Objective To describe the case fatality rate of SARS in Beijing. Methods Data of SARS cases notified from Beijing Center for Disease Control and Prevention (BCDC) and supplemented by other channels were collected. The data were analyzed by rate calculation. Results The case fatality rate of SARS in Beijing was 7.66%, and had an ascending trend while the age of cases was getting older, and a descending trend while the epidemic development. The case fatality rate in Beijing was lower than that in other main epidemic countries or regions. Conclusions The risk of death increases with the increment of age of SARS patients. Beijing is successful in controlling and treating SARS.
Tom, S; Galbraith, J C; Valiquette, L;
Lethal outcomes can be expressed as a case fatality ratio (CFR) or as a mortality rate per 100 000 population per year (MR). Population surveillance for community-onset methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus bacteraemia was conducted in Canada, Austral......-onset S. aureus bacteraemia, particularly MSSA, is associated with major disease burden. This study highlights complementary information provided by evaluating both CFR and MR.......Lethal outcomes can be expressed as a case fatality ratio (CFR) or as a mortality rate per 100 000 population per year (MR). Population surveillance for community-onset methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus bacteraemia was conducted in Canada, Australia...
Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae
Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages.......Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....
Gbary, Akpa Raphaël; Sossou, Roch Aristide; Dossou, Jean-Paul; Mongbo, Virginie; Massougbodji, Achille
The 2008 cholera outbreak in Benin was characterized by a low case fatality rate (0.39 p.100) in the Littoral department, where 502 cases were recorded between July and December. The aim of this study was to identify the key factors associated with the low case fatality rate within the department. The cross-sectional, descriptive and analytical study conducted as part of this research used 404 patient records, focus group discussions with ten former patients, in-depth interviews with 8 health authorities involved in the response and structured face-to-face interviews with 12 health personnel involved in the treatment of patients. The data were analyzed using qualitative and quantitative content analysis based on EPIINFO 3.3.2 and EXCEL 2007 software. The results from several sources were cross-checked through triangulation. The mean age of patients was 23.72 ± 14.8 years. 39.35% patients were admitted with severe dehydration. Oral rehydration, intravenous rehydration and antibiotic therapy were given to 99.5%, 85% and 97.77% of patients, respectively. Only one hospital death was noted. The low case fatality rate was mainly due to the following factors: the high quality of care provided in a center with qualified personnel and available and free of charge treatment kits, protocols based on massive rehydration and appropriate hygiene measures, and patient compliance with the treatment plan. The response was also characterized by good coordination, wide mass and local health promotion, and selective antibiotic prophylaxis, which contributed significantly to reducing the spread of the infection. PMID:22177702
Benjamin F Johnson
Full Text Available BACKGROUND: In the northern hemisphere winter of 2003-04 antigenic variant strains (A/Fujian/411/02 -like of influenza A H3N2 emerged. Circulation of these strains in the UK was accompanied by an unusually high number of laboratory confirmed influenza associated fatalities in children. This study was carried out to better understand risk factors associated with fatal cases of influenza in children. METHODOLOGY/PRINCIPAL FINDINGS: Case histories, autopsy reports and death registration certificates for seventeen fatal cases of laboratory confirmed influenza in children were analyzed. None had a recognized pre-existing risk factor for severe influenza and none had been vaccinated. Three cases had evidence of significant bacterial co-infection. Influenza strains recovered from fatal cases were antigenically similar to those circulating in the community. A comparison of protective antibody titres in age stratified cohort sera taken before and after winter 2003-04 showed that young children had the highest attack rate during this season (21% difference, 95% confidence interval from 0.09 to 0.33, p = 0.0009. Clinical incidences of influenza-like illness (ILI in young age groups were shown to be highest only in the years when novel antigenic drift variants emerged. CONCLUSIONS/SIGNIFICANCE: This work presents a rare insight into fatal influenza H3N2 in healthy children. It confirms that circulating seasonal influenza A H3N2 strains can cause severe disease and death in children in the apparent absence of associated bacterial infection or predisposing risk factors. This adds to the body of evidence demonstrating the burden of severe illness due to seasonal influenza A in childhood.
Lopes Antonio Alberto
Full Text Available The main objective was to compare the in-hospital case-fatality rate of leptospirosis between pediatric (19 years patients, taking into account gender, renal function, duration of symptoms and jaundice. Medical records of 1016 patients were reviewed. Comparative analysis was restricted to 840 patients (100 pediatric, 740 adults with recorded information on the variables included in the analysis. Among these patients 81.7% were male and 91.5% were icteric. The case-fatality rate of leptospirosis was 14.4%. The odds of death adjusted for gender, jaundice, duration of symptoms, serum urea and serum creatinine were almost four times higher for the adult than for the pediatric group (odds ratio (OR = 3.94; 95% confidence interval = 1.19-13.03, p = 0.029. Among adults, increased age was also significantly and independently associated with increased risk of death (p < 0.01. Older patients were also more often treated by dialysis. In conclusion, the data suggest that the in-hospital case fatality rate of leptospirosis is higher for adults than for children and adolescents, even after taking into account the effects of several potential risk factors of death. Among adults, older age was also strongly and independently associated with higher risk of death.
Grant, William B.; Giovannucci, Edward
Deaths during the 1918–1919 influenza pandemic have been linked to both the influenza virus and secondary bacterial lung infections. Case fatality rates and percentage of influenza cases complicated by pneumonia were available from survey data for twelve United States locations in the 1918–1919 pandemic. This study analyzes case fatality rates and cases complicated by pneumonia with respect to estimated summertime and wintertime solar ultraviolet-B (UVB) doses as indicators of population mean...
Pandey, Deb P; Vohra, Rais; Stalcup, Philip; Shrestha, Bhola R
Snakebite envenomation affects thousands of people annually in Nepal. Published hospital-based studies of snakebite treatment in Nepal are scarce. Here we present the results of the first prospective, cross-sectional study of hospitalized envenomed snakebite cases in southcentral Nepal, a region characterized by poor pre-hospital care of snakebites, limited supply and excessive use of antivenom, and a high case/fatality ratio. We seek to identify clinical management problems and suggest potential interventions to improve treatment of snakebites. Out of the 342 patients presented with snakebites to an urban emergency department in the Terai region of Nepal between April and September of 2007, 39 patients were enrolled based on development of ptosis or swelling of bitten body parts. We collected patient demographic information and documented circumstances of snakebite, prehospital care, hospital care, and development of complications. Among 39 envenomated patients admitted to Bharatpur Hospital enrolled in the study 34 (92%) exhibited features of clinically significant neurotoxicity and were treated with antivenom. Antivenom use ranged from 4 to 98 vials of Polyspecific Indian Antivenom per patient. Each of victims (n=34) received antivenom an average of 4.3 (median) ±0.73 (standard error of mean) hours after receiving the snakebite. The overall case fatality rate was 21%. Neurotoxicity developed up to 25.8hr after suspected elapid snakebites. This was not observed for viperid snake bites. No enrolled patients received any of the currently recommended first aid for snake bite. The prevalence of nocturnal elapid snake bites, the practice of inappropriate first aid measures and highly variable administration of antivenom were identified as major challenges to appropriate care in this study. To address these issues we suggest development of a comprehensive checklist for identification of snake species, management of envenomation, and an educational program which
Pui Hing Chau; Jean Woo; Goggins, William B; Moses Wong; Kam Che Chan; Ho, Suzanne C.
Geographical variations in stroke incidence and case-fatality have been documented worldwide. This study examines whether there are spatio-temporal variations in stroke incidence and case-fatality in Hong Kong and attempts to determine to what extent socioeconomic status (SES) and healthcare provision account for these variations. Residence-based hospital discharge data from the Hospital Authority (HA) in Hong Kong were geo-referenced and used to examine incidence rates and case-fatality rate...
Full Text Available Abstract Background In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs, are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1 to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2 to identify starting points for quality improvement. Methods Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287 included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. Results We identified problems regarding both the CFR's numerator and denominator. Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (ORadj 23.0; 95% CI [20.9;25.2], and five-year age groups ORadj 1.23; 95
Full Text Available Perthes syndrome, or traumatic asphyxia, is a clinical syndrome associating cervicofacial cyanosis with cutaneous petechial haemorrhages and subconjonctival bleeding resulting from severe sudden compressive chest trauma. Deep inspiration and a Valsalva maneuver just prior to rapid and severe chest compression, are responsible for the development of this syndrome. Current treatment is symptomatic: urgent relief of chest compression and cardiopulmonary resuscitation if needed. Outcome may be satisfactory depending on the duration and severity of compression. Prolonged thoracic compression may sometimes lead to cerebral anoxia, irreversible neurologic damage and death. We report a fatal case of Perthes syndrome resulting from an industrial accident.
Proença, Paula; Teixeira, Helena; Castanheira, Fernando; Pinheiro, João; Monsanto, Paula V.; Marques, Estela P.; Vieira, Duarte Nuno
Imidacloprid [1-(6-chloro-3pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine] is a new and potent nitromethylene insecticide with high insecticidal activity at very low application rates. It is the first highly effective insecticide that, like nicotine, acts on the nervous system, causing blockage of postsynaptic nicotinergic acetylcholine receptors. Two fatal cases with this insecticide in two male individuals, of 33 and 66 years old, are presented.
Blanc, P D; Kearney, T E; Olson, K.R.
We assessed fatal drug overdose and poisoning case surveillance by a regional poison control center, comparing it with medical examiner determinations of death by poisoning over the same 2-year period and from the same catchment area. We studied 358 fatal cases of poisoning or drug overdose reported by a medical examiner and 10 fatal cases of poisoning or drug overdose reported by a poison control center, analyzing demographics and other case-associated factors with with possible successful p...
Venara, A; Mauillon, D; Gaudin, A; Rouge-Maillart, C; Jousset, N
Though rare occurrences, fatal falls from bicycles are generally linked to the absence of a protective helmet and/or a collision with another vehicle. The case presented here is exceptional due to its circumstances and the consequences of the accident: a fall with no obstacle at a low speed that brought about multiple traumas and the death of a cyclist wearing a protective helmet. Comparing this against a review of cyclist accidentology literature, this case is unique. The increased use of autopsy in terms of forensic accidentology is to be encouraged so as not to misunderstand the possibility of such lesion-based consequences following a simple fall from a bicycle. PMID:23312586
Duband, Sébastien; Bidat, Carolyne; Gaillard, Yvan; Rochet, Max; Camdessanche, Jean-Philippe; Péoc'h, Michel
Ropinirole, a specific non-ergoline dopamine D2-receptor agonist, belongs to the drugs applied in treatment of Parkinson's disease (PD) and restless legs syndrome (RLS) and acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D3. Therapeutic ropinirole plasma levels in adults are defined between 0.4 and 6 ng/mL. This case report documents a fatal intoxication involving ropinirole. Information about lethal ropinirole concentrations is hitherto lacking in the literature and the assessed ropinirole levels of this case may present a step towards defining potentially lethal concentrations. A 37-year-old man without medical history was found dead in a converted van used as place of residence and an autopsy was performed. The pathological findings did not reveal an apparent cause of death but the toxicological analysis revealed the presence of ropinirole, paracetamol, and alcohol in the peripheral blood sample. Quantitative analysis revealed that ropinirole was present at a peripheral blood concentration of 64 ng/mL. The ropinirole concentrations determined in vitreous humor, urine and bile were respectively, 11 ng/mL, 2670 ng/mL and 826 ng/mL. Paracetamol was detected at a blood level of intoxication with ropinirole in combination with alcohol. PMID:22920767
Vallet, Sophie; Legrand-Quillien, Marie-Christine; Dailland, Thomas; Podeur, Gaëtan; Gouriou, Stéphanie; Schuffenecker, Isabelle; Payan, Christopher; Marcorelles, Pascale
A fatal case of enterovirus 71 infection with pulmonary edema and rhombencephalitis occurred in Brest, France, in April 2007. The virus was identified as subgenogroup C2. This highly neurotropic enterovirus merits specific surveillance outside the Asia-Pacific region.
Floyd, A.K.; Pedersen, L; Nielsen, GL;
Secular Trends in Incidence and 30-Day Case Fatality of Acute Pancreatitis in North Jutland County, Denmark: A Register-based Study from 1981-2000 A. Floyd, L. Pederson, G. Lauge Nielsen, O. Thorlacius-Ussing and H. T. Sorensen Background: The incidence rate of acute pancreatitis has been...... reported as having increased during recent decades in Western countries. Reported mortality lies around 10% and has improved during the past 20 years. The incidence rate and 30-day case fatality rate of acute pancreatitis in North Jutland County, Denmark were examined for the period 1981 to 2000. Methods......: Data were collected from the Hospital Discharge Registry of North Jutland County for the period 1981-2000. Sex- and age-standardized incidence rates and 30-day case fatality rate of a first attack of acute pancreatitis were calculated. Data on endoscopic procedures were assessed for the period 1992 to...
Manigandan G; Peranantham S; Shanmugam K
Electric accidents cause serious injuries by direct heat exposure or by igniting clothes. The severity varies between simple harmless shocks to death. Many at times the victims are thrown to ground from the electric poles sustaining fatal non electric injuries. In this article two cases of high voltage electrocution are reported and discussed. In the first case the victim sustained injuries due to arcing of current. In the second case, there were multiple exit wounds in both legs...
Lupo, Julien; Morel-Baccard, Christine; Michard-Lenoir, Anne-Pascale; Germi, Raphaële; Pothier, Pierre; Ambert-Balay, Katia; Morand, Patrice
We report a fatal case of acute gastroenteritis in a child with autism spectrum disorder. Multiple viral coinfections were detected by PCR in the patient's stool and digestive biopsy specimens. As viral detection is not necessarily associated with symptomatic disease, a semi-quantitative approach using cycle treshold values was proposed for the clinical interpretation of PCR. We discuss whether concomitant viral infections could be a risk factor for severe outcome in gastroenteritis cases. Individual risk factors are also addressed. PMID:26655270
Patil, Mahantesh; C, Shivaprasad; Varghese, Jaicob; Rajagopalan, Natarajan
Pulmonary nocardiosis is a serious, most often considered an opportunistic infection affecting the respiratory tract. Even though it is more common in immunocompromised hosts, it is not infrequently seen in immunocompetent patients as well. The aerosol route is the main portal of entry in to the body. Molecular techniques have revolutionised the identification of Nocardia species. However such tests are limited to referral laboratories. The radiographic appearances of Nocardia infection vary from a small nodule to bilateral infiltrates with cavitation. Traditionally sulphonamides have been considered the treatment of choice. However, resistance to sulphonamides is increasingly recognised. Carbapenems and linezolid have been found to be uniformly active against all the pathogenic species of Nocardia that affect human beings. The authors report a case of pulmonary nocardiosis in an immunocompetent patient, in whom the infection relentlessly progressed to florid sepsis despite prompt institution of right antibiotics. Florid sepsis relating to pulmonary nocardiosis is rare. PMID:22665550
Full Text Available Abstract Introduction Ranitidine hydrochloride (Zantac®, a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature. Case presentation We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac® 50 mg prescribed as a routine post-surgical prophylaxis for stress ulcer. Conclusion Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients.
Adesh D. Mishra
Full Text Available Ciprofloxacin is a very commonly used antibiotic. Mild to moderate gastrointestinal side effects commonly reported whereas serious reactions such as Steven and ndash;Johnson syndrome and toxic epidermal necrolysis (TEN are very rare. We report the fatal case of 25 years female who had TEN after ingestion of tablet ciprofloxacin. This case report highlights the need to be critically aware of this rare, but life-threatening side effect of this commonly prescribed antibiotic. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1090-1092
Full Text Available Abstract Background Severe acute respiratory syndrome (SARS has claimed 349 lives with 5,327 probable cases reported in mainland China since November 2002. SARS case fatality has varied across geographical areas, which might be partially explained by air pollution level. Methods Publicly accessible data on SARS morbidity and mortality were utilized in the data analysis. Air pollution was evaluated by air pollution index (API derived from the concentrations of particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ground-level ozone. Ecologic analysis was conducted to explore the association and correlation between air pollution and SARS case fatality via model fitting. Partially ecologic studies were performed to assess the effects of long-term and short-term exposures on the risk of dying from SARS. Results Ecologic analysis conducted among 5 regions with 100 or more SARS cases showed that case fatality rate increased with the increment of API (case fatality = - 0.063 + 0.001 * API. Partially ecologic study based on short-term exposure demonstrated that SARS patients from regions with moderate APIs had an 84% increased risk of dying from SARS compared to those from regions with low APIs (RR = 1.84, 95% CI: 1.41–2.40. Similarly, SARS patients from regions with high APIs were twice as likely to die from SARS compared to those from regions with low APIs. (RR = 2.18, 95% CI: 1.31–3.65. Partially ecologic analysis based on long-term exposure to ambient air pollution showed the similar association. Conclusion Our studies demonstrated a positive association between air pollution and SARS case fatality in Chinese population by utilizing publicly accessible data on SARS statistics and air pollution indices. Although ecologic fallacy and uncontrolled confounding effect might have biased the results, the possibility of a detrimental effect of air pollution on the prognosis of SARS patients deserves further investigation.
Munire Erman Akar
Full Text Available We describe a rare case of fatal disseminated tuberculous peritonitis in a young woman with rapid progressive clinical course following spontaneous abortion of 20-week gestation. Clinical and laboratory findings were initially unremarkable. She underwent diagnostic laparoscopy which revealed numerous tiny implants on the peritoneum and viscera. Histopathology showed chronic caseating granulomas, and the tissue culture grew Mycobacterium tuberculosis. At fifth day of the antituberculous treatment multiorgan failure occurred in terms of pulmonary, hepatic, and renal insufficiency. She developed refractory metabolic acidosis with coagulopathy and pancytopenia, and she died of acute respiratory distress syndrome and septic shock on her twelfth day of hospitalization.
Full Text Available Abstract Background Histologically documented cases of parvoviral myocarditis are exceedingly rare. Case presentation Here, we report a 41-year old African American immunocompetent patient who died of parvoviral myocarditis after a 10 day illness characterized by fever, headaches, generalized arthralgias, and a maculopapular rash. Autopsy revealed an infiltrate myocarditis composed primarily of T-lymphocytes and macrophages associated with extensive myocardial fibrosis. The diagnosis of parvovirus was determined by polymerase chain reaction (PCR on both pre-mortem serum and post-mortem myocardial tissue Methods DNA was extracted from tissue and serum and primers were used to amplify DNAsequences of parvovirus B19 using nested polymerase chain reaction (PCR. Conclusion The diagnosis of parvovirus should be considered in cases of fatal myocarditis, and diagnosis can be confirmed at autopsy by molecular techniques.
Packer Clifford D
Full Text Available Abstract Introduction Metformin is a widely prescribed biguanide antidiabetic drug that has been implicated as a cause of hemolytic anemia in three previous case reports. We report a case of rapidly fatal hemolysis that was temporally associated with the initiation of metformin treatment for diabetes. Clinicians need to be aware of this rare but potentially serious side effect of metformin. Case presentation A 56-year-old Caucasian man with type 2 diabetes mellitus was started on metformin to improve glycemic control. Shortly afterwards, he developed progressive fatigue, exertional dyspnea, cranberry-colored urine and jaundice. Laboratory studies showed severe hemolysis, with a drop in hemoglobin from 14.7 to 6.6 g/dl over 4 days, markedly elevated lactate dehydrogenase, bilirubin and reticulocyte counts, and a low haptoglobin level. A peripheral blood smear showed no schistocytes, and a direct Coombs test was positive for anti-IgG and negative for anti-C3. Despite corticosteroid treatment and transfusion of packed red blood cells, the patient developed increasing dyspnea, hypotension, further decline in hemoglobin to 3.3 g/dl, and fatal cardiorespiratory arrest 12 hours after admission. Conclusion The serologic findings in this case suggest an autoimmune hemolytic anemia, caused either by a drug-induced autoantibody or a warm autoantibody. Based on the temporal association with metformin and the lack of other clear precipitating causes, we propose that metformin-induced hemolysis with a drug-induced autoantibody is a strong possibility. This mechanism differs from a previously described case with a possible antibody to the erythrocyte-drug complex. It has been shown, however, that hemolysis may occur via multiple mechanisms from the same drug. Clinicians should consider the possibility of metformin-associated immune hemolytic anemia in patients with otherwise unexplained hemolysis.
Motaleb, Hesham Y Abdel; Mohamed, Mostafa S.; Mobarak, Fahmy A
Rhino-orbito-cerebral mucormycosis is an uncommon aggressive life-threatening opportunistic fungal infection that affects mainly the immunocompromised population with mortality rate up to 50%. Due to its aggressive nature, early detection and prompt management are of great importance for a good prognosis. Our report describes a fatal outcome of a case of rhino-orbito-cerebral mucormycosis following tooth extraction in an uncontrolled non-insulin-dependent diabetes mellitus patient after 14 da...
Nazer, Lama; Alnajjar, Taghreed; Salah, Samer; Khzouz, Jakub; Alfaqeer, Nour; Qandeel, Monther
Noninfectious pneumonitis (NIP) has been reported with everolimus; however, the majority of the reported cases were mild to moderate. We report a fatal case of cryptogenic organizing pneumonia (COP) in a 61-year-old man. About 4 weeks after starting everolimus, the patient was admitted to the hospital with complaints of a 1-week history of progressive dyspnea with exertion and cough. The chest radiograph showed bilateral multifocal dense opacities, and he was started on antibiotics. However, his respiratory status deteriorated, and he was subsequently intubated and transferred to the intensive care unit. Chest computed tomography showed bronchocentric consolidation associated with widespread bilateral fine reticular opacification. Video-assisted thoracoscopic lung biopsy showed noncaseating granulomatous inflammation and features of COP. All cultures were negative for bacterial, viral, and fungal infections. Despite discontinuing everolimus and initiating corticosteroids, the patient died of progressive respiratory failure secondary to COP. PMID:25827702
Full Text Available OBJECTIVES: To identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore. METHODS: Multi-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with fatal cases. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF, warning signs and severe dengue. Statistical significance was assessed by conditional logistic regression modeling. RESULTS: Significantly more fatal cases than matched controls had pre-existing co-morbid conditions, and presented with abdominal pain/tenderness. Median pulse rates were significantly higher while myalgia was significantly less frequent in cases. . Fatal cases also had higher leucocyte counts, platelet counts, serum sodium, potassium, urea, creatine and bilirubin levels on admission compared to controls. There was no statistical significant difference between the prevalence of DHF and hematocrit level among cases and controls. Multivariate analysis showed myalgia and leucocyte count at presentation were independent predictors of fatality (adjusted odds ratios 0.09 and 2.94 respectively. None of the controls was admitted to intensive care unit (ICU or given blood transfusion, while 71.4% and 28.6% of fatal cases received ICU admission and blood transfusion. CONCLUSIONS: Absence of myalgia and leucocytosis on admission were independently associated with fatality in our matched case-control study. Fatalities were also commonly associated with co-morbidities and clinicians should be alarmed if dengue patients fulfilled severe dengue case definition on admission.
Full Text Available This article is a case report of a case of diphtheria which presented as diphtheritic tonsillitis in stridor and finallysuccumbed to diphtheritic myocarditis. Here we describe the case presentation, the treatment modalities undertaken,and the fatal course of events followed by an elaborate discussion on diphtheria.
Yang, Sam Shiyao; Chandran, Nisha Suyien; Huang, Jing Xiang; Tan, Kong-Bing; Aw, Derrick Chen-Wee
Erysipelas is a generally benign superficial bacterial skin infection, and its bullous form constitutes a rare and more severe variant. We describe the first and fatal case of "bullous erysipelas-like" septic vasculitis due to Pseudomonas bacteremi. A 69-year-old Chinese man presenting with diarrhea and septic shock initially began to rapidly develop sharply defined erythematous plaques with non-hemorrhagic bullae over his lower limbs. Culture of the aspirate from the bullae was positive for Pseudomonas aeruginosa. This was also consistent with his blood cultures showing Pseudomonas bacteremia. Histology of the skin lesion showed microthrombi and neutrophilic infiltrates in blood vessels with Gram-negative bacilli extruding from the vessel walls, characteristic of septic vasculitis. The bullous erysipelas-like lesions seen in this patient represents a rare manifestation of both septic vasculitis and Pseudomonas infection. PMID:26955132
Meehan, William P.; Lee, Lois K.; Fischer, Christopher M.; Mannix, Rebekah C.
