higher in AGD cases than in non-AGD cases in female but not male cases.The relative risk of suicide increased to 2.27(1.20-4.30)and 6.50(1.58-26.76)in AGD patients with Lewy and progressive supranuclear palsy pathology,respectively,and decreased to 0.88(0.38-2.10)in those with advanced AD pathology.In AGD cases,23.4%had dementia;however,the difference was not significant after controlling for age,sex,and comorbid pathology.Conclusion Our study demonstrated that AGD is a significant and isolated risk factor for psychiatric hospital visits and suicide completion.In older adults,AGs may contribute to the progression of functional impairment of the limbic system,which leads to psychiatric disorders and suicide attempts.

Two Forensic Autopsy Cases of Liposarcoma

Primary liposarcoma outside thighs is rare.We present two forensic autopsy cases of clinically undiagnosed primary liposarcoma(Case 1:Mediastinum,Case 2:Mesentery).Case 1 was a thin male in his 60s who had a well‑differentiated liposarcoma(850 g,23 cm×20 cm×10 cm)in the superior mediastinum.Case 2 was a thin female in her 50s who had a pleomorphic liposarcoma(10 kg,40 cm×25 cm×11 cm)in the abdominal cavity with liver metastases.The cause of death in Case 1 was airway obstruction due to liposarcoma of the neck;that in Case 2 was complications of liposarcoma with metastasis.Because liposarcoma often appears in deeper tissue without pain,it will grow quite large before it is noticed.

Deaths Due to Electrocution:An Evaluation of Death Scene Investigations and Autopsy Findings

The purpose of the study was to delineate the epidemiological characteristics of electrocution deaths in Maryland,identify any potential risks,and address preventive measures.A retrospective review of all the deaths due to electrocution was conducted at the Office of the Chief Medical Examiner in the State of Maryland from 2005 to 2015.During the 11-year period,a total of 55 electrocution deaths were identified from the autopsy cases at the statewide medical examiner system.More males died of electrocution than females with its ratio of(M:F)=9:l.Of the 55 cases,67.3%were White,18.2%were African-American,12.7%were Hispanic,and 1.8%were other races.The age of the victims ranged from 4 to 83 years with mean age of 40 years.>96%deaths due to accidents and 3.4%were suicide.The majority of deaths(70.9%)were caused by high-voltage circuits.Approximately 64%of fatalities were work-related accidents.The study indicated that electrocution deaths frequently affected young male workers who were in contact with a high-voltage currents while on the job.The detailed death scene investiRation and autopsy findings are presented.The potential hazards of electricity must continue to be addressed in public safety campaigns to prevent such deaths.Strategies should ensure safe work environments for any contact with electric currents.

An Autopsy Case of Suspected Anti‑N‑Methyl‑D‑Aspartate Receptor Encephalitis

N-methyl-D-aspartate receptor(NMDAR)encephalitis is a rare type of autoimmune limbic encephalitis.Herein,we report an autopsy case of highly suspected anti‑NMDAR encephalitis,based on the patient’s past psychiatric history and autopsy findings of bilateral hippocampal sclerosis and ovarian teratoma.We found that it can be difficult to accurately diagnose autoimmune encephalitis at postmortem forensic autopsy without a case history and background information.

