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ABSTRACT: Since January 2023, a series of fatalities has occurred in the Cook County Jail. Upon reviewing surveillance videos, in some cases, the inmates shared paper strips, and it was followed by the onset of labored breathing and loss of consciousness. Scene investigation revealed burnt paper strips near the body in 3 cases. No trauma was observed during autopsy. The expanded toxicology panels did not detect any illegal drugs in the postmortem blood samples. However, additional analysis specifically targeting synthetic cannabinoids revealed the presence of MDMB-4en-PINACA [methyl 3,3-dimethyl-2-{[1-(pent-4-en-1-yl)-1H-indazole-3-carbonyl]amino}butanoate], a synthetic cannabinoid associated with a wide range of adverse effects, including cardiovascular complications such as tachycardia and hypertension, respiratory depression, and acute kidney injury. There is limited research on the lethality of MDMB-4en-PINACA. This case series suggests that even isolated use can potentially lead to death. This study aims to raise public awareness regarding MDMB-4en-PINACA, highlighting its unpredictable effects and potential for severe adverse reactions, and to facilitate the development of effective prevention and harm reduction strategies. Implementing screening methods in correctional facilities is crucial to prevent the circulation of potentially fatal substances.
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One of the rare complications of low-grade pancreatic neoplasms is fistulization into nearby structures. This often does not present clinically, but is incidentally identified in patients who have been imaged serially to monitor the progression of the disease. In this report, we present an uncommon complication of an intraductal papillary mucinous neoplasm, which developed a spontaneous gastropancreatic fistula in a patient who was conservatively managed. The clinical course, imaging features, and management of this case are discussed.
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Successful ecdysis in insects depends on proper timing and sequential activation of an elaborate series of motor programs driven by a relatively conserved network of neuropeptides. The behaviors must be activated at the appropriate times to ensure successful loosening and shedding of the old cuticle, and can be influenced by environmental cues in the form of immediate sensory feedback and by circadian rhythms. We assessed the behaviors, components of the neural network and the circadian basis of ecdysis in the stick insect, Carausius morosus. C. morosus showed many of the characteristic pre-ecdysis and ecdysis behaviors previously described in crickets and locusts. Ecdysis was described in three phases, namely the (i) preparatory or pre-ecdysis phase, (ii) the ecdysial phase, and (iii) the post-ecdysis or exuvial phase. The frequencies of push-ups and sways during the preparatory phase were quantified as well as durations of all the phases. The regulation of ecdysis appeared to act via elevation of cGMP, as described in many other insects, although eclosion hormone-like immunoreactivity was not noted using a lepidopteran antiserum. Finally, C. morosus showed a circadian rhythm to the onset of ecdysis, with ecdysis occurring just prior to or at lights on. Ecdysis could be induced precociously with mechanical stimulation.