Objective To assess the association between bicycle helmet legislation and bicycle-related deaths sustained by children involved in bicycle-motor vehicle collisions. Study design We conducted a cross sectional study of all bicyclists aged 0-16 years included in the Fatality Analysis Reporting System (FARS) who died between January 1999 and December 2010. We compared fatality rates per age-specific state populations between states with helmet laws and those without helmet laws. We used a clustered Poisson multivariate regression model to adjust for factors previously associated with rates of motor vehicle fatalities: elderly driver licensure laws, legal blood alcohol limit ( 0.08 between states with helmet laws and those without helmet laws. The mean unadjusted rates of fatalities were lower in states with helmet laws (2.0/1,000,000 vs. 2.5/1,000,000; p= 0.03). After adjusting for potential confounding factors, states with mandatory helmet laws continued to be associated with a lower rate of fatalities (adjusted Incidence Rate Ratio 0.84; 95% CI 0.70, 0.98). Conclusions Bicycle helmet safety laws are associated with a lower incidence of fatalities among child bicyclists involved in motor vehicle collisions. PMID:23706604
Full Text Available Abstract Introduction Cold agglutinin disease usually develops as a result of the production of a specific immunoglobulin M auto-antibody directed against the I/i and H antigens, precursors of the ABH and Lewis blood group substances, on red blood cells. Autoimmune and lymphoproliferative disorders, Mycoplasma pneumoniae and other infections can be associated with the production of cold agglutinins. In its classic presentation with haemolytic anaemia and Raynaud's syndrome, cold agglutinin disease is usually idiopathic. Several factors play a role in determining the ability of a cold agglutinin to induce a haemolytic anaemia such as antibody concentration and temperature range, in particular the highest temperature at which antibodies interact with red blood cells. Case presentation A 48-year-old Caucasian man presented to our hospital with symptoms of extreme asthenia caused by severe anaemia. The transfusion of red blood cells (O Rh-positive, started as prescribed by the emergency guidelines in force without pre-transfusion tests, induced fatal haemolysis because of the presence of high levels of anti-H antibodies in his blood, that reacted with the large amount of H antigen in universal (0 red blood cells. Conclusion Emergency transfusion of universal red blood cells (0 Rh-positive or negative is usually accepted by the international guidelines in force in emergency departments. In this report we describe a rare complication caused by the very high concentration in the recipient of cold agglutinins and the activation of the complement system, responsible for red blood cell lysis and consequent fatal cardiovascular shock. We conclude that emergency transfusion of universal red blood cells (0 Rh-positive or negative may be dangerous and its risk should be assessed against the risk of delaying transfusion until the pre-transfusion tests are completed.
JI Tao; GUO Wei; SHEN Dan-hua; YANG Yi; TANG Shun
@@ Chordoma as a rare malignant tumor arising from remnants of the fetal notochord accounts for 1%-4% of primary bone tumors.It is usually predominant in males.Local recurrences are common (44%-78%)1-3 and distant metastases may occur years after the initial presentation.The reposed rates of metastases range from 10% to 48%,4-6 which are usually accompanied by a sacrococcygeal chordoma.Cases of surgical seeding and intradural spinal seeding also have been reported clinically.7-9 To our knowledge,the present case is the first one concerning cerebrospinal fluid metastases and fatal progression of a sacrococcygeal chordoma.
Sodemann, Morten; Veirum, Jens Erik; Biai, S;
During a recent armed conflict in Guinea-Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country.......During a recent armed conflict in Guinea-Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country....
Siriyakorn, Nirada; Insiripong, Somchai
Dengue hemorrhagic fever is caused by dengue virus infection. The classical manifestations consist of fever, thrombocytopenia, and hemoconcentration. However, its unusual complications may be fatal, such as prolong shock, massive bleeding, volume overload, and unusual manifestations, for example, severe rhabdomyolysis. Here we report a case of 17-year old Thai man who was referred to our hospital because of 7-day fever with thrombocytopenia, hemoconcentration and right pleural effusion. The serology tests confirmed to be dengue infection. He developed various complications: severe hepatitis, coagulopathy, and heavy proteinuria; encephalopathy that needed a respiratory ventilator. On day 12 of fever, he had myalgia and passed dark urine. Serum creatinine and serum creatinine phosphokinase (CPK) were found abnormally high. He was diagnosed as severe rhabdomyolysis with acute kidney injury, and immediate hemodialysis was performed. He did not respond to treatment and expired within three hours. Although the mechanism of severe rhabdomyolysis in dengue fever is not clearly known, it may theoretically be proposed such as direct muscle cell injury leading to myositis by dengue virus, myotoxic cytokines which are produced in response to viral infection, dehydration or hypophosphatemia. PMID:26506741
Hitosugi, Masahito; Tsukada, Chie; Yamauchi, Shinobu; Matsushima, Kazumi; Furukawa, Satoshi; Morita, Satomu; Nagai, Toshiaki
We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1h after the collapse, he was in cardiopulmonary arrest and subsequently died 10h after his arrival. The forensic autopsy performed 5.5h after death revealed the 380ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1μg/ml and 558.2μg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household. PMID:25982958
Oliveira, D B; Machado, G; Almeida, G.M.F.; P. C. P. Ferreira; C.A. Bonjardim; G. de Souza Trindade; Abrahão, J.S.; E.G. Kroon
We describe what is to our knowledge the first fatal case of central nervous system Enterovirus infection in Brazil. Molecular and phylogenetic characterization revealed that Enterovirus A was the aetiologic agent of this case.
Davidsen, M; Brønnum-Hansen, H; Jørgensen, Torben; Madsen, M; Gerdes, Lars Ulrik; Osler, M; Schroll, M
BACKGROUND: Growing awareness of risk factors for myocardial infarction (MI), continuous mass campaigns on lifestyle factors, increasing use of heart rehabilitation and improved treatment should imply decreases in the incidence, case-fatality and recurrence rates of MI. The purpose of the study was...
Humayun Fawwaz; Shehab Thomas M; Tworek Joseph A; Fontana Robert J
Abstract Background Bupropion is approved for the treatment of mood disorders and as an adjuvant medication for smoking cessation. Bupropion is generally well tolerated and considered safe. Two randomized controlled trials of bupropion therapy for smoking cessation did not report any hepatic adverse events. However, there are three reports of severe but non-fatal bupropion hepatotoxicity published in the literature. Case Presentation We present the case of a 55-year old man who presented with...
Chien-Ming Chao; Kun-Kuang Lee; Chia-Sheng Wang; Ping-Jen Chen; Tsung-Chih Yeh
Mycotic aneurysm is a serious clinical condition with significant morbidity and mortality. Staphylococcus aureus and Salmonella species are the most common causative pathogens. Klebsiella pneumoniae was rarely reported as a possible pathogen causing mycotic aneurysm; therefore, we describe a K. pneumoniae-related fatal bacteremia mycotic aneurysm in a patient in spite of appropriate antimicrobial agents and surgical management.
Daniell, James; Wenzel, Friedemann; McLennan, Amy; Daniell, Katherine; Kunz-Plapp, Tina; Khazai, Bijan; Schaefer, Andreas; Kunz, Michael; Girard, Trevor
In this study, analysis is undertaken showing disaster fatalities trends from around the world using the CATDAT Natural Disaster and Socioeconomic Indicator databases from 1900-2015. Earthquakes have caused over 2.3 million fatalities since 1900; however absolute numbers of deaths caused by them have remained rather constant over time. However, floods have caused somewhere between 1.7 and 5.4 million fatalities, mostly in the earlier half of the 20th century (depending on the 1931 China floods). Storm and storm surges (ca. 1.3 million fatalities), on the other hand, have shown an opposite trend with increasing fatalities over the century (or a lack of records in the early 1900s). Earthquakes due to their sporadic nature, do not inspire investment pre-disaster. When looking at the investment in flood control vs. earthquakes, there is a marked difference in the total investment, which has resulted in a much larger reduction in fatalities. However, a key consideration for decision-makers in different countries around the world when choosing to implement disaster sensitive design is the risk of a natural disaster death, compared to other types of deaths in their country. The creation of empirical annualised ratios of earthquake, flood and storm fatalities from the year 1900 onwards vs. other methods of fatalities (cancer, diseases, accidents etc.) for each country using the CATDAT damaging natural disasters database is undertaken. On an annualised level, very few countries show earthquakes and other disaster types to be one of the highest probability methods for death. However, in particular years with large events, annual rates can easily exceed the total death count for a particular country. An example of this is Haiti, with the equivalent earthquake death rate in 2010 exceeding the total all-cause death rate in the country. Globally, fatality rates due to disasters are generally at least 1 order of magnitude lower than other causes such as heart disease. However, in
Nura H Alkali
Full Text Available Background: Stroke is the second leading cause of death and the leading cause of adult disability worldwide. A better understanding of stroke risk factors and outcome may help guide efforts at reducing the community burden of stroke. This study aimed to understand stroke risk factors, imaging subtypes, and 30-day outcomes among adult Nigerians. Materials and Methods: We prospectively recruited all patients presenting with acute stroke at the National Hospital Abuja between January 2010 and June 2012. We assessed clinical and laboratory variables, as well as brain computerized tomography, magnetic resonance imaging, and carotid Doppler ultrasound scans. We also assessed case fatality and functional outcome at 30 days after stroke. Results: Of 272 patients studied, 168 (61.8% were males. Age at presentation (mean ± standard deviation was 56.4 ± 12.7 years in males and 52.9 ± 14.8 years in females ( P = 0.039. Neuroimaging was obtained in 96.7% patients, revealing cerebral infarction (61.8%, intracerebral hemorrhage (ICH (34.8%, and subarachnoid hemorrhage (SAH (3.4%. Carotid plaques or stenosis ≥50% were detected in 53.2% patients with cerebral infarction. Stroke risk factors included hypertension (82.7%, obesity (32.6%, diabetes (23.5%, hyperlipidemia (18.4%, atrial fibrillation (9.2%, and cigarette smoking (7.7%. At 30 days after stroke, case-fatality rate was 18.8%, whereas modified Rankin Scale (mRS scores for cerebral infarction, ICH, and SAH were 3.71, 4.21, and 4.56, respectively. Atrial fibrillation, a previous stroke, and age older than 50 years were all associated with worse mRS scores at 30 days. Conclusion: Although hypertension, obesity, diabetes mellitus, and atrial fibrillation were important stroke risk factors, in many patients, these were detected only after a stroke. While the commonest stroke subtype was cerebral infarction, observed in almost two-third of patients, SAH was associated with the highest case-fatality rate at
Leyland Alastair H; Davies Carolyn A
Abstract Background There have been substantial declines in ischemic heart disease in Scotland, partly due to decreases in acute myocardial infarction (AMI) incidence and case fatality (CF). Despite this, Scotland's IHD mortality rates are among the worst in Europe. We examine trends in socioeconomic inequalities in short-term CF after a first AMI event and their associations with age, sex, and geography. Methods We used linked hospital discharge and death records covering the Scottish popula...
Full Text Available Abstract Background Bupropion is approved for the treatment of mood disorders and as an adjuvant medication for smoking cessation. Bupropion is generally well tolerated and considered safe. Two randomized controlled trials of bupropion therapy for smoking cessation did not report any hepatic adverse events. However, there are three reports of severe but non-fatal bupropion hepatotoxicity published in the literature. Case Presentation We present the case of a 55-year old man who presented with jaundice and severe hepatic injury approximately 6 months after starting bupropion for smoking cessation. Laboratory evaluation demonstrated a mixed picture of hepatocellular injury and cholestasis. Liver biopsy demonstrated findings consistent with severe hepatotoxic injury due to drug induced liver injury. Laboratory testing was also notable for positive autoimmune markers. The patient initially had clinical improvement with steroid therapy but eventually died of infectious complications. Conclusion This report represents the first fatal report of bupropion related hepatotoxicity and the second case of bupropion related liver injury demonstrating autoimmune features. The common use of this medication for multiple indications makes it important for physicians to consider this medication as an etiologic agent in patients with otherwise unexplained hepatocellular jaundice.
Brennan, Yvonne; Gottlieb, David J; Baewer, David; Blyth, Emily
Human herpesvirus 6 (HHV-6) is an ubiquitous virus that can reactivate in immunocompromised hosts, resulting in diverse clinical sequelae. We describe a case of fatal acute HHV-6 myocarditis in a patient who underwent allogeneic haemopoietic stem cell transplantation (HSCT). To our knowledge, this is the first reported case of biopsy proven HHV-6 myocarditis post-HSCT. PMID:26465970
Cantrell, F Lee; Mena, Othon; Gary, Ray D; McIntyre, Iain M
Gabapentin (GBP) (Neurontin®, Horizant®, Gralise®) is a widely prescribed medication used primarily for the treatment of epilepsy and neuropathic pain. GBP has a favorable adverse effect profile in therapeutic dosing with the most common reported effects being dizziness, fatigue, drowsiness, weight gain, and peripheral edema. Even with intentional GBP self-poisonings, serious effects are rare. A 47-year-old female was found dead at work with her daughter's bottle of GBP 600 mg. There were 26 tablets missing and the decedent's only known medication was hydrocodone/acetaminophen. Following initial detection by an alkaline drug screen (GC-MS), analysis utilizing specific liquid chromatography-mass spectrometry revealed an elevated postmortem GBP peripheral blood concentration of 37 mg/L, central blood 32 mg/L, liver 26 mg/kg, vitreous 32 mg/L, and gastric contents 6 mg. Screening for volatiles, drugs of abuse, alkaline compounds, and acid/neutral compounds was negative with the exception of ibuprofen (<2 mg/L) detected in peripheral blood. This report presents a fatality that appears to be associated with an isolated and acute GBP ingestion. PMID:25904080
Morais, Paulo; Mota, Alberto; Eloy, Catarina; Lopes, José Manuel; Torres, Fátima; Palmeiro, Aida; Tavares, Purificação; Azevedo, Filomena
A 13-year-old boy, born prematurely and hypotonic, from non-consanguineous healthy parents, was referred to our department because of easy bruising. A slightly extensible, thin and translucent skin, associated with dysmorphic facies, acrogeria, multiple ecchymoses, hypermobility of the small joints, dorsal kyphosis, genu valgum, flat feet, elongated upper limbs, and low muscle tone were all evident. A history of learning disability and bilateral inguinal hernia was present. Blood and imaging studies were unremarkable. A skin biopsy disclosed an unremarkable dermis; electron microscopy showed abnormalities in the diameter, contour, and shape of collagen fibrils/fibers. Genetic analysis revealed heterozygosity for a novel mutation in COL3A1 gene (c.3527G>A), confirming the diagnosis of vascular Ehlers-Danlos syndrome (VEDS). The patient died at 15 years of age because of aortic dissection. Vascular Ehlers-Danlos syndrome is a rare, life-threatening, autosomal dominant variant of EDS, resulting from mutations in COL3A1 gene. Affected individuals are prone to serious and potentially fatal complications, especially vascular, intestinal, and uterine ruptures. Delay in diagnosis is common, even when the clinical presentation is typical. Therefore, dermatologists should be familiar with VEDS features because the skin findings may be the first signs. Early diagnosis will improve management of visceral complications and allow early genetic counseling. PMID:21549076
Full Text Available Abstract Background Sorafenib is an orally available kinase inhibitor with activity at Raf, PDGFβ and VEGF receptors that is licensed for the treatment of advanced renal cell carcinoma (RCC and hepatocellular carcinoma (HCC. Current evidence-based post-nephrectomy management of individuals with localized RCC consists of surveillance-based follow up. The SORCE trial is designed to investigate whether treatment with adjuvant sorafenib can reduce recurrence rates in this cohort. Case presentation Here we report an idiosyncratic reaction to sorafenib resulting in fatal hepatotoxicity and associated renal failure in a 62 year-old man treated with sorafenib within the SORCE trial. Conclusion This is the first reported case of sorafenib exposure associated fatal toxicity in the adjuvant setting and highlights the unpredictable adverse effects of novel adjuvant therapies.
Cracco Laura; Zou Wen-Quan; Maddox Ryan A; Schonberger Lawrence B; Moody Karen M; Cali Ignazio
Abstract Background Sporadic fatal insomnia (sFI) and fatal familial insomnia (FFI) are rare human prion diseases. Case Presentation We report a case of a 33-year-old female who died of a prion disease for whom the diagnosis of sFI or FFI was not considered clinically. Following death of this patient, an interview with a close family member indicated the patient's illness included a major change in her sleep pattern, corroborating the reported autopsy diagnosis of sFI. Genetic tests identifie...
Kitching, A; Addiman, S; Cathcart, S; Bischop, L; Krahé, D; Nicholas, M; Coakley, J; Lloyd, G; Brooks, T; Morgan, D; Turbitt, D
In January 2009, the eleventh [corrected] case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified. PMID:19215723
Salameh, Ahmad; Bello, Nancy; Becker, Jennifer; Zangeneh, Tirdad
Granulomatous amoebic encephalitis (GAE) due to Acanthamoeba is almost a uniformly fatal infection in immune-compromised hosts despite multidrug combination therapy. We report a case of GAE in a female who received a deceased donor kidney graft. She was treated with a combination of miltefosine, pentamidine, sulfadiazine, fluconazole, flucytosine, and azithromycin. PMID:26280011
Sorafenib is an orally available kinase inhibitor with activity at Raf, PDGFβ and VEGF receptors that is licensed for the treatment of advanced renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC). Current evidence-based post-nephrectomy management of individuals with localized RCC consists of surveillance-based follow up. The SORCE trial is designed to investigate whether treatment with adjuvant sorafenib can reduce recurrence rates in this cohort. Here we report an idiosyncratic reaction to sorafenib resulting in fatal hepatotoxicity and associated renal failure in a 62 year-old man treated with sorafenib within the SORCE trial. This is the first reported case of sorafenib exposure associated fatal toxicity in the adjuvant setting and highlights the unpredictable adverse effects of novel adjuvant therapies
Seyed Ahmad Hashemi; Amir Azimian; Sara Nojumi; Tahereh Garivani; Saghar Safamanesh; Majid Ghafouri
Background. Bacillus species are aerobic or facultative anaerobic, gram-positive, or gram-variable spore-forming rods. They are ubiquitous in the environmental sources. Bacillus anthracis may usually cause three forms of anthrax: inhalation, gastrointestinal, and cutaneous. The gastrointestinal (GI) anthrax develops after eating contaminated meat. In this paper we report septic intestinal anthrax. Case Presentation. We report an isolation of Bacillus anthracis from blood culture of patient wi...
Seyed Ahmad Hashemi
Full Text Available Background. Bacillus species are aerobic or facultative anaerobic, gram-positive, or gram-variable spore-forming rods. They are ubiquitous in the environmental sources. Bacillus anthracis may usually cause three forms of anthrax: inhalation, gastrointestinal, and cutaneous. The gastrointestinal (GI anthrax develops after eating contaminated meat. In this paper we report septic intestinal anthrax. Case Presentation. We report an isolation of Bacillus anthracis from blood culture of patient with intestinal anthrax. Bacillus anthracis was isolated from a blood culture of a 34-year-old man who had a history of severe abdominal pain, bloody diarrhea, nausea, vomiting, fever, sweating, and lethargy within 4 to 5 days after eating the meat of domestic goat. He had evidence of severe infection and septic shock and did not respond to treatments and subsequently expired 9 hours after hospitalization. Conclusion. Gastrointestinal anthrax is characterized by rapid onset, fever, and septicemia. Rapid diagnosis and prompt initiation of antibiotic therapy can help in survival. Most of previous cases of septicemic anthrax were related to injection drug users but, in our case, septicemia occurred after gastrointestinal anthrax.
Hashemi, Seyed Ahmad; Azimian, Amir; Nojumi, Sara; Garivani, Tahereh; Safamanesh, Saghar; Ghafouri, Majid
Background. Bacillus species are aerobic or facultative anaerobic, gram-positive, or gram-variable spore-forming rods. They are ubiquitous in the environmental sources. Bacillus anthracis may usually cause three forms of anthrax: inhalation, gastrointestinal, and cutaneous. The gastrointestinal (GI) anthrax develops after eating contaminated meat. In this paper we report septic intestinal anthrax. Case Presentation. We report an isolation of Bacillus anthracis from blood culture of patient with intestinal anthrax. Bacillus anthracis was isolated from a blood culture of a 34-year-old man who had a history of severe abdominal pain, bloody diarrhea, nausea, vomiting, fever, sweating, and lethargy within 4 to 5 days after eating the meat of domestic goat. He had evidence of severe infection and septic shock and did not respond to treatments and subsequently expired 9 hours after hospitalization. Conclusion. Gastrointestinal anthrax is characterized by rapid onset, fever, and septicemia. Rapid diagnosis and prompt initiation of antibiotic therapy can help in survival. Most of previous cases of septicemic anthrax were related to injection drug users but, in our case, septicemia occurred after gastrointestinal anthrax. PMID:25918652
Yu Shun-Zhang; Wang Hua; Zhao Jinkou; Froines John; Zhang Zuo-Feng; Cui Yan; Detels Roger
Abstract Background Severe acute respiratory syndrome (SARS) has claimed 349 lives with 5,327 probable cases reported in mainland China since November 2002. SARS case fatality has varied across geographical areas, which might be partially explained by air pollution level. Methods Publicly accessible data on SARS morbidity and mortality were utilized in the data analysis. Air pollution was evaluated by air pollution index (API) derived from the concentrations of particulate matter, sulfur diox...
Barretto, Adriana Rodrigues; Felício, João Soares; Sales, Lucia Helena Messias; Yamada, Elizabeth Sumi; Lopes, Maria Luiza; da Costa, Ana Roberta Fusco
Mycobacterium avium complex (MAC) is a heterogeneous group of species found in several environmental sources and that exhibit variable degrees of pathogenicity. Among the MAC members, Mycobacterium colombiense has been related to pulmonary disease and disseminated infection in HIV-infected patients in Colombia. Lymphadenopathy cases have also been reported. We have described a fatal case of M. colombiense pulmonary disease in a Brazilian patient without evidence of HIV infection or other known causes of immunosuppression. PMID:27133309
Avoni, P; Cortelli, P; Montagna, P; Tinuper, P; Sforza, E; Contin, M; Parchi, P; Pierangeli, G; Maltoni, P; Pavani, A
We used a chronobiological inferential statistical method to investigate circadian rhythms of hypophyseal hormones, cortisol, melatonin and catecholamines in two females of the same family affected by fatal familial insomnia. Case 1 (confirmed at autopsy) presented an absent or progressive loss of circadian rhythms of all hormones. In case 2 there was a loss of GH circadian rhythm and a less significant rhythm for melatonin, catecholamines and gonadotropins. These results confirm the role of the thalamus in regulating hormonal circadian rhythm. PMID:1805556
Bawany, Fauzia Ahmad; Sharif, Hasanat
Background Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive. Case Presentation Literature search has not revealed any case of T...
Diferença de letalidade hospitalar do infarto agudo do miocárdio entre homens e mulheres submetidos a angioplastia primária Difference in the case-fatality rate of acute myocardial infarction between men and women submitted to primary angioplasty
Luiz Carlos Santana Passos
Full Text Available OBJETIVO: Comparar a letalidade hospitalar (LH de homens e mulheres submetidos a angioplastia transluminal coronária primária (ATCP como estratégia de reperfusão no infarto agudo do miocárdio (IAM. MÉTODOS: Estudo de coorte retrospectivo baseado em informações de prontuários médicos de pacientes hospitalizados devido a IAM em hospital de referência para doença coronária, utilizando preferencialmente a ATCP como técnica de reperfusão miocárdica precoce. Foram incluídos 83 pacientes, 35 (42% mulheres e 48 (58% homens, que preencheram critérios para reperfusão miocárdica precoce. RESULTADOS: A média de idade das mulheres foi superior a dos homens (66±10 vs 58±11 anos; pPURPOSE: To compare the in-hospital case-fatality rate of men and women submitted to percutaneous transluminal coronary angioplasty (PTCA as a strategy of reperfusion in acute myocardial infarction (MI. METHODS: A retrospective cohort study based on information abstracted from medical records of MI patients admitted to a hospital where PTCA is used as the prefered method for early myocardial reperfusion. A total of 83 patients, 35 (42% women and 48 (58% men, who met the criteria for early myocardial reperfusion was included in the analysis. RESULTS: The mean age of women was higher than that of men (66±10 vs 58±11 years; p<0.001. The women also had a higher frequency of diabetes mellitus (37.1% vs 6.4%; p<0.001. Despite these differences in age and in the frequency of diabetes mellitus, the percentage of patients in whom the PTCA was considered successful was similar between men (83.3% and women (82.3%. The case-fatality rate was also similar between men and women; 14.6% and 14.3%, respectively. CONCLUSION: The possibility that the excess risk of death in women with MI may be reduced and even eliminated with the use of PTCA, supports to the need for the development of a clinical trial to assess this question.
Mario Enrique Baltazares-Lipp
Full Text Available Hypereosinophilic syndrome (HES is a rare disorder with unknown global prevalence, barely reported in Hispanic population, and characterized by persistent eosinophilia in association with organ dysfunctions directly attributable to eosinophilic infiltration. Cardiac involvement may be present in 50 to 60% of the patients. This is known as Löffler endocarditis. We present a case of a 36-year-old Hispanic man with signs of heart failure. Laboratory studies showed eosinophilia (23,100/μL. Thoracic computer tomography showed bilateral pleural effusion and a large left ventricular mass. Transthoracic echocardiography showed left ventricle apical obliteration and a restrictive pattern. Pulmonary angiography demonstrated a thrombus in the lingular and middle lobe. Despite treatment, the patient deceased seven days after admission. Autopsy confirmed the diagnosis of Löffler endocarditis.