The Impact of COVID-19 on Adolescent Suicide Deaths in the State of Maryland

On March 11, 2020, the World Health Organization officially declared the SARS-CoV-2 virus (COVID-19) a worldwide pandemic. As of December 2021, there have been over 278 million cases and 5.4 million deaths reported. One area of concern regarding the pandemic was its potential impact on mental health, and it was feared that the onset of such a devastating pandemic would lead to increased suicide risks among the general population. With suicide being a leading cause of death in adolescents, it is important to assess the potential mental health consequences that the COVID-19 pandemic may impose. Aim: The aim of the study was to analyze the impact of COVID-19 on suicide deaths among adolescents in the state of Maryland from 2019 to 2021. Subjects and Methods: This was a retrospective study of adolescent suicide victims, aged 10-19 years, from January 2019 to December 2021 in the state of Maryland. De-identified data were collected from the statewide medical examiner’s office which is responsible for the medicolegal death investigation in Maryland. Results: A total of 102 adolescent suicide deaths were investigated statewide by the Maryland Office of the Chief Medical Examiner during these 3 years. The number of adolescent suicide cases stayed relatively stable during the COVID-19 pandemic, with slightly more cases during the pre-COVID-19 pandemic period (2019: n = 37;2020: n = 31;and 2022: n = 34). Looking at months of incidence, less cases were reported in March-May 2020 (n = 5), which marks the beginning of the pandemic when compared to the same period in 2019 (n = 13). The number was higher for August-November 2020 (n = 15) than for that of 2019 (n = 8) and 2021 (n = 8). The male-to-female suicide ratio was 3.7:1 (n = 80/22). However, the data exhibited a significant increase in the number of female adolescent suicides, from 8.11% in 2019 (n = 3) to 25.81% in 2020 (n = 8) and 32.35% in 2021 (n = 11). Of the cases examined, more than 50% were white and approximately 27% were African-Americans. The two leading causes of death were hanging (47%) and firearm injuries (29%). Maryland consists of 23 countries and Baltimore City. The majority of adolescent suicides occurred in county residents with only 8.8% of cases in Baltimore City.

Characteristics of Suicides Caused by Drug Overdose in the State of Maryland

Suicidal drug overdose is a major public health issue.In the United States,every year more than 33,000 people commit suicides.Our study focused on the characteristics of suicide victims in the state of Maryland.Material and methods:This study was a retrospective review of autopsy cases of all suicide deaths caused by drug(s)or drug(s)with alcohol intoxication investigated by the OCME in Maryland over a 7-year period from January 2004 to December 2011.All deaths investigated by the OCME that require autopsy examination are subject to comprehensive toxicology testing for drugs and alcohol.The screen tests were performed using gas chromatography(GC)and radioimmunoassay techniques.All detected drugs and/or metabolites were confirmed using GC-mass spectrometry(GC-MS).Results:From 2004 to 2011,434 deaths were certified as suicide.Of the 434 suicidal overdose deaths,84%were white,11%were African-American,and about 5%were either Hispanic or Asian.The male and female ratio was almost equal.Their ages ranged 15-82 years.Of the 434 suicidal drug overdose deaths,277 victims(63.8%)consumed a single drug type and 157(36.2%)consumed more than one type of drug.Of the 277 single-drug overdose cases,71.1%suicides were due to prescription drugs,23.5%due to over-the-counter drugs,and 5.4%due to street/recreational drugs.Among single-type prescription drugs,analgesic(N=76),antidepressant(N=45),and neuroleptic(N=35)classes were the three leading type of drugs used in suicidal deaths.Oxycodone,morphine,quetiapine,and amitriptyline were the most common prescription drugs in suicidal overdose.Diphenhydramine was the leading over-the-counter drug.Of the 157 victims who consumed more than one drug,combined prescription drugs were present in 54.1%,mixed prescription and overthe-counter drugs in 29.3%,and prescription drugs/over-the-counter drugs and street drugs in 16.6%of cases.Of the multiple-drug overdose suicides,66.2%cases involved antidepressants.Discussion:Suicide is found in every age,racial,and ethnic group.In the USA,poisoning is thethird-leading method of suicide,following firearm injuries and hanging/strangulation.Our study indicates that prescription drugs,such as those in the opioid analgesic,neuroleptic,and antidepressant class(e.g.,oxycodone,morphine,quetiapine,amitriptyline,doxepin,and citalopram),are of special concern in the context of suicidal overdose deaths in the state of Maryland.Therefore,addressing the problems of intentional drug overdose in our society is worthy of public attention.