Agonal Thrombi at Autopsy.

Clots and thrombi identified at autopsy are generally classified dichotomously as antemortem or postmortem. Current articles and textbooks support this approach. Earlier literature often contained descriptions of a third category, the agonal thrombus that forms while the patient is dying. We collected 238 autopsy cases including 80 rapid/sudden deaths by violence and 21 (including 1 pediatric) deaths from acute pulmonary emboli. We analyzed the gross and microscopic features of clots and thrombi. Agonal thrombi were identified in 122 cases (89% of cases of "slow" death). Agonal thrombi were not identified in cases of sudden death. We found that a comprehensive description of the macroscopic features was a key to interpretation. The gross and microscopic features of agonal thrombi "chicken fat" support their hybrid nature. The dichotomous classification of clots and thrombi seems to be founded on assumptions of clinical significance but is perhaps oversimplified. Agonal thrombi area distinct class of thrombus that, although not clinically significant as an immediate cause of death, arises by its own mechanisms and has its own morphology. It is advisable to avoid classifying agonal thrombi as mere postmortem clots because in forensic cases, they may help support an argument against sudden death.

Death Due to Caffeine and Methamphetamine Toxicity: A Case Report.

Caffeine (1,3,7-trimethylxanthine) is an over-the-counter psychostimulant that, when used in appropriate amounts, is generally considered safe. However, excessive use can cause various symptoms and, in severe cases, can even be life-threatening. A 34-year-old man with a reported history of psychiatric disorders was found unresponsive at his girlfriend's house and transported to an emergency department. He was presumed to have taken several caffeine pills and was pronounced dead approximately six hours later. There was no evidence of trauma or natural diseases at autopsy. Toxicology testing on hospital blood samples revealed toxic levels of caffeine and methamphetamine. After investigation of the circumstances surrounding the death and accounting for the autopsy and toxicology findings, the cause and manner of death were certified as combined caffeine and methamphetamine toxicity and accident, respectively. Lethal levels of caffeine have been reported when blood concentration exceeds 80 mg/L. Caution is needed to avoid excessive caffeine intake, especially when consumed in concentrated forms like tablets or powders. Caffeine should be used with care not only in cases of cardiovascular disease or genetic vulnerability but also for those with psychiatric disorders. Although deaths from caffeine are rare, they are consistently reported, necessitating attention and caution in its use.

Bayesian modeling of follow-up studies with missing data.

PURPOSE: The purpose of this study is to illustrate the impact of ignoring missing data in follow-up studies and to provide a hierarchical Bayesian approach to simultaneously estimate rates and missing data probabilities. METHODS: To account for missing data in follow up studies, a hierarchical Bayesian procedure is proposed and investigated via simulation. RESULTS: A simulation study demonstrates the impact of ignoring missing data on inferences in terms of bias and in ranking populations in terms of risk. An example of rates of disabilities for various German construction worker professions also illustrates the usefulness of the method. CONCLUSIONS: Use of a hierarchical Bayesian approach allows for flexible modeling of rates and data availability.