Halil Uğur Hatipoğlu
Full Text Available Acquired immune deficiency syndrome is a clinical condition caused by human immunodeficiency virus (HIV which can be transmitted either vertically or horizontally. More than 90% of children living with HIV in developing countries have been infected through mother to child transmission during pregnancy, around the time of birth, or through breastfeeding. In order to reduce the number of infected children, increasing emphasis should be placed on preventing mother to child transmission programs with the use of antiretroviral medications in the pregnant woman during pregnancy and at delivery and, starting immediately after birth for the exposed infant. Here, we present the case of a 60-day-old infant heavily immunocompromised due to an extremely high viral burden of HIV, which was acquired perinatally from an undiagnosed and untreated mother, leading to severe bronchopneumonia, sepsis, septic shock and death.
Reusche, E; Pilz, P; Oberascher, G; Lindner, B; Egensperger, R; Gloeckner, K; Trinka, E; Iglseder, B
We report a 52-year-old woman who underwent otoneurosurgery to resect acoustic neurinoma. Bone reconstruction was performed with an aluminium (Al)-containing cement. Six weeks later the patient suffered from loss of consciousness, myoclonic jerks, and persistent grand mal seizures, clinical symptoms that resembled those of lethal dialysis encephalopathy of the 1960s and 1970s. She died 6 months later because of septic complications. Light- and electron-microscopic investigation of the central nervous system (CNS) showed pathognomonic Al-containing intracytoplasmic argyrophilic inclusions in choroid plexus epithelia, neurons, and cortical glia. These changes are characteristics of dialysis-associated encephalopathy (DAE), induced nowadays by long-term ingestion of Al-containing drugs (and with benign clinical courses). Atomic absorption spectrometry showed an increase of mean bulk Al concentration of the cortex and subcortex up to 9.3 microg/g (normal range <2 microg/g); laser microprobe showed the increase of Al in subcellular structures. This unique case again shows the extraordinary neurotoxicity of Al, which was, in our patient, initiated by an amount of about 30 mg Al and apparently caused by direct Al access to the brain parenchyma via a cerebrospinal fluid leakage. PMID:11679949
Mahantesh V Parande
Full Text Available Exomphalos minor is one among uncommon disorders of the umbilical region. Here, we report a fatal case of exomphalos minor with enterococcal septicemia. A male baby, born with exomphalos minor, developed clinical features of septicemia on the fourth postnatal day. Blood samples were collected by venepuncture from two sites for culture. Enterococcus faecium was isolated from both the blood samples. The swabs collected from the site of exomphalos also yielded growth of Enterococcus faecium, confirming the source of infection. The antibiogram with Minimum Inhibitory Concentrations (MIC for various antibiotics was done for isolates from all three sites, which was similar. The isolate was resistant to multiple antibiotics with high level aminoglycoside resistance. The baby was treated with antibiotics and other supportive measures. However, the baby succumbed to the septicemia. As per our knowledge, this is the first reported case of fatal septicemia by multidrug-resistant Enterococcus faecium in a case of exomphalos minor.
Abildstrom, Steen Z; Rasmussen, Søren; Madsen, Mette
OBJECTIVE: We evaluated trends in in-hospital case fatality after acute myocardial infarction (AMI) in Denmark and analysed changes in the hospitalization rate for AMI. DESIGN: National population-based registries were used to identify patients (> or =30 years) who were admitted for their first A...
Wang, Zijun; Nicholls, John M; Liu, Fengfeng; Wang, Joshua; Feng, Zijian; Liu, Dongge; Sun, Yanni; Zhou, Cheng; Li, Yunqian; Li, Hai; Qi, Shunxiang; Huang, Xueyong; Sui, Jilin; Liao, Qiaohong; Peiris, Malik; Yu, Hongjie; Wang, Yu
In the past 17 years, neurological disease associated with enterovirus A71 (EV-A71) has increased dramatically in the Asia-Pacific region with a high fatality rate in young infants, often due to pulmonary oedema, however the mechanism of this oedema remains obscure. We analysed the brainstem, heart and lungs of 15 fatal cases of confirmed EV-A71 infection in order to understand the pathophysiological mechanism of death and pulmonary oedema. In keeping with other case studies, the main cause of death was neurogenic pulmonary oedema. In the brainstem, 11 cases showed inflammation and all cases showed parenchymal inflammation with seven cases showing moderate or severe clasmatodendrosis. No viral antigen was detected in sections of the brainstem in any of the cases. All fatal cases showed evidence of pulmonary oedema; however, there was absence of direct pulmonary viral damage or myocarditis-induced damage and EV-A71 viral antigen staining was negative. Though there was no increase in staining for Na/K-ATPase, 11 of the 15 cases showed a marked reduction in aquaporin-4 staining in the lung, and this reduction may contribute to the development of fatal pulmonary oedema. PMID:27020504
Uzün, Ibrahim; Büyük, Yalçin; Gürpinar, Kağan
We retrospectively analyzed the autopsy records of the Institute of Forensic Medicine during the five-year period between 1998 and 2002 to document the characteristics of fatalities resulting from hanging which is the commonest mode of suicide in Istanbul. Upon analysis of death scene investigation and autopsy reports together with the information gathered from the police, the cases of hanging fatalities of suicidal origin were selected. Seven hundred sixty one hanging cases of suicidal origin were detected and evaluated in terms of demographic features, the type of hanging material used for ligature, cause of death, internal findings in neck organs, other traumatic findings suggesting the use of another method for suicide, toxicological findings and microscopic findings in delayed death cases. In 364 of these cases suspension was complete and in 397 incomplete. Five hundred thirty seven of those (70.56%) were male and 224 (29.44%) were female. The preponderance of male cases in our autopsy population was also detected in suicidal hanging cases. There was no case aged lower 10 and the number of the cases in the age group of cases aged over 80 was the lowest (n=3, 0.4%). In 634 of cases, the place of hanging was the subject's own house, most victims selected rope (652 cases) for the ligature with the rest using sheet, belt, cable and necktie. There were traumatic findings showing attempts of suicide other than hanging in 24 cases (tentative marks in 22 cases and non-fatal burning in 2). In 23 of cases, there were bruises of different ages. In these cases females constituted the majority suggesting violence against women that is a social problem in various cultural subgroups of our country. This violence may have played a role in the decision of suicide. Superficial bruises were detected in 56 cases and were attributed to the trauma. Fractures in neck organs were detected in 446 of cases. In fracture-determined cases, fracture in hyoid bone was seen in 177, in
Verma, Rajanshu; Dhamija, Radhika; Batts, Donald H.; Stephen C Ross; Loehrke, Mark E
Moxifloxacin is a newer-generation synthetic fluoroquinolone that is used for treatment of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, community acquired pneumonia, intra-abdominal infections and skin/skin structure infections. We describe a case of fatal hepatotoxicity caused by Moxifloxacin in a 72-year-old man. He presented with jaundice and epigastric tenderness that started one week after being treated for acute exacerbation of his chronic bronchitis with Moxiflo...
Almond, Paul James; Colover, Sarah
This paper concerns an empirical investigation into public attitudes towards work-related fatality cases, where organizational offenders cause the death of workers or members of the public. This issue is particularly relevant following the introduction of the Corporate Manslaughter and Corporate Homicide Act 2007 into UK law. Here, as elsewhere, the use of criminal law against companies reflects governmental concerns over public confidence in the law’s ability to regulate risk. The empirical ...
YİĞİT, Aytaç; ÇELİK, Tuncay; Canan Togay IŞIKAY
We present a case of fatal lithium toxicity with EEG changes suggesting Creutzfeldt-Jakob disease. A 52-year-old woman was admitted with declined consciousness, fever, and generalized seizures. She had bipolar affective disorder and was on lithium and chlorpromazine treatment for about three decades. Her family described that she had systemic symptoms of lithium toxicity such as anorexia, nausea, vomiting, diarrhea, and insomnia for one month. Neurological examination disclosed declined consc...
Hu, Yan; Li, Jingjing; SU, XIAOYAN
Radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer. Intensity-modulated radiotherapy (IMRT) with inverse planning enables us to achieve the desired dose distribution. However, there are many high-risk procedures associated with lung irradiation, including chemotherapy and surgery. We report a case of fatal treatment-related pneumonitis, where the patient had undergone postoperative IMRT for lung cancer. Following completion of ...
Seksik, P; Gozlan, J; Guitton, C; Galula, G; Maury, E; Offenstadt, G
Herpes simplex virus hepatitis (HSV hepatitis) is an uncommon and severe complication of HSV type 1 and HSV type 2 infection. HSV hepatitis affects mostly immunocompromised patients. We report the case of a young man without any previous known immunodeficiency who developed fatal HSV hepatitis in the first 8 days of oral corticotherapy given for ulcerative colitis. A prompt diagnosis was possible because HSV was recovered from peripheral blood leukocytes. PMID:10342519
Nozari, Neda; Divsalar, Parisa
This case report demonstrates fatal gastrointestinal vasculitis as a rare presentation of systemic lupus erythematosus. A 34-year-old woman presented with abdominal pain and diarrhea. Anti nuclear antibody was positive and high titre of anti-ds DNA antibody was also reported. Treatment with corticosteroid and supportive cares were started; however, her condition worsened. Eventually, she was considered as a candidate for diagnostic laparoscopy. Immediately after laparoscopy, she developed res...
Narahara, Maiko; Tamaki, Keiji; Yamada, Ryo
Background DNA profiling is essential for individual identification. In forensic medicine, the likelihood ratio (LR) is commonly used to identify individuals. The LR is calculated by comparing two hypotheses for the sample DNA: that the sample DNA is identical or related to a reference DNA, and that it is randomly sampled from a population. For multiple-fatality cases, however, identification should be considered as an assignment problem, and a particular sample and reference pair should ther...
Martie van der Walt; Joey Lancaster; Karen Shean
Introduction South Africa has the highest reported rates of multi-drug resistant TB in Africa, typified by poor treatment outcomes, attributable mainly to high default and death rates. Concomitant HIV has become the strongest predictor of death among MDR-TB patients, while anti-retroviral therapy (ART) has dramatically reduced mortality. TB Case fatality rate (CFR) is an indicator that specifically reports on deaths due to TB. Aim The aim of this paper was to investigate causes of death among...
Kularatne, Senanayake A M; Raveendran, Sathasivam; Edirisinghe, Jayanthi; Karunaratne, Inoka; Weerakoon, Kosala
In the order Hymenoptera, bees, hornets, and wasps are well-known stinging insects whose envenoming can be fatal. Their stinging attacks are common in rural and forested areas of Sri Lanka. However, fatal stinging by the large-bodied carpenter bees is unreported. We report the first known case of a fatal sting by the large carpenter bee, Xylocopa tranquebarica, in a forested area in Puttalam (North Western Province) in the dry zone of Sri Lanka. A 59-year-old healthy male manual laborer accompanied by a fellow worker had been fixing a fence on a coconut estate bordering a forested area when a flying insect emerged from a dead tree trunk and stung him on his face. His coworker, who was watching the incident, killed the insect. The victim complained of immediate intense pain in the face and collapsed on the ground just after resuming work after 10 minutes of resting. He was found dead on admission to the hospital 90 minutes later. Autopsy showed normal coronary arteries and heart, but the lungs were slightly congested and contained secretions in the bronchi. Acute anaphylaxis was the most likely cause of death. This case presents the habitat, morphology, attack pattern, and the medical importance of large carpenter bees. PMID:27061039
Monica Galiano; Johnson, Benjamin F.; Richard Myers; Joanna Ellis; Rod Daniels; Maria Zambon
During the Northern Hemisphere winter of 2003-2004 the emergence of a novel influenza antigenic variant, A/Fujian/411/2002-like(H3N2), was associated with an unusually high number of fatalities in children. Seventeen fatal cases in the UK were laboratory confirmed for Fujian/411-like viruses. To look for phylogenetic patterns and genetic markers that might be associated with increased virulence, sequencing and phylogenetic analysis of the whole genomes of 63 viruses isolated from fatal cases ...
Eickhardt, Steffen; Braendstrup, Peter; Clasen-Linde, Erik; Jensen, Karl E; Alhede, Morten; Bjarnsholt, Thomas; Høiby, Niels; Vindeløv, Lars; Moser, Claus
Post-transplant infections in allogeneic haematopoietic cell transplant (allo-HCT) recipients often have severe consequences. This is especially the case when dealing with zygomycete infections where the result is often fatal. A major problem when dealing with zygomycete infections is the need for...... an accurate and fast diagnosis as the phylum is highly resistant towards the conventional antifungals. We herein describe a non-fatal case of Lichtheimia corymbifera infection in an allo-HCT recipient....
Fernando Agüero; Dégano, Irene R.; Isaac Subirana; Maria Grau; Alberto Zamora; Joan Sala; Rafel Ramos; Ricard Treserras; Jaume Marrugat; Roberto Elosua
BACKGROUND AND OBJECTIVE: Coronary heart disease (CHD) is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI) incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain. METHODS: Using a population-based registry (the REGICOR Study), we compared population incidence, hospitalization, and mortality rates, and 28-day...
Fais, Paolo; Giraudo, Chiara; Viero, Alessia; Miotto, Diego; Bortolotti, Federica; Tagliaro, Franco; Montisci, Massimo; Cecchetto, Giovanni
Cases of subtle fatal neck compression are often complicated by the lack of specificity of the post-mortem signs of asphyxia and by the lack of clear signs of neck compression. Herein we present a forensic case of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest and who died after two days in a vegetative state. The deposition of the roommate of the deceased, who claimed responsibility for the killing of the victim by neck compression, was considered unreliable by the prosecutor. Autopsy, toxicological analyses, and multi-slice computed tomography (MSCT), micro computed tomography (micro-CT) and histology of the larynx complex were performed. Particularly, micro-CT analysis of the thyroid cartilage revealed the bilateral presence of ossified triticeous cartilages and the complete fragmentation of the right superior horn of the thyroid, but it additionally demonstrated a fracture on the contralateral superior horns, which was not clearly diagnosable at MSCT. On the basis of the evidence of intracartilaginous laryngeal hemorrhages and bilateral microfracture at the base of the superior horns of the larynx, the death was classified as a case of asphyxia due to manual strangulation. Micro-CT was confirmed as a useful tool in cases of subtle fatal neck compression, for the detection of minute laryngeal cartilage fractures, especially in complex cases with equivocal findings on MSCT. PMID:26832384
Full Text Available During the Northern Hemisphere winter of 2003-2004 the emergence of a novel influenza antigenic variant, A/Fujian/411/2002-like(H3N2, was associated with an unusually high number of fatalities in children. Seventeen fatal cases in the UK were laboratory confirmed for Fujian/411-like viruses. To look for phylogenetic patterns and genetic markers that might be associated with increased virulence, sequencing and phylogenetic analysis of the whole genomes of 63 viruses isolated from fatal cases and non fatal "control" cases was undertaken. The analysis revealed the circulation of two main genetic groups, I and II, both of which contained viruses from fatal cases. No associated amino acid substitutions could be linked with an exclusive or higher occurrence in fatal cases. The Fujian/411-like viruses in genetic groups I and II completely displaced other A(H3N2 viruses, but they disappeared after 2004. This study shows that two A(H3N2 virus genotypes circulated exclusively during the winter of 2003-2004 in the UK and caused an unusually high number of deaths in children. Host factors related to immune state and differences in genetic background between patients may also play important roles in determining the outcome of an influenza infection.
Full Text Available BACKGROUND: Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if there have been changes in the presentation of severe to fatal dengue. Nine of ten fatal cases involved adult females with a median age of 32 years. All had secondary dengue infection. The mean duration of illness prior to hospitalization was 4.7 days and deaths occurred at an average of 2.4 days post-admission. Gastrointestinal pain, vomiting, diarrhea, intravascular leakages and bleeding occurred in the majority of cases. DSS complicated with severe bleeding, multi-organ failure and coagulopathy were the primary causes of deaths. Seven patients presented with thrombocytopenia and hypoalbuminemia, five of which had hemoconcentration and increased ALT and AST indicative of liver damage. Co-morbidities particularly diabetes mellitus was common in our cohort. Prominent unusual presentations included acute renal failure, acute respiratory distress syndrome, myocarditis with pericarditis, and hemorrhages over the brain and heart. CONCLUSIONS: In our cohort, dengue fatalities are seen primarily in adult females with secondary dengue infection. The majority of the patients presented with common clinical and laboratory warning signs of severe dengue. Underlying co-morbidities may contribute to the rapid clinical deterioration in severe dengue. The uncommon presentations of dengue are likely a reflection of the changing demographics where adults are now more likely to contract dengue in dengue endemic regions.
Andreasen, Mette Findal; Telving, Rasmus; Rosendal, Ingrid;
described in several scientific papers. However, there are few scientific reports of intoxication with the other NBOMe-derivatives. Recently, drugs of the NBOMe class have entered the Scandinavian drug scene, and in the present work, we describe the first death related to the intake of 25C-NBOMe in Denmark....... Since October 2013, this drug has been controlled in Denmark. To the best of our knowledge, the present work reports the first quantification of 25C-NBOMe in biological specimens obtained from a fatal intoxication case. Aims Quantification of 25C-NBOMe. Methods Ultra-performance liquid chromatography...
Ritu J. Budania
Full Text Available Toxic epidermal necrolysis (TEN and Stevens-Johnson syndrome (SJS are rare (one to two per 10,00,00 population per year but life threatening adverse drug reactions. Drugs commonly implicated are anti-epileptics, anti-microbials and non-steroidal anti-inflammatory drugs (NSAIDS. Amongst anti-epileptics, carbamazepine and phenytoin are the major culprits. We report here a fatal case of SJS due to phenytoin. [Int J Basic Clin Pharmacol 2013; 2(6.000: 843-845
Ostovan Mohammad Ali; Kamali Maliheh; Zolghadrasli Abdolali
A newly described immediate complication after percutaneous pulmonary valvuloplasty is acute lung injury. Here we report a case of fatal acute lung injury after pulmonary valvuloplasty.The patient was a 26-year-old woman, referred to a general hospital with the diagnosis of livercirrhosis. In her work-ups severe pulmonary stenosis was detected and so a decision was madeto relieve the valve stenosis. Despite the procedural success, the patient developed severe dyspneaand desaturation a few hou...
Maria Cristina Antunes Willemann
Full Text Available Introduction: In Brazil, hantavirus cardiopulmonary syndrome (HCPS has a high lethality rate that varies by region. This study aimed to identify the risk factors associated with fatal hantavirosis. Methods: This study was a case-control study that included all laboratory confirmed cases of hantavirosis. The cases were stratified by the different Brazilian regions using data from the Notifiable Diseases Information System. “Cases” were patients who progressed to death, whereas “controls” were patients who were cured. The odds ratio (OR and the adjusted OR were calculated. Results: Overall, 158 cases and 281 controls were included in this study. In the Midwest region, the cases were 60% less likely to present with flank pain, and the time between the beginning of symptoms and death was shorter than the time between the beginning of symptoms and a cure. In the Southeast region, the cases were 60% less likely to present with thrombocytopenia or reside in rural areas compared to those who progressed to a cure. Additionally, the cases sought medical assistance, notification and investigation more quickly than the controls. In the Southern region, the cases that died were 70% less likely to be male compared to the controls. Conclusions: HCPS manifests with nonspecific symptoms, and there are few published studies related to the condition, so determining a patient's therapeutic strategy is difficult. This study presents findings from different Brazilian regions and highlights the need for further investigations to improve comprehension about regional risk factors associated with hantavirosis and to reduce morbimortality.
Full Text Available Abstract Background Sporadic fatal insomnia (sFI and fatal familial insomnia (FFI are rare human prion diseases. Case Presentation We report a case of a 33-year-old female who died of a prion disease for whom the diagnosis of sFI or FFI was not considered clinically. Following death of this patient, an interview with a close family member indicated the patient's illness included a major change in her sleep pattern, corroborating the reported autopsy diagnosis of sFI. Genetic tests identified no prion protein (PrP gene mutation, but neuropathological examination and molecular study showed protease-resistant PrP (PrPres in several brain regions and severe atrophy of the anterior-ventral and medial-dorsal thalamic nuclei similar to that described in FFI. Conclusions In patients with suspected prion disease, a characteristic change in sleep pattern can be an important clinical clue for identifying sFI or FFI; polysomnography (PSG, genetic analysis, and nuclear imaging may aid in diagnosis.
Richard Fowles; Peter Loeb; William A. Clarke
This paper examines the potential effect of cell phones on motor vehicle fatality rates normalized for other driving related and socioeconomic factors. The model used is nonlinear so as to address both life-taking and life-saving attributes of cell phones. The models are evaluated using classical methods along with Bayesian Extreme Bounds Analysis (EBA). The use of both classical and Bayesian methods diminishes the model and parameter uncertainties which afflict more conventional modeling met...
Full Text Available Dengue hemorrhagic fever (DHF is a severe febrile disease, characterized by abnormalities in hemostasis and increased vascular permeability, which in some cases results in hypovolemic shock syndrome and in dengue shock syndrome. The clinical features of DHF include plasma leakage, bleeding tendency and liver involvement. We studied the histopathological features of a fatal case of dengue-3 virus infection. The patient, a 63-year old male, presented with an acute onset of severe headache, myalgia and maculopapular rash. Tissue fragments (liver, spleen, lung, heart, kidney and lymph nodes were collected for light microscopy studies and stained by standard methods. Histopathology revealed severe tissue damage, caused by intense hemorrhage, interstitial edema and inflammation. Some tissue sections were also processed with the immunoperoxidase reaction, which revealed the dengue viral antigen. Dengue-3 virus was isolated and identified with electron microscopy in a C6/36 cell culture inoculated with the patient's serum. Viral particles were detected in the infected cell culture.
Subedi, Nuwadatta; Yadav, Bishwanath; Jha, Shivendra
In forensic casework, investigation of injury severity is important in evaluating the mortality, occasionally in terms of the adequacy of clinical management. The study was conducted with an objective to study the relationship of severity of the injuries using Abbreviated Injury Scale and Injury Severity Score (ISS) with survival period and place of death among fatal cases with abdominopelvic trauma.The total number of cases studied was 80. The injuries in all the body parts were allotted using the Abbreviated Injury Scale 2005, Update 2008, and the ISS was calculated. The male/female ratio was 4:1, and the mean (SD) age was 30.76 (15.2) years. The cause of trauma was road traffic accidents in 82.5% of the cases. The median duration of survival was 2 hours. The mean (SD) ISS was 38.90 (14.89). Abbreviated Injury Scale scores of 5 and 4 were the most common in the region. With increase in the ISS, the survival period was decreased. There was a highly significant difference between the mean ISS of the victims who died prehospital and that of who died in the emergency department (P < 0.005). The mean ISS of the victims who died in the emergency department and of those who died in the ward, intensive care unit, or after discharge was also significantly different (P < 0.05).Although the cases with more severe injuries died sooner, there should be provision of treatment on the spot without delay. More time taken to start the treatment increases the fatalities. PMID:25354224
Full Text Available Abstract Introduction Dermatomyositis has been described in the setting of lyme infection in only nine previous case reports. Although lyme disease is known to induce typical clinical findings that are observed in various collagen vascular diseases, to our knowledge, we believe that our case is the first presentation of acute lyme disease associated with amyopathic dermatomyositis, which was then followed by severe and fatal interstitial pulmonary fibrosis only two months later. Case presentation We present a case of a 64-year-old African-American man with multiple medical problems who was diagnosed with acute lyme infection after presenting with the pathognomonic rash and confirmatory serology. In spite of appropriate antimicrobial therapy for lyme infection, he developed unexpected amyopathic dermatomyositis and then interstitial lung disease. Conclusions This case illustrates a potential for lyme disease to produce clinical syndromes that may be indistinguishable from primary connective tissue diseases. An atypical and sequential presentation (dermatomyositis and interstitial lung disease of a common disease (lyme infection is discussed. This case illustrates that in patients who are diagnosed with lyme infection who subsequently develop atypical muscular, respiratory or other systemic complaints, the possibility of severe rheumatological and pulmonary complications should be considered.
Peter D. Loeb; William A. Clarke; Richard Anderson
This paper develops a set of models for the determinants of automobile fatalities with particular attention devoted to the effects of increased cell phone usage. Cell phones have been associated with both life-taking and life-saving properties. However, prior statistical evaluations of the effects of cell phones have led to fragile results. We develop in this paper econometric models using time series data, allowing for polynomial structures of the regressors. The models are evaluated with a ...
