Commode Cardia-Death by Valsalva Maneuver: A Case Series.

The Valsalva maneuver is used in clinical medicine for the diagnosis and/or treatment of various cardiovascular conditions. It can also be used in activities of daily living, such as defecation. Due to the cardiovascular effects produced during the Valsalva maneuver, it may be contraindicated in certain medical conditions and could be a trigger of sudden cardiac death. The incidence and prevalence of death following Valsalva maneuver in the presence of underlying cardiovascular disease, or "commode cardia," has not been examined. In 2012, the Wayne County Medical Examiner's Office (Detroit, MI) investigated 21 deaths that occurred on the toilet, fourteen of which were due to cardiovascular disease. In another 31 deaths in the bathroom due to cardiovascular disease, the possibility that the decedent defecated immediately prior to death could not be excluded. Hence, the incidence of commode cardia in this population ranges from 2.3 to 7.4% of all cardiovascular-related deaths.

Methylenedioxypyrovalerone ("bath salts"), related death: case report and review of the literature.

Cathinone derivatives (bath salts) have emerged as the latest drugs of abuse. 3,4-methylenedioxypyrovalerone (MDPV) is the primary active ingredient in bath salts used in this country. This article presents the second reported cause of death by MDPV intoxication alone. In April 2011, a delusional man was emergently brought to a hospital, where he self-reported bath salt usage. He became agitated, developed ventricular tachycardia, hyperthermia, and died. Comprehensive alcohol and drug testing was performed. Using the alkaline drug screen, heart blood contained 0.7 mg/L MDPV and peripheral blood contained 1.0 mg/L MDPV. His bizarre behavior with life-threatening hyperthermia was consistent with an MDPV-induced excited delirium state. MDPV is not yet found by routine immunoassay toxicology screens. Testing for MDPV should be considered in cases with a history of polysubstance abuse with stimulant type drugs, report of acute onset of psychogenic symptoms, excited delirium syndrome, or presentation in a hyperthermic state.

Hierarchical linear modeling of California Verbal Learning Test--Children's Version learning curve characteristics following childhood traumatic head injury.

California Verbal Learning Test-Children's Version (CVLT-C) indices have been shown to be sensitive to the neurocognitive effects of traumatic brain injury (TBI). The effects of TBI on the learning process were examined with a growth curve analysis of CVLT-C raw scores across the 5 learning trials. The sample with history of TBI comprised 86 children, ages 6-16 years, at a mean of 10.0 (SD=19.5) months postinjury; 37.2% had severe injury, 27.9% moderate, and 34.9% mild. The best-fit model for verbal learning was with a quadratic function. Greater TBI severity was associated with lower rate of acquisition and more gradual deceleration in the rate of acquisition. Intelligence test index scores, previously shown to be sensitive to severity of TBI, were positively correlated with rate of acquisition. Results provide evidence that the CVLT-C learning slope is not a simple linear function and further support for specific effects of TBI on verbal learning.