Fat embolism syndrome associated with atraumatic compartment syndrome of the bilateral upper extremities: An unreported etiology

Fat embolism syndrome (FES) is a potentially life-threatening condition that develops when fat embolism leads to clinical symptoms and multisystem dysfunction. The classic triad of respiratory distress, neurologic symptoms, and petechial rash are non-specific, and the lack of specific laboratory tests makes the diagnosis of FES difficult. Although FES is most common after long bone fractures, multiple conditions some of which are atraumatic have been associated with the development of FES. We report a case of FES that occurred in the setting of a non-traumatic compartment syndrome of the upper extremities. The pathologic and clinical findings, pathophysiology, diagnostic challenges, and pathologic methods to properly diagnose FES are discussed with a review of the relevant literature. This case highlights the importance of the autopsy in making a diagnosis of FES in cases where death could otherwise be incorrectly attributed to multi-organ system failure, shock, or sepsis.     

A case of fatal overdose involving both hydromorphone and kratom

Kratom is a plant originating in Southeast Asia that has been used for its dose-dependent stimulant and opioid effects. The main active compound in kratom is mitragynine, an alkaloid with affinity for the mu-opioid receptor. Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44-year-old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with >4 L of ascites. Toxicology testing was performed on femoral blood which showed 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.     

Clinical Challenges in Addressing Intimate Partner Violence (IPV) with Pregnant and Parenting Adolescents

Intimate partner violence (IPV) has been identified as a significant issue for pregnant and parenting adolescents. This study thematically analyzed data from focus groups with service providers (n?=?43) who work with pregnant and parenting adolescents to learn about barriers and strategies for addressing IPV. Service providers described four primary barriers to addressing IPV with their adolescent clients: adolescent clients?? definitions of love, intergenerational relationship patterns, cultural norms about gender and violence, and developmental-contextual considerations. Service providers also indicated that they respond to adolescents?? IPV related concerns by taking steps to identify IPV, building working relationships, and taking appropriate follow-up action. Results suggest that providers can benefit from increased training and skill development in working with IPV, as well as working in interdisciplinary, collaborative teams to increase effectiveness with challenging cases. Programs should consider integrating IPV prevention initiatives that target broader social norms. Future research should pilot and test the effectiveness of targeted IPV training and programmatic interventions with service providers who work with this population.