Leyland Alastair H
Full Text Available Abstract Background There have been substantial declines in ischemic heart disease in Scotland, partly due to decreases in acute myocardial infarction (AMI incidence and case fatality (CF. Despite this, Scotland's IHD mortality rates are among the worst in Europe. We examine trends in socioeconomic inequalities in short-term CF after a first AMI event and their associations with age, sex, and geography. Methods We used linked hospital discharge and death records covering the Scottish population (5.1 million. Between 1988 and 2004, 178,781 of 372,349 patients with a first AMI died on the day of the event (Day0 CF and 34,198 died within 28 days after surviving the day of their AMI (Day1-27 CF. Results Age-standardized Day0 CF at 30+ years decreased from 51% in 1988-90 to 41% in 2003-04. Day1-27 CF decreased from 29% to 18% over that period. Socioeconomic inequalities in Day0 CF existed for both sexes and persisted over time. The odds of case fatality for men aged 30-59 living in the most deprived areas in 2000-04 were 1.7 (95%CI: 1.3-2.2 times as high as in the least deprived areas and 1.9 (1.1-3.2 times as high for women. There was little evidence of socioeconomic inequality in Day1-27 CF in men or women. After adjustment for socioeconomic deprivation, significant geographic variation still remained for both CF definitions. Conclusions A high proportion of AMI incidents in Scotland result in death on the day of the first event; many of these are sudden cardiac deaths. Short-term CF has improved, perhaps reflecting treatment advances and reductions in first AMI severity. However, persistent socioeconomic and geographic inequalities suggest these improvements are not uniform across all population groups, emphasizing the need for population-wide primary prevention.
Mercado, Marcela; Acosta-Reyes, Jorge; Parra, Edgar; Pardo, Lissethe; Rico, Angélica; Campo, Alfonso; Navarro, Edgar; Viasus, Diego
We report clinical features and histopathological findings in fatal cases with dengue (DENV) and chikungunya (CHIKV) co-infection identified at the Colombian National Institute of Health between September 2014 and October 2015. Seven such cases were documented. Dengue serotype 2 virus was identified in six cases. All patients were adults and comorbidities were present in four. Fever, arthralgia or myalgia was present in all cases. The frequency of rash, haemorrhage, oedema, and gastrointestinal symptoms was variable. Laboratory findings such as thrombocytopenia, renal failure, and leukocyte count were also inconsistent between cases. Post-mortem tissue examination documented focal hepatocellular coagulative necrosis in three cases, incipient acute pericarditis in one and tubulointerstitial nephritis in one. This study provides evidence of mortality in patients with DENV and CHIKV co-infection. Fatal cases were characterised by variable clinical and laboratory features. Evaluation of histopathology of autopsy tissues provided evidence of the pathological consequences of the disease. PMID:27277216
M Baig, Mirza; Phillips, Martin
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal disorder of the central nervous system. It occurs worldwide with an incidence of 0.5-1 new case per million population per year. No specific treatment is available and management is limited to supportive care. Autopsy or biopsy provides a definitive diagnosis. Because of the transmissible nature of the disease and hesitancy of patients/family members to give consent for biopsy, numerous challenges in confirming the clinical diagnosis are faced by healthcare professionals. We report a case of 66-year-old male who was hospitalized due to hip fracture following a fall. Acute mental status changes followed the surgical fixation of hip fracture which triggered neurologic work up. This finally revealed suspicion and confirmation of CJD. Patient had progressive cognitive decline with akinetic mutism during further hospital stay and was later discharged home with hospice. Shorter thereafter he died at home. This case demonstrates the importance of keeping an open mind towards possibility of CJD when faced with esoteric neurologic presentations. Also this case provides insight into challenges in quarantine and sterilization of surgical instruments when these patients go through major surgeries. PMID:24470960
The aim of radioiodine therapy following surgery for thyroid carcinoma is to ablate the remnant thyroid tissue in the neck by delivering a minimum dose of 300 gray to the residual thyroid tissue. Side-effects are usually minimal and transient, and use of rhTSH can reduce their incidence. In patients with functioning metastases, successive doses of radio iodine are administered until complete ablation of metastatic disease is achieved. A 54-year-old woman with diffuse pulmonary metastases from thyroid cancer died from a fatal sudden alveolar haemorrhage that occurred 3 weeks after radioiodine therapy. Post mortem biopsy of specimens taken from the sites of pulmonary metastasis revealed massive haemorrhage and apoptosis. It is known that in vitro, beta-irradiation can activate apoptosis pathways. This effect seems to depend on dose of radioiodine and time point. In humans, I-131 therapy can induce apoptosis in hyper-functioning thyroid tissue. This effect is dependent on iodine concentration which is dependent on NIS expression itself. A sudden wave of apoptosis occurring 3 weeks after radioiodine dose could be lethal. On the other hand in order to have favourable treatment response it is essential to have high I-131 uptake by pulmonary metastases. Although fatal effect of radioiodine therapy are rare, this particular case suggests that a high level of I-131 concentration in critical organs detected by post-therapy whole-body scan (WBS) should be an indication for imposing particular care in the management of such patients, and perhaps consideration for prolonged hospitalization and late discharge. (author)
Huso, Manuela; Dalthorp, Daniel; Miller, T J; Bruns, Dawn
Monitoring fatalities at wind energy facilities after they have been constructed can provide valuable information regarding impacts of wind power development on wildlife. The objective of this monitoring is to estimate abundance of a super-population of carcasses that entered the area within a designated period of time. By definition, the population is not closed and carcasses can enter as they are killed through collision with turbines, and leave as they are removed by scavengers or decompose to a point where they are not recognizable. In addition, the population is not inherently mobile, but can only change location through some external force. A focus on number of animal carcasses comprising the super-population, combined with peculiar traits that resist classic assumptions, distinguish fatality estimation at wind-power facilities from more classic abundance estimates that can be addressed through mark-recapture techniques or other well-known abundance estimators. We review the available methods to estimate the super-population of carcasses at wind power facilities. We discuss the role of these estimates in determining appropriate levels of minimization and mitigation of impacts to individual species of concern. We discuss the potential to extrapolate these measurements to reflect the cumulative effect of the industry on individual species. Finally, we suggest avenues of research needed to strengthen our understanding of the effect wind power development has, and might have in the future, on wildlife on this continent and worldwide.
Denk, Daniela; Boufana, Belgees; Masters, Nicholas J; Stidworthy, Mark F
Tapeworms of the genus Echinococcus reside in the small intestine of a number of carnivorous species, predominantly canids. In enzootic areas, hydatidosis caused by taeniid metacestodes can present a significant problem in accidental intermediate hosts, including humans. Whereas the United Kingdom is currently considered free of Echinococcus multilocularis, Echinococcus granulosus sensu stricto (s.s.) and Echinococcus equinus are endemic in the UK and have been reported in a variety of captive mammals. The presentation of echinoccocosis in non-human primates widely parallels disease in humans, and public health concerns are related to the four genera, E. granulosus, E. multilocularis, Echinococcus vogeli and Echinococcus oligarthrus. In contrast, sporadic outbreaks and individual hydatid disease cases in non-human primates have been associated with several Echinococcus and Taenia species. Here we describe three fatal cases of cystic echinococcosis in two captive ring-tailed lemurs (Lemur catta) and one captive red-ruffed lemur (Varecia variegata rubra) and provide molecular tapeworm characterisation. To the best of the authors' knowledge, this includes the first report of Echinococcus ortleppi in a UK born ring-tailed lemur and provides the first in depth case reports of echinococcosis due to E. equinus in UK born ring-tailed and red ruffed lemurs with detailed clinical and pathological findings. The cestode life cycle and implications for zoo collections are discussed. PMID:26872922
Full Text Available A small focus of hemorrhagic fever (HF cases occurred near Cochabamba, Bolivia, in December 2003 and January 2004. Specimens were available from only one fatal case, which had a clinical course that included fever, headache, arthralgia, myalgia, and vomiting with subsequent deterioration and multiple hemorrhagic signs. A non-cytopathic virus was isolated from two of the patient serum samples, and identified as an arenavirus by IFA staining with a rabbit polyvalent antiserum raised against South American arenaviruses known to be associated with HF (Guanarito, Machupo, and Sabiá. RT-PCR analysis and subsequent analysis of the complete virus S and L RNA segment sequences identified the virus as a member of the New World Clade B arenaviruses, which includes all the pathogenic South American arenaviruses. The virus was shown to be most closely related to Sabiá virus, but with 26% and 30% nucleotide difference in the S and L segments, and 26%, 28%, 15% and 22% amino acid differences for the L, Z, N, and GP proteins, respectively, indicating the virus represents a newly discovered arenavirus, for which we propose the name Chapare virus. In conclusion, two different arenaviruses, Machupo and Chapare, can be associated with severe HF cases in Bolivia.
Choi, Sang-Sik; Kim, Won Young; Kim, Won; Lim, Kyung-Su
Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine outp...
Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva;
BACKGROUND: Lower case fatality and increased use of evidence-based invasive management incl. coronary angiography (CAG) have been reported for patients admitted with acute myocardial infarction (AMI) in the last 25 years. This article seeks to investigate whether these advances have benefitted...
Hong, Seung-Dok; Park, Seong-Hwan; Kang, Seung-Ji; Kwon, Yong Soo; Kee, Seung-Jung; Park, Kyung-Hwa; Jung, Sook-In; Jang, Hee-Chang
It has been suggested that oseltamivir-resistant influenza viruses harboring the H274/275Y mutation are less virulent than are those that are oseltamivir-sensitive, and fatality attributed to infection with an oseltamivir-resistant virus is very rare. Here we report the first fatal adult case of oseltamivir-resistant 2009 pandemic influenza A (H1N1) in Korea. A 60-year-old Korean male who had hypertension, diabetes mellitus, chronic kidney disease, and dilated cardiomyopathy visited Chonnam N...
Full Text Available Abstract Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further
Full Text Available Aim: To present a fatal case of serotonin syndrome accompanied by moclobemide and paroxetine overdose. Case presentation: A 34-year-old married woman was presented following intentional ingestion of 3.5 g moclobemide and 2.6 g paroxetine. She was drowsy, agitated, and having rigor. In 1 h she developed myoclonus and diffuse muscle rigidity prominent in lower extremities. All laboratory tests were unremarkable except hyperglycemia (160 mg/dl, sinus tachycardia (103/min, and metabolic acidosis (7.051 pH, 52 mmHg pO2, 74.7 mmHg pCO2, 15% HCO3, 77% SaO2. Despite oxygen supplementation, her respiratory acidosis got worse and the SaO2 concentration decreased to 72%. Endotracheal intubation and paralysis were decided to control muscle hyperactivity followed by hyperthermia (max. 42.3°C unresponsive to benzodiazepine. Even aggressive supportive treatment (mechanical ventilation, buffer replacement, cyproheptadine, and dantrolene were applied, the patient could not recover and suffered cardiopulmonary arrest 20 h after presentation. Conclusion: Physicians working in the emergency departments and intensive care units, managing patients presenting with acute ingestion of selective serotonin reuptake inhibitors combined with monoamine oxidase inhibitors, should be aware of recognizing and treating serotonin stndrome. This is because many of these patients may require intensive care monitoring as well as tracheal intubation and ventilatory support.
Howe, Laryssa; Hunter, Stuart; Burrows, Elizabeth; Roe, Wendi
Four cases of fatal toxoplasmosis in three endemic New Zealand avian species are reported. Between 2009 and 2012, two kereru (Hemiphaga novaeseelandiae), one North Island brown kiwi (Apteryx mantelli), and one North Island kaka (Nestor meridionalis) were submitted for necropsy examination. On gross postmortem, the kiwi had marked hepatosplenomegaly while the kaka and two kereru had swollen, slightly firm, deep-red lungs. Histologically there was extensive hepatocellular necrosis in the liver of the kiwi while the kaka and kereru showed severe fibrinous bronchointerstitial pneumonia. In the kiwi, protozoal organisms were present within both hepatocytes and Kupffer cells of the liver and within the epithelial cells and macrophages of the interstitium of the lungs in the kaka and two kereru. The diagnosis of toxoplasmosis was confirmed with immunohistochemistry and PCR of paraffin-embedded formalin-fixed tissue of the liver, lungs, or both. Genotyping of up to seven markers revealed that an atypical Type II isolate of Toxoplasma gondii was present in at least three of the cases. This study provides evidence that T. gondii can cause mortality in these endemic species and suggests further research is needed to determine the full extent of morbidity and mortality caused by this parasite in New Zealand's unique avifauna. PMID:24758132
Drago, F; Cogorno, L; Broccolo, F; Ciccarese, G; Parodi, A
We report the first case of drug rash with eosinophilia and systemic symptoms (DRESS) following strontium ranelate (SR) treatment associated with systemic human HHV-7 reactivation. DRESS syndrome is a severe adverse drug-induced reaction presenting as a diffuse maculopapular skin rash with fever, hematological abnormalities (leukocytosis, eosinophilia, and/or atypical lymphocytosis), and multiorgan involvement. In our patient, diagnosis of DRESS was confirmed by the presence of six of the seven diagnostic criteria established in 2006 by the Japanese Research Committee on Severe Cutaneous Adverse Drug Reaction: maculopapular skin rash developing at least 3 weeks after starting therapy with a limited number of drugs, prolonged clinical symptoms after discontinuation of the causative drug, lymphadenopathy, fever, leukocyte abnormalities, and liver abnormalities. The diagnostic criteria of human herpesvirus (HHV)-6 reactivation have not been fulfilled in our patient, but a HHV-7 active infection was demonstrated by the presence of HHV-7 DNA and IgM in the patient's serum. In fact, in some DRESS instances, reactivation of HHVs other than HHV-6 may be detected, including HHV-7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Our case underlines that not only HHV-6 but also HHV-7 systemic reactivation may be associated with a more severe and even fatal course of this syndrome. PMID:26519419
Full Text Available BACKGROUND AND OBJECTIVE: Coronary heart disease (CHD is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain. METHODS: Using a population-based registry (the REGICOR Study, we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA/European Society of Cardiology (ESC and the World Health Organization (WHO-Monitoring trends and determinants in cardiovascular diseases (MONICA. RESULTS: In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively. Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition. CONCLUSIONS: The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD.
Ng, Dianna L; Al Hosani, Farida; Keating, M Kelly; Gerber, Susan I; Jones, Tara L; Metcalfe, Maureen G; Tong, Suxiang; Tao, Ying; Alami, Negar N; Haynes, Lia M; Mutei, Mowafaq Ali; Abdel-Wareth, Laila; Uyeki, Timothy M; Swerdlow, David L; Barakat, Maha; Zaki, Sherif R
Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes an acute respiratory illness and is associated with a high case fatality rate; however, the pathogenesis of severe and fatal MERS-CoV infection is unknown. We describe the histopathologic, immunohistochemical, and ultrastructural findings from the first autopsy performed on a fatal case of MERS-CoV in the world, which was related to a hospital outbreak in the United Arab Emirates in April 2014. The main histopathologic finding in the lungs was diffuse alveolar damage. Evidence of chronic disease, including severe peripheral vascular disease, patchy cardiac fibrosis, and hepatic steatosis, was noted in the other organs. Double staining immunoassays that used anti-MERS-CoV antibodies paired with immunohistochemistry for cytokeratin and surfactant identified pneumocytes and epithelial syncytial cells as important targets of MERS-CoV antigen; double immunostaining with dipeptidyl peptidase 4 showed colocalization in scattered pneumocytes and syncytial cells. No evidence of extrapulmonary MERS-CoV antigens were detected, including the kidney. These results provide critical insights into the pathogenesis of MERS-CoV in humans. PMID:26857507
Harder, A; Gregor, A; Wirth, T; Kreuz, F; Schulz-Schaeffer, W J; Windl, O; Plotkin, M; Amthauer, H; Neukirch, K; Kretzschmar, H A; Kuhlmann, T; Braas, R; Hahne, H H; Jendroska, K
Fatal familial insomnia (FFI) is a prion disease exhibiting the PRNP D178N/129M genotype. Features of this autosomal dominant illness are progressive insomnia, dysautonomia, myoclonus, cognitive decline and motor signs associated with thalamic nerve cell loss and gliosis. In contrast to the new variant of Creutzfeldt-Jakob disease (vCJD) the onset of FFI is in middle to late adulthood. We report two male patients who belong to a large German FFI kindred. They were examined clinically, and postmortem neuropathological examination was carried out in collaboration with the German reference centre for prion disease. Additionally, the prion protein gene (PRNP) was analysed. To identify further patients with disease onset under 30 years of age a comprehensive literature review was carried out. Two male patients presented with typical symptoms of FFI at the age of 23 and 24 years. In their kindred, the age of onset has never before been under 44 years of age. Our literature review identified five additional early onset cases who died at age 21 to 25 years. In all 22 reviewed FFI families the median manifestation age was 49.5 years. Although phenotypic variability of FFI is common, age of onset under 30 years has been considered to be a hallmark of vCJD with a mean manifestation at 27 years of age. Our findings underline that in addition to vCJD, FFI must be considered in cases of young-onset prion disease. This has considerable impact on clinical management and genetic counselling. PMID:15311348
Lee, Chung-Hsun; Wang, Chao-Ling; Lin, Hsiu-Fen; Chai, Chee-Yin; Hong, Ming-Yuan; Ho, Chi-Kung
To document two cases of patients who were fatally exposed to tetramethylammonium hydroxide (TMAH) on the skin and to establish a rat model to investigate the effects of dermal exposure to TMAH. The charts of two workers who died from occupational accidental exposure to TMAH were reviewed. The 4-hour lethal dose (LD₅₀) of TMAH was determined by applying solutions mimicking the two most common industrially used concentrations (2.38% and 25%) of TMAH to the skin of Sprague-Dawley rats. Exposure of the rat's skin to 2.38% or 25% TMAH generated LD₅₀ values of 85.9 mg/kg and 28.7 mg/kg, respectively. Application of either concentration of TMAH to the skin produced a rapid, significant increase in the rate of respiration. The serum concentrations of tetramethylammonium (TMA) also changed significantly with time of exposure to both concentrations of TMAH. The level of blood urea nitrogen decreased significantly in rats exposed to the 2.38% TMAH, and rats exposed to the 25% solution had a significant decrease in the serum concentration of sodium. Injection of atropine after 5 minutes of exposure did not significantly overcome any of the toxic effects observed with either solution of TMAH. The preliminary results in the rat model indicated that the lethality of TMAH cannot be fully explained by the severity of the patients' chemical burns, and the physiologic effects on respiratory and kidney functions were probably involved. PMID:21310775
Borges, Adolfo; Morales, Melva; Loor, Wilmer; Delgado, Miguel
The presence in rural areas of western Ecuador of scorpions in the genus Tityus capable of producing pediatric mortality is hereby evidenced. The medical significance of scorpions in Ecuador has been underestimated partly because of the clinically unimportant stings delivered by Centruroides margaritatus and Teuthraustes atramentarius, which have venom with low toxicity to vertebrates. Five intra-domiciliary cases of scorpion envenoming in victims aged between 1.9 and 16 years old, including one fatality, are reported from rural settings in forest areas of Chone (n = 2) and Flavio Alfaro (n = 3) counties, northern Manabí province, western Ecuador. Three cases were graded as Class II (moderate) and two in Class III (severe) envenoming. Manifestations showed characteristic autonomic nervous system hyper-stimulation and the fatality (a 1.9-year-old boy from Flavio Alfaro) was due to cardio-respiratory failure. Marked leukocytosis in four of the cases (21,800-31,800 cells/mm(3)), with notable neutrophilia (58-82%), suggests induction of a venom-mediated systemic inflammatory response-like syndrome. Specimens responsible for cases in Flavio Alfaro County, including the fatality, were classified as Tityus asthenes Pocock, accountable for severe scorpionism in Colombia. These findings demand implementation of control and therapeutic measures in affected areas in Ecuador, including evaluation of available scorpion antivenoms. PMID:26344916
McIntyre, Iain M; Trochta, Amber; Gary, Ray D; Wright, Jennifer; Mena, Othon
In this case report, we present an evaluation of the distribution of postmortem concentrations of butyr-fentanyl in a fatality attributed principally to the drug. A man who had a history of intravenous drug abuse was found unresponsive on the bathroom floor of his home. Drug paraphernalia was located on the bathroom counter. Toxicology testing, which initially screened positive for fentanyl by enzyme-linked immunosorbent assay, subsequently confirmed butyr-fentanyl, which was then quantitated by gas chromatography-mass spectrometry-specific ion monitoring (GC-MS SIM) analysis following liquid-liquid extraction. The butyr-fentanyl peripheral blood concentration was quantitated at 58 ng/mL compared with the central blood concentration of 97 ng/mL. The liver concentration was 320 ng/g, the vitreous was 40 ng/mL, the urine was 670 ng/mL and the gastric contained 170 mg. Acetyl-fentanyl was also detected in all biological specimens tested. Peripheral blood concentration was quantitated at 38 ng/mL compared with the central blood concentration of 32 ng/mL. The liver concentration was 110 ng/g, the vitreous was 38 ng/mL, the urine was 540 ng/mL and the gastric contained <70 mg. The only other drug detected was a relatively low concentration of benzoylecgonine. The cause of death was certified as acute butyr-fentanyl, acetyl-fentanyl and cocaine intoxication, and the manner of death was certified as accident. PMID:26683128
Kauppi, Anne Leena Marika; Vanamo, Tuija; Karkola, Kari; Merikanto, Juhani
A parent who continuously physically abuses her/his child doesn't aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12%) were caused by child battering and 13 (7%) by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot) and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse) were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent) and often substance dependence (31%). None of them were psychotic. Authorities and community members should pay attention to the change in child's behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent's life, the child may be in danger. PMID:25478105
Řehulka, Hynek; Čechová, Eva; Mottlová, Jitka; Valenta, Martin; Mareška, Zdeněk
The authors deal with a case of suicidal attempt resulting in a fatal head injury. A young man shot himself with a serially produced mechanical sports crossbow. The young man with a critical intracranial injury, a penetration, was nevertheless capable of basic locomotive activity, as well as of coherent communication with another people present at the scene. The critically injured patient was transported from the scene directly to medical centre where he subsequently underwent a neurologic surgery. On the eight day after the incident he died in the hospital as a result of sustained wounds. During the autopsy, a penetrating arrow-shot wound head injury was certified, occurring in the right and left temple area. Signs of a complex decompressive craniectomy were established too. The shooting channel was generally horizontally oriented, extending from the right to the left side, from behind in a 10 up to 15 degrees angle to the frontal plane, penetrating the brain from the right temple lobe and the frontal lobe, thereby pervading also frontal horns of lateral ventricles, and from the left afflicting the frontal lobe on the left side of the brain. In the course of the shooting channel, brain contusion occurred, accompanied by intraventricular haemorrhage. In addition, a heavy cerebral oedema, multiple secondary malacias, Durett haemorrhages and extensive thrombosis of cerebral sinuses were stated. In the course of police investigation, based mainly on the information given by the wounded man right after he had been found at the scene, it was revealed that another person might have been involved. The forensic autopsy, the investigation of the Police and the subsequent criminalist-ballistics expert investigation, supported by a series of experimental substitutive target shots, didnt, however, decidedly prove that any other culprit had been involved. PMID:27108656
Full Text Available A parent who continuously physically abuses her/his child doesn’t aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12% were caused by child battering and 13 (7% by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent and often substance dependence (31%. None of them were psychotic. Authorities and community members should pay attention to the change in child’s behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent’s life, the child may be in danger.
Peng, Bin; Zhang, Shenqi; Dong, Hongjuan; Lu, Zuneng
To explore clinical, histopathological and genetic features of a case with fatal familial insomnia (FFI) and review the related literatures. A middle-aged woman who complained of “insomnia for 9 months and psychosis for 3 months” was suspicious of FFI. The clinical features of the patient were analyzed, and the dead patient was examined by autopsy and the brain tissues were obtained for histopathological studies, and the blood samples from the patient and some of her familial members were col...
Lee, Mi Ji; Shin, Jisoo; Chung, Eun Joo; Kim, Sang-Jin; Kwon, Soonwook; Kim, Jung-Hyun; Seo, Sang Won; Ki, Chang-Seok; Na, Duk L.
Background and Methods Fatal familial insomnia (FFI) is a rare genetic disease characterized by intractable insomnia, dysautonomia, and dementia. Herein we describe a patient with FFI. In order to study brain glucose hypometabolism in the patient, we used statistical parametric mapping (SPM) analysis of [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET). Case Report The patient was a 34-year-old Korean man. He presented with intractable insomnia, rapidly progressive dementia and ...
Full Text Available A case of near-fatal oseltamivir-resistant seasonal influenza A infection in a previously healthy four-year-old boy is reported. This case highlights three important points for physicians: oseltamivir-resistant influenza A (H1N1 has recently emerged in North America; contrary to previously held beliefs, such strains are capable of causing severe disease in healthy children; and given this change in epidemiology, clinicians caring for children with severe seasonal influenza A infection should consider empiric dual therapy with oseltamivir and amantadine.
Wilson X. Camargo Filho
Full Text Available Traffic accidents in Brazil kill more than 40,000 people a year and injure another 400,000, with largely permanent health impacts. This paper proposes the use of Forensic Intelligence, a field of Forensic Science that is able to convert forensic data into useful information, as a means to support policy measures and strategies, in order to prevent accidents. The selected study site was a small stretch on a Federal Highway (BR-040, where four fatal crashes occurred at the beginning of 2012. This highway had good mobility conditions and had no problems that could be correlated with these four fatal events, although speeding, alcohol abuse, and/or driver inattention were present in the crashes. We propose some possible interventions here, such as the use of advertising campaigns, strengthening traffic law enforcement, reduction of the speed limit, and the installation of electronic speed control devices in order to avoid future traffic accidents.
Rautji, Ravi; Rudra, A; Dogra, T D
A 20 year-old male driver of a heavy duty crane, employed in an industry located in an industrial area on the outskirts of Delhi was fatally injured while repositioning an ill-fitted locking rim of a crane tyre (Fig. 1). The inner tube of the crane tyre had accidentally burst, dislodging the loose iron-locking rim, which hit the individual with a great force resulting in multiple injuries. He died on his way to the hospital. PMID:14642727
Oliver W Morgan
Full Text Available BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires
Full Text Available Abstract Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic, and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years. In 92 cases (89%, death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases, followed by ethanol (9%, tricyclic anti-depressants (TCAs (4%, benzodiazepines (4%, and zopiclone (4%. Seventy-one (69% were evaluated as accidental deaths and 32 (31% as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04. Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91, 14% (95% C.I., 0.04-0.33, and 10% (95% C.I., 0.02-0.27, respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental
Ranganath R Kulkarni
Full Text Available Linezolid is a synthetic antimicrobial agent of the oxazolidinone class with weak, nonspecific inhibitor of monoamine oxidase enzymes. Concomitant therapy with an adrenergic or serotonergic agent or consuming tyramine (>100 mg/day may induce serotonin syndrome (SS. We present a case report of near-fatal adverse interaction between linezolid and escitalopram inducing SS in a 65-year-old woman with sepsis, under empirical antibiotic treatment. This report also summarizes the current relevant literature as identified via PubMed, EMBASE, and PsycINFO, supplemented with a manual search of cross references.
Kawasaki, K; Wakabayashi, K; Kawakami, A; Higuchi, M; Kitamoto, T; Tsuji, S; Takahashi, H
We describe a 68-year-old man with a 53-month history of progressive dementia and clinical features of a progressive supranuclear palsy-like syndrome and dysautonomia. In the late stage of his illness, the patient also developed generalized myoclonic seizures. There was no family history of similar disorders. Histological examination revealed neuronal loss and gliosis with spongiosis in the cerebral cortex. In addition, more severe neuronal loss and gliosis without spongiosis were observed in the thalamus, especially in the anterior ventral and mediodorsal nuclei, and the inferior olivary nucleus. There was also obvious loss of Purkinje cells. Immunohistochemically, no protease-resistant prion protein (PrPres)-positive structures were demonstrated. However, Western blotting revealed the presence of PrPres in the cerebral cortex. This patient had a wild type of PrP genotype. We initially considered this to be a case of the thalamic form of Creutzfeldt-Jakob disease (CJD) with a long duration. However, it is noteworthy that essentially similar pathology, albeit with less severe cerebral cortical changes, has also been reported in fatal familial insomnia, a newly identified phenotypically different prion disease with a mutation in the PrP gene. On the basis of clinicopathological features, we eventually felt that this patient was more likely to have been a sporadic case of fatal insomnia (FI) of long duration. The present case appears to draw further attention to the possible relationship between CJD and FI. PMID:9083566
Full Text Available A 77-year-old male patient with a history of tuberculosis applied to emergency service with complaints of confusion, shortness of breath, tachycardia, hypothermia and hypotension. A bronchoalveolar lavage culture was collected because a fungus ball was seen on repeat chest X-ray and thoracic CT of the patient. Aspergillus fumigatus grew and voricona-zole treatment was started, but the patient was lost from multiple organ failure (MOF. In diagnosis of patients with SIRS clinic, causative factor may be aspergillus located in an old tuberculosis cavity, and this may have a fatal course in an old patient having previous pulmonary and systemic diseases.
Martínez-Ruiz, Virginia; Jiménez-Mejías, Eladio; Amezcua-Prieto, Carmen; Olmedo-Requena, Rocío; Luna-del-Castillo, Juan de Dios; Lardelli-Claret, Pablo
This study was designed to quantify the percent contribution of exposure, risk of collision and fatality rate to the association of age and sex with the mortality rates among cyclists in Spain, and to track the changes in these contributions with time. Data were analyzed for 50,042 cyclists involved in road crashes in Spain from 1993 to 2011, and also for a subset of 13,119 non-infractor cyclists involved in collisions with a vehicle whose driver committed an infraction (used as a proxy sample of all cyclists on the road). We used decomposition and quasi-induced exposure methods to obtain the percent contributions of these three components to the mortality rate ratios for each age and sex group compared to males aged 25-34 years. Death rates increased with age, and the main component of this increase was fatality (around 70%). Among younger cyclists, however, the main component of increased death rates was risk of a collision. Males had higher death rates than females in every age group: this rate increased from 6.4 in the 5-14 year old group to 18.8 in the 65-79 year old group. Exposure, the main component of this increase, ranged between 70% and 90% in all age categories, although the fatality component also contributed to this increase. The contributions of exposure, risk of crash and fatality to cyclist death rates were strongly associated with age and sex. Young male cyclists were a high-risk group because all three components tended to increase their mortality rate. PMID:25658669
Budagoda BDSS; Kularatne SAM; Kodikara KAS; Kularatne WKS; Mudiyanse RM; Edussuriya DH; Edirisinghe JP; Karunaratne IP; Weerakoon KGAD; Medagedara SC
The sting of Giant Asian honeybee (Apis dorsata) or Bambara in Sinhala and Karunge Kulavi in Tamil is a common environmental hazard in Sri Lanka known to cause immediate allergic reactions, which could be fatal in sensitized individuals. We reported myocardial infarction, bowel gangrene and fatal anaphylaxis in a prospectively proven case series and the association of these uncommon complications with delayed removal of stingers from the patients’ skin.
Invasive candidiasis has increased as nosocomial infection recently in cancer patients who receive systemic chemotherapy, and the timely risk assessment for developing such specific infection is crucial. Especially in those concomitantly with hypopituitarism, febrile neutropenia with candidiasis can cause severe stress and lead potentially to sudden fatal outcome when the temporal steroid coverage for the adrenal insufficiency is not fully administered. We report a 72-year-old male case diagnosed as non-small-cell lung cancer, Stage 3A. He had received a steroid replacement therapy for the prior history of hypophysectomy due to pituitary adenoma with hydrocortisone of 3.3 mg/day, equivalent to prednisolone of 0.8 mg/day. This very small dosage of steroid was hardly supposed to weaken his immune system, but rather potentially led to an inappropriate supplementation of his adrenal function, assuming that the serum sodium and chlorine levels decreased. On Day 6 of second cycle of chemotherapy with carboplatin and paclitaxel, he developed sudden febrile neutropenia, septic shock and ileus, leading to death. After his death, the venous blood culture on Day 7 detected Candida albicans. Autopsy findings showed a massive necrotizing enterocolitis with extensive Candida invasion into submucous tissue. In conclusion, this case may suggest that (1) immediate initiation of antifungal therapy soon after the careful risk assessment of Candida infection and (2) adequate administration of both basal steroid replacement therapy and temporal steroid coverage for febrile neutropenia might have improved his fatal outcome. (author)
Full Text Available No abstract available. Article truncated at 150 words. Introduction: Left ventricular assist device (VAD therapy is an increasingly utilized treatment as a bridge to heart transplantation or as long-term destination therapy. Recent reports show there is a 22% - 32% incidence of VAD-associated infections with staphylococci and nosocomial gram-negative bacilli being the most common causative organisms (1,2. These organisms are often found in intensive care units, where they have the highest proportion of resistance, thus exposing already critically ill patients to the possibility of resistant organism VAD-associated infections (3. Mortality rates exceed 60% when sepsis develops in a patient with a continuous flow left VAD and infection is the number one cause of death in those awaiting cardiac transplantation (4,5. With continued left VAD use clinicians will likely see multidrug-resistant (MDR or even pandrug-resistant organism VAD-associated infections. Clinicians need to be prepared to manage such an intimidating entity. Case Report: We report a case of a 25 year-old ...
Full Text Available Mediterranean spotted fever (MSF is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a ‘tache noire’, serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman.
Full Text Available We report a case of fatal pulmonary embolism (PE following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.
Banerjee, Priya; Ali, Zabiullah; Fowler, David R
Streptobacillus moniliformis is the primary cause of rat bite fever in North America. Children under 12 years of age are primarily infected, presenting with an acute syndrome of fever, rash, and polyarthritis. Common vectors include rats and mice. Transmission is predominantly from a bite or scratch, but contact with or ingestion of food contaminated with feces or saliva has also been reported. We report a fatal case of S. moniliformis infection in a 14-month-old-boy. At home, the child was exposed to filthy living conditions and the family had pet ferrets. Autopsy revealed a red-pink, mostly confluent rash and a circumscribed area suspicious for a possible bite mark. Cerebrospinal fluid cultures were positive for S. moniliformis. This case highlighted key features, such as the morbiliform rash, but lacked lymphadenopathy or joint manifestations. It is important to consider rat or rodent exposure as a source of infection. PMID:21306374
Reissier, Sophie; Masson, Romain; Guérin, François; Viquesnel, Gérald; Petitjean-Lecherbonnier, Joëlle; Pereyre, Sabine; Cattoir, Vincent; Isnard, Christophe
Meningitis due to Mycoplasma hominis in adults is rarely described, with only three cases having been reported to date. A case of fatal meningitis in a 39-year-old patient after a neurosurgical procedure for a subarachnoid haemorrhage is reported herein. Identification and treatment were significantly delayed because of the rarity of the aetiology and difficulty identifying this organism with the routinely used conventional methods, such as Gram staining and agar growth on standard agar plates. Clinical procedures and the treatment of 'culture-negative' central nervous system infections is a real challenge for clinical microbiologists and clinicians, and M. hominis has to be considered as a potential, although very uncommon, pathogen. PMID:27208637
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de la Grandmaison, Geoffroy Lorin; Fermanian, Christophe; Aegerter, Philippe; Durigon, Michel
A retrospective study was carried out on 132 fatalities due to gunshot wounds secondary to long firearms. One group of suicide (n=72) and one group of homicide (n=60) were statistically compared regarding age and sex of the victim, number of shots, range of fire, direction of the projectile(s), anatomical distribution of entrance sites, weapon and ammunition types and the nature of eventual associated traumatic lesions. The frequency of suicide was higher when the victim's age increased. Females constituted about 43% of the homicide victims and about 8% of the suicide victims. 51.5% of the homicide victims and about 10% of the suicide victims had sustained more than one gunshot wound. Close range was respectively found in 53.5% of the homicide cases and in all suicide cases. Most of the suicide cases (85% of the cases) showed typical entrance sites. Entrance sites in the limbs and lateral or posterior wall of the chest were only encountered in homicide cases. Associated traumatic lesions were found in about 23% of the homicide cases and in 18% of the suicide cases. In case of suicidal gunshots to the left chest, both upwards and downwards directions, and also both right-to-left and left-to-right directions can occur. From 22 suicide cases showing entrance wound in the mouth, a downwards direction was found in only one. This study underlines the importance but also the limits of the autopsy findings (including direction of the projectile(s) related to the entrance site) for giving an indication of the manner of death (homicide vs. suicide). PMID:18282673
Kopits, Elizabeth; Cropper, Maureen
This paper examines the relationship between traffic fatality risk and per capita income and uses it to forecast traffic fatalities by geographic region. Equations for the road death rate (fatalities/population) and its components--the rate of motorization (vehicles/population) and fatalities per vehicle (F/V)--are estimated using panel data from 1963 to 1999 for 88 countries. The natural logarithm of F/P, V/P, and F/V are expressed as spline (piecewise linear) functions of the logarithm of real per capita GDP (measured in 1985 international prices). Region-specific time trends during the period 1963-1999 are modeled in linear and log-linear form. These models are used to project traffic fatalities and the stock of motor vehicles to 2020. The per capita income at which traffic fatality risk (fatalities/population) begins to decline is 8600 US dollars (1985 international dollars) when separate time trends are used for each geographic region. This turning point is driven by the rate of decline in fatalities/vehicles as income rises since vehicles/population, while increasing with income at a decreasing rate, never declines with economic growth. Projections of future traffic fatalities suggest that the global road death toll will grow by approximately 66% over the next twenty years. This number, however, reflects divergent rates of change in different parts of the world: a decline in fatalities in high-income countries of approximately 28% versus an increase in fatalities of almost 92% in China and 147% in India. The road death rate is projected to rise to approximately 2 per 10,000 persons in developing countries by 2020, while it will fall to less than 1 per 10,000 in high-income countries. PMID:15607288
This fact sheet outlines the development of the number of road fatalities in the Netherlands since 1950. After a rise in the 1950s and 1960s, the number of road deaths in the Netherlands has shown a gradual decline since 1973. As was the case in 2013, the Netherlands counted 570 road fatalities in 2014. Nearly a third of the fatalities are car occupants (187), another near third are cyclists (185). Measured by the population size, relatively many fatalities occur among young people and young ...
Pindyck, Talia N; Dvorscak, Lauren E; Hart, Blaine L; Palestine, Michael D; Gallant, Joel E; Allen, Sarah E; SantaCruz, Karen S
Balamuthia mandrillaris is a free-living amoeba that can cause granulomatous amebic encephalitis (GAE). We report a case in an individual with a history of alcohol abuse, cocaine use, and ditch water exposure. This is the first reported case of GAE due to B mandrillaris in New Mexico. PMID:25734132
Pindyck, Talia N.; Dvorscak, Lauren E.; Hart, Blaine L.; Palestine, Michael D.; Gallant, Joel E.; Allen, Sarah E; SantaCruz, Karen S.
Balamuthia mandrillaris is a free-living amoeba that can cause granulomatous amebic encephalitis (GAE). We report a case in an individual with a history of alcohol abuse, cocaine use, and ditch water exposure. This is the first reported case of GAE due to B mandrillaris in New Mexico.
Holm, Janni Schmidt; Brixen, Kim; Andries, Alin;
room treatment was extracted from a population-based registration system. RESULTS: Personality disorders were diagnosed in all five patients and substance abuse in three patients. In all cases, illness duration was more than 10 years and late onset was seen in two cases. None of the deaths were due...
Kent, Richard; Henary, Basem; Matsuoka, Fumio
This study describes the fatal crash experiences of older drivers. Data from two U.S. databases (NASS-CDS and FARS) were used. Several crash, vehicle, and occupant characteristics were compared across age groups, including vehicle type, crash direction (PDOF), severity (ΔV), and injured body region. A sub-set of 97 fatally injured drivers was chosen for a detailed case study. The mean travel speed, ΔV, and airbag deployment rate decreased significantly with age (p
Mahadeva, U; Al-Mrayat, M; Steer, K; Leen, E
The phenytoin (hydantoin) hypersensitivity syndrome is rare but potentially fatal. Often, as in this case, it presents with non-specific symptoms and signs, requiring a high degree of clinical suspicion for diagnosis. Keywords: phenytoin; hydantoin; hypersensitivity.
Rutherford, Jeremiah S.; Macaluso, Kevin; Smith, Nathaniel; Zaki, Sherif R.; Paddock, Christopher D.; Davis, Jon; Peterso, Norman; Azad, Abdu F.; Rosenberg, Ronald
We report a fatal case of rickettsiosis in a woman from the United States living in Kenya, who had a history of tick exposure. Immunohistochemical staining of skin, kidney, and liver demonstrated spotted fever group rickettsiae. The clinical findings, severity, and fatal outcome are most consistent with Rickettsia conorii infection.
Bonney Joseph Humphrey; Kwame-Aryee Robert A; Obed Samuel; Tamatey Ama; Barnor Jacob; Armah Naa; Oppong Samuel; Osei-Kwesi Mubarak
Abstract Background Viral infections during pregnancy can pose serious threats to mother and fetus from the time of conception to the time of delivery. These lead to congenital defects, spontaneous abortion and even death. The definitive diagnosis and management of pregnancy-related viral infections may be challenging especially in less resourced countries. Case presentation We present clinical and laboratory responses to the diagnosis and management of three cases of fulminant hepatitis seco...
S.M. Barreto; Swerdlow, A J; Smith, P G; Higgins, C D
OBJECTIVES: To estimate the relative risk of death from work related injury in a steelworks, associated with exposure to various occupational hazards, sociodemographic factors, and medical history. MATERIAL AND METHODS: The study was a nested case-control design. It was based on a cohort of men employed in the steel plant of USIMINAS, Brazil between January 1977 and August 1990, who were followed up to November 1992. The cases were defined as all workers in the cohort who died from injury in ...
R.A.M. Fouchier (Ron); P.M. Schneeberger (Peter); F.W. Rozendaal (Frans); J.M. Broekman (Jan); S.A. Kemink (Stiena); V.J. Munster (Vincent); G.F. Rimmelzwaan (Guus); M. Schutten (Martin); G.J.J. van Doornum (Gerard); G. Koch (Guus); A. Bosman (Arnold); M.P.G. Koopmans D.V.M. (Marion); A.D.M.E. Osterhaus (Albert); T. Kuiken (Thijs)
textabstractHighly pathogenic avian influenza A viruses of subtypes H5 and H7 are the causative agents of fowl plague in poultry. Influenza A viruses of subtype H5N1 also caused severe respiratory disease in humans in Hong Kong in 1997 and 2003, including at least seven fatal cases, posing a serious
Full Text Available In Denpasar the capital of Bali Province, motorcycle accident contributes to about 80% of total road accidents. Out of those motorcycle accidents, 32% are fatal accidents. This study investigates the influence of accident related factors on motorcycle fatal accidents in the city of Denpasar during period 2006-2008 using a logistic regression model. The study found that the fatality of collision with pedestrians and right angle accidents were respectively about 0.44 and 0.40 times lower than collision with other vehicles and accidents due to other factors. In contrast, the odds that a motorcycle accident will be fatal due to collision with heavy and light vehicles were 1.67 times more likely than with other motorcycles. Collision with pedestrians, right angle accidents, and heavy and light vehicles were respectively accounted for 31%, 29%, and 63% of motorcycle fatal accidents.
Cook, Deborah S; James, Ryk S
This article presents a case report of a shooting using an antique pistol. The unusual pathological findings are presented, together with a review of the law in this area. It seems that there is currently a loophole in the 1997 Firearms Act by means of which 'enthusiasts' or 'collectors' may legally possess weapons and then subsequently acquire ammunition illegally. PMID:12487522
Full Text Available Abstract Introduction Leiomyosarcomas are neoplasms of smooth muscles that most commonly arise from the uterus, gastrointestinal tract, or soft tissue. Primary pleural leiomyosarcoma is extremely rare. To the best of our knowledge, only nine cases have been published to date. Because of the rarity of pleural leiomyosarcoma and its similarity (clinical and histological to other pleural neoplasms, particularly sarcomatous mesothelioma, diagnosis is often difficult. Case presentation A 58-year-old North African man was admitted with complaints of dyspnea and chest pain to our hospital. Chest computed tomography revealed right pleural effusion and pleural thickening. A transthoracic needle biopsy yielded a diagnosis of leiomyosarcoma, and tumor cells were strongly and uniformly positive for vimentin, a smooth muscle actin at immunohistochemical analysis. A general examination did not show any metastatic lesions in other areas. One month after diagnosis, the tumor grew rapidly, with pulmonary invasion, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Because no organ of origin of the leiomyosarcoma, other than the pleura, was detected, this case was diagnosed as a primary pleural leiomyosarcoma. Conclusions Although leiomyosarcoma originating from the pleura is rare, this entity is increasingly described. The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified.
Venous embolization of barium has been recognized for 4 decades as one of the most dreaded complications of barium enema. Fortunately, the condition is extremely rare. In this report, the radiographic findings in 2 cases of venous embolization (one involving the portal vein and one systematic) are described, and ways to decrease the risk of this complication are discussed. (author)
Jaffre, S; Jardin, F; Dominique, S; Duet, E; Hubscher, Ph; Genevois, A; Corne, F; Bota, S; Nouvet, G; Thiberville, L
Lymphomatoid granulomatosis is a rare angiocentric and angiodestructive disease, which commonly involves the lungs but also the brain, kidneys, liver and skin. This report describes the case of a 33-yr-old female with an aggressive form of lymphoid granulomatosis treated with an anti-CD20 antibody. Dramatic radiological improvement was seen at the fourth week. However, the patient died at home 1 month after the last rituximab administration from a massive haemoptysis. PMID:16507866
Full Text Available Background and objective Massive hemoptysis was a rare but severe postoperative complication of lung cancer. The aim of the present study is to investigate the mechanisms, risk factors, early symptoms, prevention, and treatment options for fatal hemoptysis. Methods From April 2007 to May 2011, 1,737 patients with lung cancer were surgically treated in the West China Hospital of Sichuan University. Twenty patients died during the perioperative period, seven of whom died of massive hemoptysis. These seven cases were analyzed, and their clinical data, as well as related literatures, were reviewed. Results Massive hemoptysis is the second cause of death after lung cancer surgery. Six patients died directly of massive hemoptysis. One patient underwent secondary surgery because of massive hemoptysis, but eventually died because of lung infection and respiratory failure. Early symptoms of hemorrhage were observed in four cases, and the overall incidence rate of massive hemoptysis was 0.4% (7/1,737. Conclusion Bronchovascular ﬁstula (BVF caused by bronchopleural fistula (BPF is the mechanism for massive hemoptysis. Diabetes is a high risk factor. Early diagnosis and surgical treatment of BPF or BVF can prevent the occurrence of death as a result of massive hemoptysis.
Sam, Sing-Sin; Omar, Sharifah Faridah Syed; Teoh, Boon-Teong; Abd-Jamil, Juraina; Abubakar, Sazaly
Background Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. Methodology/Principal Findings We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if t...
Sing-Sin Sam; Sharifah Faridah Syed Omar; Boon-Teong Teoh; Juraina Abd-Jamil; Sazaly AbuBakar
BACKGROUND: Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if...
Miguel Ángel Serra Valdés
Full Text Available Bacterial infections of the urinary tract are a common problem in daily medical practice. They are very frequent and severe complications affecting diabetic patients. Motivation to report this case lies in its relevance to teaching, and invites reflection on how clinical practice of this entity is being performed. We report the case of a patient who started suffering from pain in the left lumbar region, radiating toward the front of the abdomen on that side of the body as far as the thigh, two months before hospital presentation. The pain was severe, constant and stabbing; it was relieved by analgesics and sometimes by bending the leg on that side. In addition, the patient experienced fatigue, loss of appetite, nausea, fever (38-39˚C, and burning sensation with frequent urination of small amounts of dark urine. Physical examination led to the diagnostic possibility of obstructive pyonephrosis which was confirmed by computed tomography. Medical treatment was applied and a left radical nephrectomy was performed.
Full Text Available Enterococcus species rarely cause bacterial meningitis without predisposing factors such as trauma, brain surgery, etc. In this study, we present a bacterial meningitis case caused by Enterococcus faecalis (E. faecalis in a 13-year-old male who was found dead at home. One hundred and forty two cm tall, 37 kg weight male had admitted to hospital two days after the beginning of complaints such as weakness, headache, swelling of left eye, nausea and vomiting. Body temperature was 37.3 oC, leucocyte count 22100/ mm3, and CRP 71 g/dl at the hospital admission. Antibiotic treatment with amoxicillin/clavulanic acid (625 mg was given to the patient but he was found dead in his house the day after. In autopsy; yellow-green purulant liquid in left frontoparietal zone, fullness of meningeal vessels and oedema was seen in brain. Isolated bacteria in cerebrospinal fluid (CSF was identificated as E. faecalis by mini API 32 Strep®. Postmortem microbiological sampling in autopsy and defining etiologic agents is important for rare meningitis cases in which antemortem identification could not be done before death.
Busardò, Francesco Paolo; Frati, Paola; Carbone, Iacopo; Pugnetti, Paola; Fineschi, Vittorio
Iatrogenic vascular injury during lumbar disk surgery, although rare, is a serious complication, and when it does occur, can be sudden and life-threatening. The risk of injury to the pelvic vessels intra-operatively can be explained by the close proximity of the retroperitoneal vessels to the vertebral column therefore causing injury to the anterior longitudinal ligament, which can give access to the retroperitoneal space. If signs of circulatory instability are noted during lumbar disk surgery, early diagnosis of vascular injury and urgent transperitoneal surgery or emergency stenting can save the patient's life. Here, is presented the case of a 52-year-old man who underwent an elective lumbar discectomy for a rightward disk herniation in the L4-L5 intervertebral space and died 12h after the operation for a hemorrhagic shock due to a severe intra-abdominal hemorrhage following iatrogenic left common iliac artery and vein perforation during lumbar discectomy. PMID:25467198
Full Text Available Introduction: The most frequent complication of A (H1N1 influenza and the leading cause of death was pneumonia with a primary viral or mixed viral and bacterial etiology. 182 patients had died because of a pandemic influenza in Poland by 31st July 2010.Material and Methods: A retrospective study of 6 fatal cases of pandemic influenza, aged 23-41, including 3 women, hospitalised between November 2009 and February 2011 in different Polish medical centres.Results: We present the clinical course of 6 late diagnosed cases of A (H1N1 influenza. All patients presented typical flu-like symptoms in the beginning. 4/6 patients had severe disease risk factors: pregnancy, arthritis, Wegener granulomatosis and obesity. All patients were seen by doctors, no one had received antiviral therapy, 4/5 were treated with antibiotics before they were hospitalized. One patient had nosocomial infection. Patients were admitted to the hospital on the 3rd to 8th day of the disease. They received oseltamivir treatment on the 4th to 9th day. All patients developed pneumonia complicated by acute respiratory distress syndrome. Death appeared between the 4th and 27th day after the onset of symptoms. Autopsies were performed in 5 cases and revealed haemorrhagic pneumonia in 2 patients.Conclusion: Delayed diagnosis and antiviral treatment initiation has a significant impact on mortality in A (H1N1 influenza. During the influenza epidemic, patients presenting typical symptoms should always be suspected of having influenza. Antiviral treatment has to be initiated immediately, especially ifthere are risk factors of severe disease.
Christine Baccarat de Godoy Martins
Full Text Available Hundreds of children and young people die from fatal accidents or violence every year and others suffer the consequences of non-lethal lesions. Knowing the associated factors is essential for moving forward in the control of these events. The study analysed the families’ perception and factors associated with deaths due to external causes of children, adolescents and young people. Cross-sectional study from deaths from accidents and violence in the age group of 0 to 24 years in the city ofCuiabá-State of Mato Grosso, followed by a domestic survey with the families. The families could not tell whether the accident/violence was a foreseeable event and do not believe that habits/lifestyle have favoured the occurrence. Intentional deaths showed a greater association with factors: maternity/paternity in adolescence, role overload of the mother, consumption of alcohol/drugs, family conflicts and prior deaths from external cause. Feelings of appreciation (study, housing, work, and whether the victim’s pregnancy has been desired were positive in a higher proportion among cases at which the victims died in an accident. The families had easy access to health care services; however, it was difficult to access the network of social and religious support. Associated factors differ according to the intentionality of the event.
Peng, Bin; Zhang, Shenqi; Dong, Hongjuan; Lu, Zuneng
To explore clinical, histopathological and genetic features of a case with fatal familial insomnia (FFI) and review the related literatures. A middle-aged woman who complained of "insomnia for 9 months and psychosis for 3 months" was suspicious of FFI. The clinical features of the patient were analyzed, and the dead patient was examined by autopsy and the brain tissues were obtained for histopathological studies, and the blood samples from the patient and some of her familial members were collected for the sequencing of prion protein gene (PRNP). The main clinical features included intractable insomnia, psychiatric symptoms and abnormal night sleep behavior, unsteady gait, difficulty swallowing, sudden death, and positive family history. The pathological studies showed neuronal loss and gliosis of multiple brain tissues in the proband, predominated with thalamus; and analysis of PRNP revealed gene D178N mutation, and linkage with 129 methionine (Met) allele in the proband and a relative. FFI patients may manifest as sudden death, and may have prominent psychiatric symptoms; the corresponding gene mutation could occur in the asymptomatic carriers; the data of autopsy and brain tissue pathology is helpful for further understanding of this disease. PMID:26617725
Full Text Available Allopurinol is used to treat hyperuricemia (HU in a patient of gout. It is also used to prevent HU in a patient of hematological malignancies who are about to undergo chemotherapy. Allopurinol is usually well-tolerated but it occasionally induces hypersensitivity reactions that manifest after few months of therapy. Cutaneous reactions are pruritic, erythematous, or maculopapular eruptions. Rarely fatal toxic epidermal necrolysis or Stevens-Johnson syndrome may occur. Transient leukopenia or leukocytosis, eosinophilia and elevated transaminases may also occur. HU is not a disease in itself. Its level is highly variable in the general population. Uric acid level is influenced by many factors such as dietary intake of proteins, hypertension, and obesity. Only very rarely patients of AHU may progress to gout and renal stones. Not much data is available that support HU alone in an asymptomatic patient in later life shows the diseases which are associated with HU. Sometimes only lifestyle changes, diet restrictions, alcohol restrictions, and treatment of underlying acquired cause may correct HU. Here, we are presenting a rare case of allopurinol hypersensitivity syndrome in an AHU patient. Our aim is to raise awareness among physicians so that they avoid using unnecessarily allopurinol in AHU patients and also titrate the dose of allopurinol in patients of renal failure. Risk-benefit ratio must be considered in these patients before starting allopurinol. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1302-1304
Ishikawa, Takaki; Yuasa, Isao; Endoh, Minoru
Caffeine has long been recognized as an addictive substance that causes autonomic nerve effect, and is known to increase catecholamine secretion from the adrenal glands. In recent years, the risk of ingesting toxic levels of caffeine has increased because of the easy availability of analgesics, CNS (Central Nervous System) stimulant medicine and dietary supplements at shops, health stores and through online purchases. We report the death of a young female resulting from the ingestion for suicide of an online purchased sleepiness-preventing medicine containing caffeine. The autopsy findings included pulmonary edema and congestion plus cutaneous emphysema. The stomach contents included a dark-brown viscous fluid without tablet or food residue. Toxicological examination revealed the presence of caffeine in the right heart blood (154.2 μg/mL) and stomach contents (197.5 μg/mL) (lethal blood level, >80 μg/mL). The highest caffeine content was in the bile (852.3 μg/mL). Biochemical findings showed that catecholamine concentration in the peripheral blood in the iliac vein was elevated. Immunostaining of catecholamine was weak in the adrenal medulla. We recommend highlighting the toxicity risk of ingesting substances with a high caffeine concentration, and we propose that caffeine concentrations should be included in the comprehensive routine forensic toxicological tests for all cases. PMID:26594005
Full Text Available A patient with mantle cell non-Hodgkin's lymphoma presented herself with fever, nausea, right upper quadrant pain on the 7th day of R-CHOP chemotherapy. After hospitalization with the suspicion of acute cholecystitis, she received antibiotherapy with G-CSF because of emerging neutropenia at the 10th day of chemotherapy. Abdominal computed tomography revealed small infarcts in the spleen and kidneys. The echymotic lesion which developed on her right lateral malleolus, became bullous in the following days and treated as ecthyma gangrenosum. Altough the patient was afebrile with a normal neutrophil count on the third day of antibiotherapy, she developed acute renal failure and deteriorated rapidly. The patient underwent hemodialysis but expired on the 10th day of hospitalization. Post mortem autopsy findings showed ischemic infarction and necrosis of parenchyma due to mycotic thrombosis of arteries and veins of many organs (heart, lung, diaphgram, kidneys, spleen, gut mucosa as well as invasion of vessel walls and parenchyma by mucor. We reviewed mucormycosis in the light of this case.
Wood, C; Wood, G S; Deneau, D G; Oseroff, A; Beckstead, J H; Malin, J
A 71-year-old white man developed an increasing number of 1-to-10 mm, erythematous nodules, many with central ulceration, most prominent on the head and trunk. Biopsy of a nodule showed infiltration of the dermis and epidermis by large cells with multilobulated nuclei and numerous mitoses. Electron microscopy showed that most tumor cells contained Langerhans' cell granules. Immunohistochemical studies demonstrated a pattern of antigen expression similar to that of Langerhans' cells including Ia and Leu-6 (T6) antigens. Chest x-ray showed diffuse pulmonary infiltration and similar tumor cells were present in the sputum and urine. He developed increasing dyspnea and jaundice despite chemotherapy, and died 6 months after the onset of the disease. Autopsy showed massive tumor infiltration of the lungs, liver, spleen, and lymph nodes, and focal involvement of the myocardium, skin and bladder. Clinical and cytologic features indicated this case to be a rare example of highly malignant histiocytosis X in an elderly man. PMID:6202393
Yuka Suzuki; Fumio Itoh; Hiroshi Yotsuyanagi; Chiaki Okuse; Yoshihiko Nagase; Hideaki Takahashi; Kyoji Moriya; Michihiro Suzuki; Kazuhiko Koike; Shiro lino
We present a case of fetal liver failure caused by the activation of lamivudine-resistant hepatitis B virus (HBV) nine months after lamivudine treatment. A 57-year old man visited our hospital for the treatment of decompensated chronic hepatitis B. Lamivudine was started in December 2001. Subsequently, serum HBV was negative for HBV DNA with seroconversion from HBeAg to anti-HBe and improvement of liver function. However, HBV DNA and HBeAg were again detected in September 2002. He was complicated by breakthrough hepatitis and admitted to our hospital in November for severely impaired liver function. Vidarabine treatment was started and serum HBV DNA and alanine aminotransferase (ALT) decreased transiently. However, after the start of a-interferon treatment, HBV DNA level increased and liver function deteriorated. He died 1 mo after admission. An analysis of amino acid sequences in the polymerase region revealed that rtM204I/V with rtL80I/V occurred at the time of viral breakthrough. After the start of antiviral treatment, rtL180M was detected in addition to rtM204I/V and rtL80I/V, and became predominant in the terminal stage of the disease. HBV clone with a high replication capacity may be produced by antiviral treatment leading to the worsening of liver function. Antiviral therapy for patients with breakthrough hepatitis in advanced liver disease should be carefully performed.
Velasco-Castrejón, Oscar; Rivas-Sánchez, Beatriz; Soriano-Rosas, Juan; Rivera-Reyes, Héctor Hugo
Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry. PMID:20191987
Elizabeth De Francesco Daher
Full Text Available Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39ºC, and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3%, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0, leukocyturia (2+/4+ and mild proteinuria (1+/4+. She was also oliguric (urinary volume <400mL/day. Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.
Full Text Available Methoxetamine (MXE is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml was within the non-toxic range, while MXE (0.32 μg/ml was within the toxic range of concentrations. Amphetamine was also detected in the patient's hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient's blood and urine suggest the possibility of adverse interactions between them.
Bakota, Erica; Arndt, Crystal; Romoser, Amelia A; Wilson, Stephen K
We present in this case report a validated method for accurate quantitative analysis of 3-methoxy phencyclidine (3-MeO-PCP) to determine postmortem blood concentrations of this PCP analog. A 29-year-old male with a history of illicit drug use was found unresponsive in his bed with a bag of white powder next to him. Resuscitation efforts were unsuccessful and the individual was pronounced dead 9 minutes after arrival to the hospital. Initial ELISA screening suggested the presence of PCP in the decedent's blood. However, confirmatory testing revealed no detectable PCP. Instead, a large peak corresponding to a m/z 274.218 species with retention time similar to PCP was present on a LC-TOF-MS drug screen, suggesting a possible PCP analog. This mass corresponds specifically to a methoxy-PCP analog, several of which are available for purchase online. Standards for 3-MeO-PCP and 4-MeO-PCP were obtained and injected on the same instrument. Although the 3- and 4-MeO-PCP analogs have identical masses and retention times, they are still distinguishable through their mass spectra. The peak from the decedent's sample matched both the mass spectrum and the retention time of 3-MeO-PCP. A quantitative LC-MS-MS method was subsequently developed and validated for casework. Analysis using this method revealed a concentration of 139 ± 41 µg/L 3-MeO-PCP in the decedent's blood. Diphenhydramine (4.1 ± 0.7 mg/L), marijuana metabolite (presumptive positive, confirmation not performed) and a small amount of amphetamine (<0.10 mg/L) were also found in the decedent's blood. The cause of death was determined to be combined 3-MeO-PCP, diphenhydramine and amphetamine toxicity. The manner of death was certified as an accident. PMID:27339479
Full Text Available Abstract Background Analysis of severe maternal morbidity (maternal near misses provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. Methods We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments. We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated. Results We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals, others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72
The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men Associação entre potássio sérico na admissão hospitalar e letalidade da leptospirose em homens
Antonio Alberto LOPES
Full Text Available Severe leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK, 3.5-5 mEq/L (normoK and above 5 mEq/L (hyperK were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1% in the hypoK, 14.7% in the normoK and 47.1% in the hyperK group (p = 0.002. In a logistic regression model (normoK as referent, including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR = 0.80; p > 0.1. On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021. In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death.Leptospirose grave afeta predominantemente os homens e apresenta alta susceptibilidade para insuficiência renal aguda com hipocalemia. Como hipocalemia e hipercalemia induzem complicações graves, é importante avaliar se o potássio sérico é um independente fator de risco de morte na leptospirose. Foram revistos os prontuários de 1016 pacientes internados com o diagnóstico de leptospirose. A análise foi restrita a 442, obedecendo os seguintes critérios: sexo masculino, idade igual ou superior a 18 anos, informação sobre morte ou alta hospitalar e registro dos valores do potássio s
Full Text Available Background: Ebola virus disease (EVD is a public health emergency of international concern. There is limited laboratory and clinical data available on patients with EVD. This is a meta-analysis to assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD. Aim: To assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD. Method: Study selection criterion: EVD articles with more than 35 EVD cases that described the clinical features were included. Data collection and extraction: Articles were searched in Medline, PubMed, Ovid journals, and CDC and WHO official websites. Statistical methods: Pooled proportions were calculated using DerSimonian Laird method (random effects model. Results: Initial search identified 634 reference articles, of which 67 were selected and reviewed. Data were extracted from 10 articles (N=5,792 of EVD which met the inclusion criteria. Bleeding events (64.5% vs. 25.1%, abdominal pain (58.3% vs. 37.5%, vomiting (60.8% vs. 31.7%, diarrhea (69.9% vs. 37.8%, cough (31.6% vs. 22.3%, sore throat (47.7% vs. 19.8%, and conjunctivitis (39.3% vs. 20.3% were more often present in pooled proportion of fatal cases as compared to EVD survivors. Conclusions: Clinical features of EVD that may be associated with higher mortality include bleeding events, vomiting, diarrhea, abdominal pain, cough, sore throat, and conjunctivitis. These patients should be identified promptly, and appropriate management should be instituted immediately.
Jin, H; Zhao, Y; Zhang, X; Wang, B; Liu, P
It is of great concern that pregnant women with acute viral hepatitis (AVH) type E have serious consequences. This study aimed to estimate the case-fatality risk (CFR) and potential risk factors of pregnant women with AVH type E. We searched the PubMed, EMBASE, and Web of Science databases for studies containing data on CFR in pregnancy with AVH type E. A pooled estimate of CFR was calculated using a random-effects model. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. We identified 47 eligible studies with a total African and Asian population of 3968 individuals. The pooled CFRs of maternal and fetal outcomes were 20·8% [95% confidence interval (CI) 16·6-25·3] and 34·2% (95% CI 26·0-43·0), respectively. Compared with these, the pooled CFR was highest (61·2%) in women with fulminant hepatic failure (FHF). Community-based surveys had lower pooled CFR (12·2%, 95% CI 9·2-15·6) and heterogeneity (25·8%, 95% CI 20·1-32·0) than hospital-based surveys. Univariate analysis showed that hospital-based surveying (P = 0·007), and patients in the third trimester of pregnancy or with FHF (P < 0·05), were significantly associated with CFR. Intrauterine fetal mortality (27·0%) was statistically higher than neonatal mortality (3·9%). Control measures for HEV infection would reduce feto-maternal mortality in Asia and Africa. PMID:26939626
Kaye, Dan K; Kakaire, Othman; Osinde, Michael O
Background Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. Methods We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010....
Kakaire Othman; Kaye Dan K; Osinde Michael O
Abstract Background Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa. Methods We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 ...
Agarwal, Saurabh; Kaeley, Nidhi; Gupta, Priyanka; Gupta, Vibha; Bhatia, Rohan
Methotrexate is being used for many years in the treatment of chronic medical disorders e.g. rheumatoid arthritis since 1951. It has been associated with various systemic toxicities and complications including bone marrow suppression and lymphomas. The development of leukaemia in a patient of chronic rheumatoid arthritis is either related with the primary disease or due to the drugs which are used in the treatment like cyclophosphamide. In our present case, a 70-year-old female who was a known case of Rheumatoid Arthritis (RA) and was on methotrexate once a week orally for the past 20 years presented with complaints of loss of appetite, loss of weight and anaemia since 2 months. After thorough examination and investigation, she was diagnosed with acute myeloid leukaemia (AML-M4) with bilateral chest consolidation. PMID:27134915
Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie; Gregersen, Markil Ebbe Gregers; Melsen, Flemming
The lower cervical spine facet joints of a road traffic crash fatality were examined using diagnostic imaging and histological techniques. No injuries to the cervical spine facet joints could be identified with diagnostic imaging including conventional radiology, CT and MRI. Examination of stained...
Bin Abdul Rashid, Saiful Nizam; Rahim, Amir Saad Abdul; Thali, Michael J; Flach, Patricia M
Fatal acute methamphetamine (MA) poisoning in cases of internal drug trafficking is rarely described in the literature. This case study reports an MA 'body packer' who died from fatal methamphetamine intoxication due to leaking drug packages in the alimentary tract. The deceased was examined by postmortem computed tomography (PMCT), and the results were correlated to subsequent autopsy and toxicological findings. The deceased was arrested by the police when he was found disoriented in the city of Kuala Lumpur. He was transferred to the emergency department on suspicion of drug abuse. The initial drug screening was reactive for amphetamines. Shortly after admission to the hospital, he died despite rigorous resuscitation attempts. The postmortem plain chest and abdominal radiographs revealed multiple suspicious opacities in the gastrointestinal tract attributable to body packages. An unenhanced whole body PMCT revealed twenty-five drug packages, twenty-four in the stomach and one in the transverse colon. At least two were disintegrating, and therefore leaking. The autopsy findings were consistent with the PMCT results. Toxicology confirmed the diagnosis of fatal methamphetamine intoxication. PMID:23404531
Berger, Florian; Steuer, Andrea E; Rentsch, Katharina; Gascho, Dominic; Stamou, Stamatios; Schärli, Sarah; Thali, Michael J; Krämer, Thomas; Flach, Patricia M
A case of fatal poisoning by ingesting formic acid, diphenhydramine, and ethanol by a 25-year-old woman who committed suicide is presented. Prior to autopsy, postmortem computed tomography and postmortem magnetic resonance tomography were performed and revealed severe damage to the stomach, the left thoracic wall, and parts of the liver. Imaging detected acid-induced fluid-fluid level within the thoracic cavity (fat-equivalent fluid and necrotic pleural effusion). This case report illustrates that postmortem cross-sectional imaging may facilitate dissection of severely damaged or complex regions, and may provide additional information compared to autopsy and toxicological examinations alone. PMID:27427196
Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?
Martensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva;
nominal equal access to health care, social inequality in case fatality after NSTEMI and unstable angina exists in Denmark. The patients with the shortest education waited longer for angiography; however, this did not seem to explain inequality in case fatality. This register-based study was approved by...... the Danish Data Protection Agency (Approval number 2010-41-5263). Register-based studies do not need approval by a medical ethics committee in Denmark....
Andrew M. Lane; Richard Godfrey
This case study reports on changes in emotions before and during an unexpected heart rate in a young, apparently healthy male with a life-long history of exercise in the absence of family history of heart problems. He completed the Brunel Mood Scale (Terry et al. , 2003) to assess emotions before, during, and after the heart attack, and also describing his thoughts during these periods. Results indicate he experienced unpleasant emotions in the build up to the heart attack, feelings he attrib...
Full Text Available Colchicine is an alkaloid extracted from autumnal Colchicum plant which is used primarily for its anti-inflammatory therapy effect. Acute intoxication with colchicine is uncommon but often severe and results in multiple visceral organ dysfunctions. The intoxication severity and mortality are directly depending on the ingested dose. The treatment is manly symptomatic. However, the development of specific anti-colchicine immunotherapy would offer a new therapeutic perspective. Authors report a case of a young patient that ingested 40 tablets colchicine, which caused a multiple organ failure and with fatal outcome.
Jornil, J; Nielsen, T S; Rosendal, I;
pharmacokinetic simulations suggested that the low metabolite ratio was the result of combined poor metabolizer (PM) status of cytochrome P450 (CYP) 2C19 and CYP2D6. This hypothesis was confirmed by genetic analysis. Simulations revealed that it was likely that the combined missing CYP2D6 and CYP2C19 activity...... combined with genotyping were considered very useful in this fatal drug poisoning case. Keywords CYP2D6; CYP2C19; Venlafaxine; Poor metabolizer; Drug poisoning; Mechanistic pharmacokinetic simulation --------------------------------------------------------------------------------...
Schiavone, Stefania; Riezzo, Irene; Turillazzi, Emanuela; Trabace, Luigia
Here, we investigated the possible role of the Nicotinamide Adenine Dinucleotide Phosphate oxidase NOX2-derived brain oxidative stress in a fatal case of cocaine-related neurotoxicity, associated to excited delirium syndrome. We detected a strong NOX2 immunoreactivity, mainly in cortical GABAergic neurons and astrocytes, with a minor presence in microglia, glutamatergic and dopaminergic neurons as well as a significant immunostaining for other markers of oxidative stress (8OhDG, HSP70, HSP90, and NF-κB) and apoptotic phenomena. These results support a crucial role of NOX2-derived brain oxidative stress in cocaine-induced brain dysfunctions and neurotoxicity. PMID:27533346
Jacobi, G; Riepert, T; Kieslich, M; Bohl, J
Detailed clinical and neuropathological report on a fatal incident during the first manual therapy according to Vojta conducted in a 3 months old baby: during forced active rotation and head retraction the baby suffered from a bleeding into the adventitia of both her vertebral arteries at the level of C1 prompting ischemia of the caudal brainstem with subarachnoid haemorrhage around. It has to be suggested that similar cases already have occurred but have not been reported yet. There might be a time lag between the performance of physiotherapy and the beginning of neurologic symptoms. The risks of manual therapy in children will be discussed. PMID:11305197
Christine Baccarat De Godoy Martins; Maria Helena Prado de Mello Jorge
Hundreds of children and young people die from fatal accidents or violence every year and others suffer the consequences of non-lethal lesions. Knowing the associated factors is essential for moving forward in the control of these events. The study analysed the families’ perception and factors associated with deaths due to external causes of children, adolescents and young people. Cross-sectional study from deaths from accidents and violence in the age group of 0 to 24 years in the city ofCui...
Leth, Peter Mygind; Gregersen, Markil Ebbe Gregers; Sabroe, Svend
handicap. METHODS: This was a case-control study of fatal fire accidents in private homes in the municipality of Copenhagen from 1991 to 1996. The fatal fire accidents were identified from a police register, and the two non-fatal fire accidents registered immediately before and after each fatal fire were...... selected as a control group. Information about the circumstances surrounding the fires was derived from the police reports. Multivariate logistic regression analysis was used to estimate the risk associated with each variable after adjusting for confounders. The analysis was performed on the basis of the......BACKGROUND: The death rate for fatal fire accidents in Denmark has doubled since 1951, mostly due to an increase in the number of fire accidents associated with smoking. The most common cause of residential fire deaths in Denmark today is smoking, often combined with alcohol intoxication or...
Chattopadhyay, Saurabh; Shee, Biplab; Sukul, Biswajit
Attacks on human beings by various animals leading to varied types of injuries and even death in some cases are not uncommon. Crocodile attacks on humans have been reported from a number of countries across the globe. Deaths in such attacks are mostly due to mechanical injuries or drowning. Bites by the crocodiles often cause the limbs to be separated from the body. The present case refers to an incident of a fatal attack by a crocodile on a 35 years old female where only the mutilated head of the female was recovered. Multiple lacerated wounds over the face and scalp along with fracture of the cranial bones was detected on autopsy. Two distinct bite marks in the form of punched in holes were noted over the parietal and frontal bones. Injuries on the head with its traumatic amputation from the body were sufficient to cause death. However, the presence of other fatal injuries on the unrecovered body parts could not be ruled out. PMID:24237838
Full Text Available BACKGROUND: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial hemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial hemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. METHODS: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. RESULTS: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. CONCLUSIONS: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.
Hermosilla, C; Coumbe, K M; Habershon-Butcher, J; Schöniger, S
A fatal case of eosinophilic and granulomatous meningoencephalitis caused by the free-living panagrolaimid nematode Halicephalobus gingivalis is reported in a 10-year-old Welsh gelding in the United Kingdom. Clinical examination first revealed behavioural abnormalities which rapidly progressed to severe ataxia, reduced mentation status and cranial nerve signs. Despite symptomatic treatment no amelioration of neurological signs was achieved and the horse was subjected to euthanasia. A complete post mortem examination revealed eosinophilic and granulomatous meningoencephalitis mainly affecting the cerebellum and brain stem with intralesional adult nematodes, larvae and eggs. There was also eosinophilic meningitis of the cervical spinal cord. The intralesional nematodes were morphologically consistent with the panagrolaimid nematode H. gingivalis. Although infection by this facultative neurotropic parasite is extremely rare, it needs to be considered in the differential diagnosis of central nervous signs in horses and, in particular, other equine helminthic infection of the central nervous system. This fatal case is unusual since lesions were locally very extensive and the nematodes did not colonise haematogenously to other organs as seen often in equine halicephalobosis. As the taxonomy of H. gingivalis has changed and some recent reports in the literature still refer to this species as Micronema deletrix or Halicephalobus deletrix, we here provide a short update of the species and some insights on the order Tylenchida, which contains free-living nematodes with parasitic tendencies. PMID:21496093
Yu Mi Ko Ko
Full Text Available We report a case of a 13-year-old girl with acute lymphoblastic lymphoma- leukemia, who presented with a cardiac metastasis in the right ventricle, resulting in a pulmonary embolism. At the time of her leukemia diagnosis, a cardiac mass was incidentally found. The differential diagnosis for this unusual cardiac mass included cardiac tumor, metastasis, vegetation, and thrombus. Empirical treatment was initiated, including anticoagulation and antibiotics. She underwent plasmapheresis and was administered oral prednisolone for her leukemia. Five days later, she experienced sudden hemodynamic collapse and required extracorporeal membrane oxygenation insertion and emergency surgery. These interventions proved futile, and the patient died. Pathology revealed that the cardiac mass comprised an aggregation of small, round, necrotic cells consistent with leukemia. This is the first known case of acute lymphoblastic leukemia presenting as a right ventricular mass, with consequent fatal acute pulmonary embolism. A cardiac mass in a child with acute leukemia merits investigation to rule out every possible etiology, including vegetation, thrombus, and even a mass of leukemic cells, which could result in the fatal complication of pulmonary embolism.
Westensee, Jeffrey; Rogé, Ignacio; Van Roo, Jon D; Pesce, Carlos; Batzli, Sam; Courtney, D Mark; Lazio, Matthew P
High altitude mountaineering is a dangerous endeavor due to the hypoxic hypobaric environment, extreme weather, and technical skills required. One of the seven summits, Aconcagua (6962 m) is the highest mountain outside of Asia. Its most popular route is nontechnical, attracting >3000 mountaineers annually. Utilizing data from the Servicio Médico Aconcagua (park medical service), we performed a retrospective descriptive analysis with the primary objective of deriving a fatality rate on Aconcagua from 2001 to 2012. The fatality rate on Aconcagua was then compared to other popular mountains. For climbers who died, we report all available demographic data, mechanisms of death, and circumstances surrounding the death. Between 2001 and 2012, 42,731 mountaineers attempted to summit Aconcagua. There were 33 fatalities. The fatality rate was 0.77 per 1000, or 0.077%. The fatality rate on Aconcagua is lower than that on Everest or Denali but higher than that on Rainier. PMID:24028641
van Steenis, A; Zhao, D P; Steggerda, S J; Kist, W J; Haak, M C; Oepkes, D; Lopriore, Enrico
Vasa previa is a condition in which one or more fetal blood vessels run through the amniotic membranes and cross or run near the external orifice of the uterus. Rupture of membranes can lead to tearing of these vessels and cause acute fetal exsanguination. In monochorionic twin (MC) pregnancies, acute exsanguination in one twin can lead to severe complications in the co-twin due to the presence of inter-twin placental vascular connections. We report a MC pair with severe perinatal asphyxia due to acute exsanguination after prenatally undetected ruptured vasa previa. This resulted in severe hemorrhagic shock in both twins with double fatal outcome. Antenatal detection of vasa previa is of paramount importance to prevent severe morbidity and mortality, especially in MCs. A review of the literature is presented. PMID:26366672
Buchweitz, John P.; Raverty, Stephen A.; Johnson, Margaret B.; Lehner, Andreas F.
We report a fatal diphenhydramine poisoning of a 10-year-old, male poodle-cross dog with pre-existing conditions and suspected co-ingestion of ethanol. This case illustrates that diphenhydramine overdose can be fatal in certain circumstances and that analytical toxicology may play an important role in animal death investigations. PMID:25392554
Brüde, Ulf; Elvik, Rune
The number of traffic fatalities reached a peak in many highly motorised countries around 1970. Some previous studies have suggested that the turning point in the number of traffic fatalities was inevitable and did not reflect a change in the underlying trends influencing the number of traffic...... fatalities. Other studies suggest that trends in traffic growth and fatality rate changed from before to after the turning point. This paper proposes two hypotheses about the turning point in the number of traffic fatalities. One hypothesis is that the long-term trends in traffic growth and fatality rate...... were the same before and after the turning point. The other hypothesis is that the long-term trends in traffic growth and fatality rate were different before and after the turning point was reached, in particular that the annual percentage decline in fatality rate became greater after the turning point...
Gallo, Maria Teresa; Di Domenico, Enea Gino; Toma, Luigi; Marchesi, Francesco; Pelagalli, Lorella; Manghisi, Nicola; Ascenzioni, Fiorentina; Prignano, Grazia; Mengarelli, Andrea; Ensoli, Fabrizio
Campylobacter jejuni (C. jejuni) bacteremia is difficult to diagnose in individuals with hematological disorders undergoing chemotherapy. The cause can be attributed to the rarity of this infection, to the variable clinical presentation, and to the partial overlapping symptoms underlying the disease. Here, we report a case of a fatal sepsis caused by C. jejuni in a 76-year-old Caucasian man with non-Hodgkin’s lymphoma. After chemotherapeutic treatment, the patient experienced fever associated with severe neutropenia and thrombocytopenia without hemodynamic instability, abdominal pain, and diarrhea. The slow growth of C. jejuni in the blood culture systems and the difficulty in identifying it with conventional biochemical phenotyping methods contributed to the delay of administering a targeted antimicrobial treatment, leading to a fatal outcome. Early recognition and timely intervention are critical for the successful management of C. jejuni infection. Symptoms may be difficult to recognize in immunocompromised patients undergoing chemotherapy. Thus, it is important to increase physician awareness regarding the clinical manifestations of C. jejuni to improve therapeutic efficacy. Moreover, the use of more aggressive empirical antimicrobial treatments with aminoglycosides and/or carbapenems should be considered in immunosuppressed patients, in comparison to those currently indicated in the guidelines for cancer-related infections supporting the use of cephalosporins as monotherapy. PMID:27077849
Frechede, Bertrand; McIntosh, Andrew S.; GRZEBIETA, Raphaël; BAMBACH, Michaël
An analysis of 2000-2007 single vehicle rollover fatalities in three Australian states was carried out using data from the Australian National Coroners Information System. In this paper, successive selection criteria were applied to the initial dataset to analyse: - Occupant fatalities in single passenger car crashes (1743 cases), - Occupant fatalities in single passenger car rollovers (474 cases), overall, rollovers accounted for 35% of all occupant fatalities in a single vehicle transport ...
Heidi G. Rodriguez-Ramirez
Full Text Available In 2009, a new influenza A (H1N1 virus affected many persons around the world. There is an urgent need for finding biomarkers to distinguish between influenza A (H1N1pdm09 and seasonal influenza virus. We investigated these possible biomarkers in the lung of fatal cases of confirmed influenza A (H1N1pdm09. Cytokines (inflammatory and anti-inflammatory and cellular markers (macrophages and lymphocytes subpopulation markers were analyzed in lung tissue from both influenza A (H1N1pdm09 and seasonal influenza virus. High levels of IL-17, IFN-γ, and TNF-α positive cells were identical in lung tissue from the influenza A (H1N1pdm09 and seasonal cases when compared with healthy lung tissue (P<0.05. Increased IL-4+ cells, and CD4+ and CD14+ cells were also found in high levels in both influenza A (H1N1pdm09 and seasonal influenza virus (P<0.05. Low levels of CD206+ cells (marker of alternatively activated macrophages marker in lung were found in influenza A (H1N1pdm09 when compared with seasonal influenza virus (P<0.05, and the ratio of CD206/CD14+ cells was 2.5-fold higher in seasonal and noninfluenza group compared with influenza A (H1N1pdm09 (P<0.05. In conclusion, CD206+ cells differentiate between influenza A (H1N1pdm09 and seasonal influenza virus in lung tissue of fatal cases.
Ataque por animales acuáticos (tiburón y cocodrilo: A propósito de dos casos fatales en la provincia de Bocas del Toro (Panamá Attack for aquatic animals (shark and alligator: Report of two fatal cases in the Bocas del Toro province (Panama
Full Text Available Los ataques por animales acuáticos, y especialmente los producidos por tiburón y cocodrilo, son muy poco frecuentes. Se han descrito ataques por tiburón en países como Australia, Sudáfrica, Brasil, Bahamas, México y Puerto Rico, algunos con resultado fatal en los últimos cinco años. En Panamá, los casos descritos de ataques por escualo son escasos, siendo el último descrito con resultado no fatal en julio de 2008 en una playa de la localidad de San Carlos mientras que el último caso fatal se remonta al año 1964. Los ataques por cocodrilo, al igual que en el caso anterior, son poco frecuentes. A nivel mundial la mayor parte de los casos descritos proceden de Australia, Angola, India, Brasil y Florida. En Panamá, el último caso fatal ocurrió en el Lago de Miraflores en mayo de 2007, pero el cadáver no fue encontrado. En este artículo se describen dos casos de depredación animal, por tiburón y cocodrilo, en la provincia de Bocas del Toro (Panamá con el objetivo de reconocer el patrón de las lesiones por mordedura y las áreas anatómicas vulnerables afectadas.Attacks for aquatic animals, especially those due to shark and alligator, are very unusual. Shark attacks have been reported in countries such as Australia, South Africa, Brazil, Bahamas, Mexico and Puerto Rico, some with fatal consequences in the last five years. In Panama, reported cases from shark attack are scarce, being the last one in the city of San Carlos, while the last fatal case was reported in the year 1964. Alligator attacks, as in the previous case, are very scarce. Worldwide, the major part of the described cases are from Australia, Angola, India, Brazil and Florida. In Panama, the last fatal case occurred in the Miraflores lake in May 2007; however, the corpse was never found. In this paper, we described two cases of animal predation, from shark and alligator, occurred in the Bocas del Toro province (Panama with the aim to recognize the pattern of bite
Andrew M. Lane
Full Text Available This case study reports on changes in emotions before and during an unexpected heart rate in a young, apparently healthy male with a life-long history of exercise in the absence of family history of heart problems. He completed the Brunel Mood Scale (Terry et al. , 2003 to assess emotions before, during, and after the heart attack, and also describing his thoughts during these periods. Results indicate he experienced unpleasant emotions in the build up to the heart attack, feelings he attributed at the time to frustration to achieve fitness goals. He maintained an exercise regime prior to having a heart attack, a finding consistent with previous research suggesting that early diagnosis, although vital for survival, is not likely to be identified among seemingly healthy individuals. During the heart attack, he experienced a rapid emotional change characterised by a rapid increase in anger coupled with thoughts of needing to survive. The intensity of emotions and regulation strategies employed before and during the heart attack provide insight this experience, and we suggest future research should investigate emotional change during adverse conditions
To determine clinical, clinicopathologic, radiographic, ultrasonographic, and coagulation abnormalities in dogs in which acute pancreatitis was fatal. Retrospective study. 70 dogs. History, clinical signs, and physical examination findings at the time of initial evaluation at the veterinary teaching hospital; results of pretreatment laboratory tests, abdominal radiography, and ultrasonography; and histologic abnormalities were obtained from medical records. Clinical signs included anorexia, vomiting, Weakness, diarrhea, polyuria and polydipsia, neurologic abnormalities, melena, weight loss, hematemesis, and passage of frank blood in feces. At the time of initial examination at the veterinary teaching hospital, 68 (97%) dogs were dehydrated, 18 (26%) were icteric, 22 (32%) were febrile, 40 (58%) had signs of abdominal pain, and 30 (43%) were classified as overweight or obese. Most dogs had leukocytosis, neutrophilia with a left shift, and thrombocytopenia. Various serum biochemical abnormalities were identified, including hypoglycemia, azotemia, hypercalcemia and other electrolyte abnormalities, hypoalbuminemia, high hepatic and pancreatic enzyme activities, hypercholesterolemia, and lipemia. For 17 of 28 (61%) dogs, results of coagulation function tests were abnormal. Results of abdominal ultrasonography and radiography were consistent with a diagnosis of acute pancreatitis in 23 of 34 (68%) and 10 of 41 (24%) dogs, respectively. For 2 dogs, results of abdominal ultrasonography were not suggestive of acute pancreatitis, but results of abdominal radiography were. Clinical signs and results of clinicopathologic tests are inconsistent. Abdominal ultrasonography may be valuable in the diagnostic evaluation of dogs suspected to have acute pancreatitis
Davidsen, M; Brønnum-Hansen, H; Jørgensen, Torben; Madsen, Mette; Gerdes, L U; Osler, M; Schroll, M
-period-cohort analyses were carried out according to a method described by Clayton and Schifflers. RESULTS: During the 10-year period a significant decrease in the incidence rate of MI was seen for men and women and for the rate of recurrent MI. The decrease in incidence and recurrence could not unambiguously be...
Atkinson, Barry; Jameson, Lisa J.; Bovill, Begoña A.; Aarons, Emma J.; Clewlow, Jodie; Lumley, Sarah; Latham, Jennie; Jenkins, Megan H.; MacGowan, Alasdair P; Simpson, Andrew J.; Ahmed, Javeed; Brooks, Timothy J.; Hewson, Roger
Highlights • Detection of hantavirus cardiopulmonary syndrome imported into Europe. • Additional evidence that Choclo hantavirus is currently circulating and causing human disease in Panama. • Novel diagnostic and sequencing assays for identifying cases of Choclo hantavirus infection.
Argüello, Ana Patricia; Hun, Laya; Rivera, Patricia; Taylor, Lizeth
This study reports the first urban human case of Rocky Mountain spotted fever caused by Rickettsia rickettsii, in Costa Rica. An 8-year-old female who died at the National Children's Hospital 4 days after her admission, and an important and significant observation was the presence of an “eschar” (tache noire), which is typical in some rickettsial infections but not frequent in Rocky Mountain spotted fever cases.
Thierauf, Annette; Preuss, Johanna; Lignitz, Eberhard; Madea, Burkhard
Fatal falls are frequent and inhomogeneous events and affect every age. The criminalistic classification can often only be done on the basis of extensive investigations and the autopsy results. We retrospectively surveyed 291 cases of fatal falls on which a post-mortem examination had been carried out in the institutes of Forensic Medicine in Bonn and Greifswald. In large part, these cases are falls from height (n=123) and ground-level falls (n=122). These are compared to fatal falls down a stairs (n=46); the analysis is confined to injuries to the cranium. In ground-level falls the injury pattern in falls under the influence of alcohol differs from that of falls with no alcohol in the case history: all injuries are seen in higher relative frequency in casualties after the consumption of alcohol. In falls from height, the previous consumption of alcohol did not influence the injury pattern; the intracranial traumas are seen in decreasing frequency with increasing heights. The aim of this retrospective analysis is to present injury patterns and influencing factors like fall heights and alcohol for the different kinds of falls on the basis of our collective and to demonstrate similarities and differences between the subgroups. PMID:20176452
Enny Santos Paixão
Full Text Available AbstractINTRODUCTION:Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011.METHODS:Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression.RESULTS:The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036, in patients aged 0-14 years (β=0.48; p=0.030 and in those aged ≥15 years (β=1.1; p<0.01. Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038 and the number of basic health units per population (MRR=0.89; p<0.001. Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002.Factors associated with mortality were inequality (RR=1.02; p=0.001 high income per capita (MRR=0.99; p=0.005, and higher proportions of populations living in urban areas (MRR=1.01; p<0.001.CONCLUSIONS:The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes.
Tokuda, H; Yahagi, N; Kasai, S; Kitamura, S; Otsuka, Y
A 57-year-old male was admitted to our hospital because of high fever, productive cough and dyspnea. Six days prior to admission he had an episode of drowning in a public bath. On admission chest X-ray showed wide-spread pneumonia causing severe respiratory distress for which mechanical ventilatory support was started. Despite chemotherapy including erythromycin and rifampicin his condition continued to deteriorate. Chemistry showed marked elevation of CPK and findings of acute renal failure. He eventually passed away with septic shock. During the course Legionellae remained negative with culture of broncho-alveolar lavage fluid. L. pneumophila serogroup 1 (SG1) antigen in the urine was not detected, and no elevation of serum antibody titer was noted. Culture of the material obtained from the lung abscess at autopsy revealed L. pneumophila SG6 and serum antibody titer against SG6 also was found to be extremely high. With this evidence we concluded that this case of pneumonia was caused by L. pneumophila SG6. We believe this is the first reported case of the SG6 pneumonia in Japan. Another remarkable feature of this case was massive rhabdomyolysis pathologically confirmed after autopsy. Although the pathogenesis of this process has not been clarified, there are several case reports of rhabdomyolysis complicated with Legionnair's disease in the past. Therefore, we should bear in mind and pay careful attention while coping with this disease. PMID:9077075
Singi, Shailesh R.; Fernandez, Evita; Sunil T Pandya; Badrinath, H. R.
Postpartum hemorrhage is leading cause of maternal mortality and still remains a challenging condition to treat and hysterectomy may be required to control the bleeding once medical interventions fail. These strategies are not always successful and a direct approach in activating the coagulation system can be more effective and life saving. We describe here the mechanism of action of rFVIIa, review of literature and its use in 10 cases with different causes for PPH with good response.
Full Text Available Ventriculoperitoneal shunt-associated ventriculitis is a serious though under-reported nosocomial complication of neurocritical settings. The treatment of CNS Methicillin-resistant Staphylococcus aureus (MRSA infections is usually successful with vancomycin or linezolid. Here, we report a case of ventriculitis due to MRSA following a shunt infection, which did not show clinical response to linezolid therapy. With the increasing use of invasive procedures, nosocomial infections have increased exponentially. Exercising extreme care in such CNS procedures becomes very important.
Moole, Harsha; Chitta, Swetha; Victor, Darlyn; Kandula, Manasa; Moole, Vishnu; Ghadiam, Harshavardhan; Akepati, Anusha; Yerasi, Charan; Uppu, Achuta; Dharmapuri, Sowmya; Boddireddy, Raghuveer; Fischer, Jacqueline; Lynch, Teresa
Background: Ebola virus disease (EVD) is a public health emergency of international concern. There is limited laboratory and clinical data available on patients with EVD. This is a meta-analysis to assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD.Aim: To assess the utility of clinical signs, symptoms, and laboratory data in predicting mortality in EVD.Method: Study selection criterion: EVD articles with more than 35 EVD cases that described th...
Parnmen, Sittiporn; Sikaphan, Sujitra; Leudang, Siriwan; Boonpratuang, Thitiya; Rangsiruji, Achariya; Naksuwankul, Khwanruan
Cases of mushroom poisoning in Thailand have increased annually. During 2008 to 2014, the cases reported to the National Institute of Health included 57 deaths; at least 15 died after ingestion of amanitas, the most common lethal wild mushrooms inhabited. Hence, the aims of this study were to identify mushroom samples from nine clinically reported cases during the 7-year study period based on nuclear ITS sequence data and diagnose lethal peptide toxins using a reversed phase LC-MS method. Nucleotide similarity was identified using BLAST search of the NCBI database and the Barcode of Life Database (BOLD). Clade characterization was performed by maximum likelihood and Bayesian phylogenetic approaches. Based on BLAST and BOLD reference databases our results yielded high nucleotide similarities of poisonous mushroom samples to A. exitialis and A. fuliginea. Detailed phylogenetic analyses showed that all mushroom samples fall into their current classification. Detection of the peptide toxins revealed the presence of amatoxins and phallotoxins in A. exitialis and A. fuliginea. In addition, toxic α-amanitin was identified in a new provisional species, Amanita sp.1, with the highest toxin quantity. Molecular identification confirmed that the mushrooms ingested by the patients were members of the lethal amanitas in the sections Amanita and Phalloideae. In Thailand, the presence of A. exitialis was reported here for the first time and all three poisonous mushroom species provided new and informative data for clinical studies. PMID:26763394
Peres, E; Savasan, S.; Klein, J; Abidi, M.; Dansey, R; Abella, E.
Epstein-Barr virus (EBV)-associated lymphoproliferative disorder (EBV-LPD) following bone marrow transplantation can be fatal. The major risk factors for the development of EBV-LPD are ex vivo T-cell depletion or in vivo T-cell depletion with either antithymocyte globulin (ATG) or monoclonal anti-T-cell antibodies. Between March 1999 and January 2001, a total of 23 transplants with ATG of equine source (20 transplants) and ATG of rabbit source (3 transplants) used as part of the preparatory r...
Full Text Available Introduction: While influenza A(H1N1pdm09 usually causes mild illness in the majority of people, there have been reports of severe cases and deaths. As there is no documented evidence on fatal outcomes from influenza in Mongolia previously, we aimed to describe the epidemiology of fatal influenza A(H1N1pdm09 cases to provide recommendations to assist the national influenza prevention and control strategy.Methods: We selected influenza A(H1N1pdm09-confirmed deaths in hospitals between 12 October 2009 and 31 January 2010 in Mongolia from the national influenza surveillance system. The mortality rate and case fatality rate (CFR of influenza A(H1N1pdm09-hospitalized deaths were calculated. Using country prevalence of pregnancy and chronic diseases, we calculated the relative risk of death from influenza A(H1N1pdm09.Results: There were 29 deaths with a mortality rate of 1.0 per 100 000 population during the study period, which was highest in children under five and the middle-aged population. Crude CFR was 2.2%. Of all fatal cases, 62% had at least one underlying condition. Most (62% were provided antivirals, although none received these within 48 hours of symptom onset. Prevalence for pregnancy, cardiovascular and chronic liver diseases was five to 50 times higher in fatal cases compared to country prevalence.Discussion: Mortality and crude CFR in our study was higher than in other studies. However, due to the diagnostic policy change during the epidemic, this estimate is likely to have overestimated actual case fatalities. Pregnancy, cardiovascular and chronic liver diseases were suggestive risk factors for death from influenza A(H1N1pdm09. Strengthening hospital-based influenza surveillance is important in predicting severity of an epidemic and responding to influenza epidemics in a timely and appropriate manner.
Larsen, C F; Hardt-Madsen, M
A series of fatal motorcycle accidents from a 7-year period (1977-1983) has been analyzed. Of the fatalities 30 were operators of the motorcycle, 11 pillion passengers and 8 counterparts. Of 41 operators 37% were sober at the time of accident, 66% had measurable blood alcohol concentration (BAC......); 59% above 0.08%. In all cases where a pillion passenger was killed, the operator of the motorcycle had a BAC greater than 0.08%. Of the killed counterparts 2 were non-intoxicated, 2 had a BAC greater than 0.08%, and 4 were not tested. The results advocate that the law should restrict alcohol...... consumption by pillion passengers as well as by the motorcycle operator. Suggestions made to extend the data base needed for developing appropriate alcohol countermeasures by collecting sociodemographic data on drivers killed or seriously injured should be supported....
Celiński, Rafał; Skowronek, Rafał; Uttecht-Pudełko, Anna
Inhalatomania with volatile organic compounds is a still present phenomenon among Polish young adolescents. Conscious, voluntary exposition on such substances may result in serious health consequences, including sudden death in the course of acute intoxication. In this paper, atypical case of death of 16-year-old teenager as a result of complications of physically forced inhalation of gas for lighters is presented. According to testimonies of witnesses, the container was placed in the mouth of victim and the gas was introduced directly to his throat. Autopsy revealed small damage of tooth with corresponding bruising of lower lip; brain and lung oedma; single bruisings in the upper respiratory tract and subpleural. Chemical-toxicological analysis of blood, brain and lung samples taken during autopsy revealed in all of them the presence of n-butan--a component of gas for lighters (the greatest in brain and lung tissues). Additionally, in blood the presence of carboxyhemoglobin (COHb) in concentration 7% was confirmed. Based on the results of analyses, acute intoxication with n-butan was estimated as a cause of death; however the key role played the information obtained during the investigation. This case shows, that deaths resulting from gas for lighters inhalation may be a consequence of forced exposition--against victim's will. So medical staff should always check, if on the body of patient there are any signs of physical constraint (the presence of bruisings in the area of viscerocranium and oral cavity, teeth damages, etc.). PMID:24167951
Full Text Available Background: Although the problem of substance use among drivers is not limited to a special part of the world, most published epidemiological reports on this topic is from industrial world.Aim: To determine drug use among Iranian adults who were imprisoned for vehicle accidents with fatality. Methods: This study enrolled 51 Iranian adults who were imprisoned for vehicle accidents with fatality. This sample came from a national survey of prisoners. Data was collected at entry to prisons during the last 4 months of 2008 in 7 prisons in different parts of the country. Self reported drug use was registered. Commercial substance use screening tests were also done. Results: Drug test was positive for opioids, cannabis and both in 37.3%, 2.0% and 13.7%, respectively. 29.4% tested positive for benzodiazepines. Using test introduced 23.5% of our sample as drug users, who had declined to report any drug use. Conclusion: Opioids are the most used illicit drug in the case of vehicle accidents with fatality, however, 20% of users do not declare their use. This high rate of drug use in vehicle accidents with fatality reflects the importance of drug use control as a part of injury prevention in Iran. There might be a need for drug screening after severe car accidents.
Böhning, D; Na Ayutha, R S
Morbidity and mortality from road traffic accidents in Bangkok metropolis is high with a trend strictly increasing in time, thus establishing one of the major public health problems and targets of the Kingdom of Thailand. An unmatched case-control study was undertaken to evaluate various risk patterns connected with the occurrence of traffic accidents. 350 cases were sampled from five major hospitals distributed over the Bangkok Metropolitan area and 350 controls were included from out-patients of Rajawithi hospital. The major interest in this case-control analysis is to estimate relative risk (through odds ratio) and measure statistical significance of association between road traffic accident and the following risk factors: the demographic risk factors are age (age between 15 and 19 years has odds ratio of 8.25 [1.01, 67.72]; age above 40 is baseline), marital status (single has odds ratio of 2.74 [1.26, 5.95]; baseline is not-single), sex (males have an odds ratio of 2.05 [0.51, 8.24], occupation (salespersons have an odds ratio of 4.27 [1.47, 12.46]; baseline are office workers); the driving related exposure factors type of vehicle (motorbikers have an odds ratio of 6.22 [2.82, 13.78]; baseline are other vehicle drivers), driving time per day (odds ratio 1.35 [0.88, 2.09]) and the number of accidents in the last three years (odds ratio of 4.36 [2.51, 7.58]); the behavioral factors one hour before driving such as the consumption of alcohol (odds ratio 3.01 [1.53, 5.94]; baseline in no alcohol) and the consumption of a lot of food (odds ratio of 0.07 [0.03, 0.16]; baseline is not eating a lot before driving). The odds ratios for traffic accident when being under allergic medication and the consumption of tranquilizer were not significant. The results are consistent with current results in traffic accident research and point to target groups for potential prevention programmes in traffic accident prevention. PMID:9499466
Recent publications have shown that general aviation accident rates in the United States are decreasing, though they remain much higher than other segments of aviation. What is behind this safety improvement? Are all types of accidents decreasing or are certain types of accidents driving the overall decrease? This study provides the preliminary results of an in depth analysis of the causes of fatal general aviation accidents from 1992 through 2002. First a database of all fatal Part 91 accide...
Wei, Kuang-Yu; Chang, Shan-Yueh; Wang, Sheng-Huei; Su, Her-Young; Tsai, Chen-Liang
Life-threatening refractory metabolic acidosis due to starvation ketoacidosis is rarely reported, even among nondiabetic pregnant women, and may be overlooked. Furthermore, stressful situations may increase the acidosis severity.In the present case, a nondiabetic multiparous woman was admitted for a near-fatal asthma attack and vomiting during the third trimester of pregnancy. She was intubated and rapidly developed high anion gap metabolic acidosis. We diagnosed the patient with starvation ketoacidosis based on vomiting with concomitant periods of stress during pregnancy and the absence of other causes of high anion gap metabolic acidosis. She responded poorly to standard treatment, although the ketoacidosis and asthma promptly resolved after an emergency caesarean section. The patient and her baby were safely discharged.Short-term starvation, if it occurs during periods of stress and medication, can result in life-threatening ketoacidosis, even among nondiabetic women during the third trimester of pregnancy. Awareness of this condition may facilitate prompt recognition and proactive treatment for dietary and stress control, and emergent interventions may also improve outcomes. PMID:27368034
Fernando, Nimal; Hui, Suk-Wai; Tsang, Chi-Ching; Leung, Shui-Yee; Ngan, Antonio H Y; Leung, Raymond W W; Groff, Joseph M; Lau, Susanna K P; Woo, Patrick C Y
Fusarium species are environmental saprophytic fungi. Among the many Fusarium species, members of the Fusarium solani species complex (FSSC) are the most prevalent and virulent in causing human and animal infections. In this study, we describe the first case of fatal FSSC infection in a black spotted stingray and three concomitant infections in scalloped hammerhead sharks. In the stingray, cutaneous lesions were characterised by ulcers and haemorrhage of the ventral pectoral fin, or 'ray', especially around the head; while cutaneous lesions in the sharks were characterised by ulcers, haemorrhage, as well as white and purulent exudates at the cephalic canals of the cephalofoil and lateral line. Histological sections of the cutaneous lesions revealed slender (1-4 μm in diameter), branching, septate fungal hyphae. Internal transcribed spacer region and 28S nrDNA sequencing of the fungal isolates from the fish showed two isolates were F. keratoplasticum (FSSC 2) and the other two were FSSC 12. Environmental investigation revealed the FSSC strains isolated from water and biofilms in tanks that housed the elasmobranchs were also F. keratoplasticum and FSSC 12. Fusarium is associated with major infections in elasmobranchs and FSSC 12 is an emerging cause of infections in marine animals. DNA sequencing is so far the most reliable method for accurate identification of Fusarium species. PMID:26095191
Carlier, Jérémy; Romeuf, Ludovic; Guitton, Jérôme; Priez-Barallon, Cédric; Bévalot, Fabien; Fanton, Laurent; Gaillard, Yvan
Atractyloside (ATR) and carboxyatractyloside (CATR) are diterpene glycosides that are responsible for the toxicity of several Asteraceae plants around the world. Mediterranean gum thistle (Atractylis gummifera L.) and Zulu impila (Callilepis laureola DC.), in particular, are notoriously poisonous and the cause of many accidental deaths, some suicides and even some murders. There is no current method for measuring the two toxins in biological samples that meet the criteria of specificity required in forensic medicine. We have endeavored to fill this analytical gap. Analysis was carried out using a solid-phase extraction and a high-performance liquid chromatography coupled with high-resolution tandem mass spectrometry detection. The method was validated in the whole blood with quantification limits of 0.17 and 0.15 µg/L for ATR and CATR, respectively. The method was applied to a non-fatal case of intoxication with A. gummifera. To the best of the authors' knowledge, this is the first time that a concentration of ATR and CATR in blood (883.1 and 119.0 µg/L, respectively) and urine (230.4 and 140.3 µg/L, respectively) is reported. ATR and CATR were quantified in A. gummifera roots by the standard method addition (3.7 and 5.4 mg/g, respectively). PMID:24990875
Full Text Available Abstract Background Poisoning is a significant public health problem worldwide and is one of the most common reasons for visiting emergency departments (EDs, but factors that help to predict overall poisoning-related fatality have rarely been elucidated. Using 1512 subjects from a hospital-based study, we sought to describe the demographic and clinical characteristics of poisoning patients and to identify predictors for poisoning-related fatality. Methods Between January 2001 and December 2002 we prospectively recruited poisoning patients through the EDs of two medical centers in southwest Taiwan. Interviews were conducted with patients within 24 hours after admission to collect relevant information. We made comparisons between survival and fatality cases, and used logistic regressions to identify predictors of fatality. Results A total of 1512 poisoning cases were recorded at the EDs during the study period, corresponding to an average of 4.2 poisonings per 1000 ED visits. These cases involved 828 women and 684 men with a mean age of 38.8 years, although most patients were between 19 and 50 years old (66.8%, and 29.4% were 19 to 30 years. Drugs were the dominant poisoning agents involved (49.9%, followed by pesticides (14.5%. Of the 1512 patients, 63 fatalities (4.2% occurred. Paraquat exposure was associated with an extremely high fatality rate (72.1%. The significant predictors for fatality included age over 61 years, insufficient respiration, shock status, abnormal heart rate, abnormal body temperature, suicidal intent and paraquat exposure. Conclusion In addition to well-recognized risk factors for fatality in clinical settings, such as old age and abnormal vital signs, we found that suicidal intent and ingestion of paraquat were significant predictors of poisoning-related fatality. Identification of these predictors may help risk stratification and the development of preventive interventions.
Wei, Hsin-Yi; Shu, Pei-Yun; Hung, Min-Nan
An unprecedented dengue outbreak involving more than 15,000 infections, including 136 dengue hemorrhagic fever (DHF) cases and 20 fatalities, occurred in Taiwan in 2014. The median age of the DHF cases was 71 years (range: 4-92 years) and most of them (N = 100, 73.5%) had comorbidities, of which the majority were hypertension (56%) and diabetes mellitus (DM; 27%). Only approximately half of the DHF cases (59/136) were classified as severe dengue, based on the 2009 WHO-revised dengue classification. The fatality rate for this DHF outbreak was 14.7%. DM (odds ratio [OR] = 3.60, 95% confidence interval [CI] = 1.22-10.63) and presentation with severe plasma leakage (OR = 6.42, 95% CI = 1.76-23.63) were independent risk factors for fatality. PMID:27273649
Full Text Available Abstract Background Primary angiitis of the central nervous system is an idiopathic disorder characterized by vasculitis within the dural confines. The clinical presentation shows a wide variation and the course and the duration of disease are heterogeneous. This rare but treatable disease provides a diagnostic challenge owing to the lack of pathognomonic tests and the necessity of a histological confirmation. Case presentation A 28-year-old patient presenting with headache and fluctuating signs of encephalopathy was treated on the assumption of viral meningoencephalitis. The course of the disease led to his death 10 days after hospital admission. Postmortem examination revealed primary angiitis of the central nervous system. Conclusion Primary angiitis of the central nervous system should always be taken into consideration when suspected infectious inflammation of the central nervous system does not respond to treatment adequately. In order to confirm the diagnosis with the consequence of a modified therapy angiography and combined leptomeningeal and brain biopsy should be considered immediately.
Full Text Available A 42-year-old Indian man received 450 mg rifampicin (RIF and 150 mg isoniazid (INH daily after being diagnosed of a latent tuberculosis infection. Baseline serum aminotransferase and total bilirubin levels were within normal limits. On day 31 of treatment, the patient experienced epigastric discomfort and general malaise and one week later he developed nausea and episodic vomiting. The patient missed his first scheduled clinic appointment and he continued taking RIF-INH despite his symptoms. He visited the tuberculosis clinic on day 47 of treatment where he was found to be jaundiced and his liver enzymes were elevated. RIF-INH was stopped and the patient was admitted to our hospital as a case of RIF-INH induced hepatitis. On the 7th day of hospitalization, the patient developed consciousness disturbance with flapping tremor and high ammonia level. The patient was diagnosed with fulminant hepatic failure and transferred immediately to the medical intensive care unit, where he died 4 days later.
Full Text Available Abstract Background The interactive effects of different types of physical activity on cardiovascular disease (CVD risk have not been fully considered in previous studies. We aimed to identify physical activity patterns that take into account combinations of physical activities and examine the association between derived physical activity patterns and risk of acute myocardial infarction (AMI. Methods We examined the relationship between physical activity patterns, identified by principal component analysis (PCA, and AMI risk in a case-control study of myocardial infarction in Costa Rica (N=4172, 1994-2004. The component scores derived from PCA and total METS were used in natural cubic spline models to assess the association between physical activity and AMI risk. Results Four physical activity patterns were retained from PCA that were characterized as the rest/sleep, agricultural job, light indoor activity, and manual labor job patterns. The light indoor activity and rest/sleep patterns showed an inverse linear relation (P for linearity=0.001 and a U-shaped association (P for non-linearity=0.03 with AMI risk, respectively. There was an inverse association between total activity-related energy expenditure and AMI risk but it reached a plateau at high levels of physical activity (P for non-linearity=0.01. Conclusions These data suggest that a light indoor activity pattern is associated with reduced AMI risk. PCA provides a new approach to investigate the relationship between physical activity and CVD risk.
Haunsø, S; Theilade, J; Winkel, B G; Holst, A G; Tfelt-Hansen, J; Svendsen, J H; Haunsø, Stig
Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings.......Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings....
The results of the 1989-1990 gas rate survey are represented. The data is a tabular compilation of basic information from natural gas rate orders issued by state public utility commissions throughout the country. It includes a summary of rates of return on common equity approved in rate-making proceedings. The table covers rate orders issued between August 31, 1989, and September 1, 1990. The table provides other basic rate case information besides return on common equity, such as the dollar amount of rate increases applied for and granted, filing dates of the application and order, test year ending dates, and identifying docket or case numbers
There is an increasing political pressure on the city planning to create more energy efficient city plans. Not only do the city plans have to enable and promote energy efficient solutions, but it also needs to be clearly assessed how energy efficient the plans are. City planners often have no or poor know how about energy efficiency and building technologies which makes it difficult for them to answer to this need without new guidelines and tools. An easy to use tool for the assessment of the energy efficiency of detailed city plans was developed. The aim of the tool is for city planners to easily be able to assess the energy efficiency of the proposed detailed city plan and to be able to compare the impacts of changes in the plan. The tool is designed to be used with no in-depth knowledge about energy or building technology. With a wide use of the tool many missed opportunities for improving energy efficiency can be avoided. It will provide better opportunities for sustainable solutions leading to less harmful environmental impact and reduced emissions. - Highlights: • We have created a tool for assessing energy efficiency of detailed city plans. • The energy source is the most important factor for efficiency of districts in Finland. • Five case districts in Finland were analyzed. • In this paper one residential district has in-depth sensitivity analyses done
Predictors of non-invasive therapy and 28-day-case fatality in elderly compared to younger patients with acute myocardial infarction: an observational study from the MONICA/KORA Myocardial Infarction Registry
Amann, Ute; Kirchberger, Inge; Heier, Margit; Thilo, Christian; Kuch, Bernhard; Peters, Annette; Meisinger, Christa
Background A substantial proportion of patients with acute myocardial infarction (AMI) did not receive invasive therapy, defined as percutaneous coronary intervention and/or coronary artery bypass grafting. Aims of this study were to evaluate predictors of non-invasive therapy in elderly compared to younger AMI patients and to assess the association between invasive therapy and 28-day-case fatality. Methods From the German population-based registry, 3475 persons, consecutively hospitalized wi...
Full Text Available The case fatality ratio (CFR of Ebola virus disease (EVD can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs.We analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%-27% for low viremia (V < 104.4 copies/ml to 53% (95% CI 44%-61% for intermediate viremia (104.4 ≤ V < 105.2 copies/ml and 81% (95% CI 75%-87% for high viremia (V ≥ 105.2 copies/ml. Compared to adults (15-44 y old [y.o.], the CFR was larger in young children (0-4 y.o. (odds ratio [OR]: 2.44; 95% CI 1.02-5.86 and older adults (≥ 45 y.o. (OR: 2.84; 95% CI 1.81-4.46 but lower in children (5-14 y.o. (OR: 0.46; 95% CI 0.24-0.86. An order of magnitude increase in mean viremia in cases after July 2014 compared to those before coincided with a 14% increase in the CFR. Our findings come from a large hospital-based study in Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care.Viremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may inform the
Full Text Available Objectives: To determine the clinical and laboratory predictors of fatality among patients with Hantavirus infection.Materials and methods: A retrospective study was conducted on the patients with Hantavirus infection between April 2009and October 2011 at the Black Sea and the Mediterranean regions in Turkey. Demographic, clinical and laboratory findings offatal cases and non-fatal cases at the admission were compared.Results: Twenty-two patients with confirmed Hantavirus infection were evaluated. Five patients died (22.7%. The cause ofdeath was massive bleeding. The rate of hemorrhage was significantly higher in the fatal cases than non-fatal cases (p<0.001.Massive gastrointestinal hemorrhage was seen in four of these patients, cerebral hemorrhage in two and both gastrointestinaland pulmonary hemorrhage in one. Disseminated intravascular coagulation (DIC was present in four of the fatal cases and aremarkable cause of the bleeding (p=0.02. White blood cell count (WBC (p=0.002, creatine phosphokinase (CPK (p=0.011,blood-urea-nitrogen (BUN (p=0.014, C reactive protein (CRP (p=0.005 and D-dimer levels (p=0.001, prothrombin time (PT(p=0.023, activated partial thromboplastin time (aPTT (p=0.001 and international normalized ratio (INR (p=0.021 were significantlyhigher, and platelet counts (p=0.038 significantly lower in the fatal cases. Optimum diagnostic cut-off points for specificlaboratory parameters which may be predictive of fatality were; WBC=16,000 μL-1, PLT=30000 μL-1, PT=19.7 s, aPTT=36s, INR=1.2, D-dimer=9.3 μg/mL, CPK=600 U/L, BUN=47 mg/dL and CRP=13.4 mg/dL.Conclusions: Physicians should be aware of the high fatality risk for patients with Hantavirus infection with hemorrhage, elevatedWBC, CPK, BUN, CRP, PT, aPTT, INR and D-dimer and reduced platelet counts. J Microbiol Infect Dis 2012; 2(4: 155-159Key words: Hantavirus; hemorrhagic fever with renal syndrome; predictors of fatality; predictive factors
Goodman, R A; Smith, J. D.; Sikes, R K; Rogers, D L; Mickey, J L
Death certificates were used as a source of information to characterize fatalities associated with farm tractor injuries in Georgia for the period 1971-81. In this period, 202 tractor-associated fatalities occurred among residents of Georgia; 198 of these persons were males. The annual tractor-associated fatality rate for males based on the population of male farm residents was 23.6 per 100,000; rates of fatal injury increased with age for this population. Persons whose primary occupation was...
Leonid S. Khodasevich; Aleksei L. Khodasevich; Sergei G. Kuzin
The literary review, related to fatal injuries in sports, contains epidemiology, their mechanisms, causes of death in sports. Injuries in different sports have their own features, concerned with sports equipment, performed exercises, sports facilities equipment and protective equipment, used by the athletes.
By saying 'No to fatalism', M. Pecqueur is forming the wish that the recent awarness of the energy situation, far from bringing about resignation, speeds up the implementation of the indispensable measures on which the economic and political stability of the world depends in the decade ahead
Gregersen, N; Winter, V; Jensen, P K;
Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is a potentially fatal inherited disease with a carrier frequency of approximately 1:100 in most Caucasian populations. The disease is implicated in sudden unexpected death in childhood. A prevalent disease-causing point mutation (A985G...
Larsen, Lars Erik; Storgaard, Torben; Holm, Elisabeth
three different outbreaks of EVA. From these fatalities, the complete open reading frame 5, encoding the EAV GL protein, was amplified by reverse transcription-polymerase chain reaction and subjected to nucleotide sequence analysis. Furthermore, DNA sequences were obtained from virus isolated from semen...
Acton, C. H.; Thomas, S; Nixon, J. W.; Clark, R; Pitt, W R; Battistutta, D.
OBJECTIVES: The objectives of the study were to ascertain the causes of accidents, injuries, and deaths in children who ride bicycles. Fatality and injury rates were also studied in order to compare with other studies. METHODS: Two studies of children were undertaken in children aged less than 15 years. In the first (retrospective fatality study), children who died as a result of a bicycle incident during the period 1981-92 were reviewed. In the second (prospective injury study) data were obt...
Elena Pădurean; Andreea Stoian; Emilia Câmpeanu
The relationship between taxation rate and tax revenues for the public budget has generated an important debate aiming that level of taxation rate that maximizes tax revenues collected for the public budget. Laffer curve involves the existence of a strong correlation between taxation rate and tax revenues. The aim of this paper is to estimate a Laffer taxation rate for Romania’s case using annual data over the period 1990-2008. The main findings highlight that a taxation rate higher than 28% ...
Jaybhaye, Prasad L; Shilawant, Santosh S
Accidental aspiration of diesel can cause consolidation, atelectasis, and abscess formation. Aspiration of diesel usually results into pneumonitis, which resolves completely within 5-7 days of treatment. Diesel aspiration resulting in bilateral pneumonia and death is rare and is scarcely documented in literature. Finding of lipoid cells in lung autopsy specimen is one of the important features of hydrocarbon aspiration. Unfortunately this important finding is not mentioned in most of the toxicology textbooks. Hence, we are reporting this case. PMID:25948973
Humar, A.; Sharma, S.; Zoutman, D; Kain, K. C.
The authors report 2 cases of severe falciparum malaria in Canadians that had fatal outcomes. In the first case a man presented to a local hospital shortly after returning from Africa, but a diagnosis of malaria was not considered. He was transferred to a secondary and then to a tertiary care facility, where he subsequently died. Intravenous quinidine therapy, the treatment of choice, was unavailable at all 3 hospitals. In the second case, a woman taking chloroquine prophylaxis while visiting...
Sosa-Gutierrez, Carolina G; Solorzano-Santos, Fortino; Walker, David H; Torres, Javier; Serrano, Carlos A; Gordillo-Perez, Guadalupe
Human monocytic ehrlichiosis is a febrile illness caused by Ehrlichia chaffeensis, an intracellular bacterium transmitted by ticks. In Mexico, a case of E. chaffeensis infection in an immunocompetent 31-year-old woman without recognized tick bite was fatal. This diagnosis should be considered for patients with fever, leukopenia, thrombocytopenia, and elevated liver enzyme levels. PMID:27088220
Colville-Ebeling, Bonnie; Lynnerup, Niels; Banner, Jytte
operator or a bystander is impacted by an object mobilized from the grass by the rotating mower blades. This type of injury often leaves only modest external trauma, which increases the risk of overlooking an entry wound. In this paper we present a case of a fatal lawn mower related projectile injury which...
Sosa-Gutierrez, Carolina G.; Solorzano-Santos, Fortino; Walker, David H.; Torres, Javier; Serrano, Carlos A.
Human monocytic ehrlichiosis is a febrile illness caused by Ehrlichia chaffeensis, an intracellular bacterium transmitted by ticks. In Mexico, a case of E. chaffeensis infection in an immunocompetent 31-year-old woman without recognized tick bite was fatal. This diagnosis should be considered for patients with fever, leukopenia, thrombocytopenia, and elevated liver enzyme levels. PMID:27088220
Haringhuizen, A.; Tjan, D.H.; Grool, A.; Vugt, R. van; Zante, A.R. van
In this report, a case of adult onset fatal cerebral oedema as a rare complication of diabetic ketoacidosis (DKA) is described and confirmed at post-mortem pathological examination. The pathogenesis of cerebral oedema due to DKA is still unknown. Potential mechanisms include the administration of so
Bordetella bronchiseptica frequently causes nonfatal tracheobronchitis, but its role in fatal pneumonia is less well-studied. The objectives of this study were to identify the frequency of Bordetella bronchiseptica infection in fatal cases of bronchopneumonia in dogs and cats and to compare the diag...
Full Text Available Kazakhstan, a developing middle-income country, has the highest road traffic collision (RTC mortality in the European Region. The aims of this study were to determine main characteristics of road traffic fatalities in Semey region, Kazakhstan and to compare findings with National data and middle-income European countries.This descriptive surveillance study assesses RTC mortality rates and epidemiology in the Semey Region of East Kazakhstan Oblast. Data of all 318 road traffic fatalities form the Semey Regional Center for Forensic Medicine were analyzed for the 5-year period of January 1, 2006 through December 31, 2010.Over the study period, the average road traffic mortality in the Semey Region was 12.1 per 100,000 population with downward trend by 35.1% (p=0.002. The victims mean age was 37.1 (SD=17 years. Males predominated at 74.5%. Vehicle fatality was the most common mode of fatality at 61.3%. The majority of collisions, 53.1%, occurred on highways. Most victims, 67.3%, have died at the scene of collision; in 67.3% of fatalities, autopsies identified multiple injuries as cause of death. The high number of fatal collisions took place in "no snow" season (P<0.001, with an overall 5-years downward dynamic.High proportion of males, pedestrians and car occupants among road traffic fatalities; high proportion of death on scene in case of highway collisions are specifics for Semey region, Kazakhstan. These findings can be used to formulate preventive strategies to reduce fatalities and to improve the medical care system for road traffic fatalities.
Sharif, Hatim; Chaturvedi, Smita
This presentation reviews flood-related fatalities in the United States between 1959 and 2013. Information on flood fatality victims and the flood-causing events was obtained from the National Climatic Data Center. The data collected included the date, time, location, and weather conditions and the gender and age of the flood victims. Long term trends in the numbers of fatalities and fatality rates were analyzed. For most of the states fatalities were largely caused by single catastrophic events. The analysis indicates that the standardized annual flood fatality rates are decreasing significantly for all states. Vehicle related fatalities represent more than 50% of flood fatalities for most of the states and can be as high as 77%. A combination of improved hydrometeorological forecasting, educational programs aimed at enhancing public awareness of flood risk and the seriousness of flood warnings, and timely and appropriate action by local emergency and safety authorities will help further reduce flood fatalities in Texas.
Schloesser, Patricia; And Others
Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse-related fatalities. Significant findings included young age of parents at first pregnancy; high rate of single parenthood; and lower educational achievement among mothers. A model for data collection is discussed. (Author/BRM)