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Sample records for high case fatality

  1. High case fatality cholera outbreak in Western Kenya, August 2010.

    Science.gov (United States)

    Onyango, Dickens; Karambu, Shirley; Abade, Ahmed; Amwayi, Samuel; Omolo, Jared

    2013-01-01

    Cholera is a disease caused by the bacterium Vibrio cholera and has been an important public health problem since its first pandemic in 1817. Kenya has had numerous outbreaks of cholera ever since it was first detected there during 1971. In August 2010 an outbreak of cholera occurred in Kuria West District spreading to the neighboring Migori District. We conducted an investigation in order to determine the magnitude of the problem and institute control measures. In order to update the line lists we reviewed records in Migori and Kuria district hospitals and conducted active case search in the community between 30th August and 6th September 2010. Data was analyzed using Epi-Info 3.5.2. A total of 114 cases and with 10 deaths (Case Fatality Rate = 9%) were documented. The index case was an 80 years old woman from Mabera Division who had hosted a cultural marriage ceremony a day before the outbreak. The mean age of case patients was 34.5 years (Standard Deviation=23.4) with a range 5 to 80 years. Females accounted for 61.4% of cases; people aged 10-39 years accounted 46.9%, those 40-69 years accounted for 29.2% and those above 70 years accounted for 9.7% of the cases. Sixty percent of deaths occurred among patients aged 50 years and over, case fatality rate was highest in this age group (16.7%) followed by those aged 40-49 years (12.5%), 20-29 years (10%) and 10-19 years (4.8%). The outbreak was confirmed within 2 weeks of onset after one (16.7%) of the six samples taken tested positive for V. cholera (serotype Inaba). High case fatality rate and late laboratory confirmation was noted in this outbreak. There was urgent need to capacity build the districts on cholera case management, outbreak management, and equip the Migori District Hospital laboratory to allow prompt confirmation.

  2. High case fatality cholera outbreak in Western Kenya, August 2010

    African Journals Online (AJOL)

    abp

    Introduction: Cholera is a disease caused by the bacterium Vibrio cholera and has ... of cholera occurred in Kuria West District spreading to the neighboring Migori District. .... Cholera treatment centres were not set up and cases were referred.

  3. Age trajectories of stroke case fatality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae

    2011-01-01

    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....

  4. High activity of indoleamine 2,3 dioxygenase enzyme predicts disease severity and case fatality in bacteremic patients.

    Science.gov (United States)

    Huttunen, Reetta; Syrjänen, Jaana; Aittoniemi, Janne; Oja, Simo S; Raitala, Annika; Laine, Janne; Pertovaara, Marja; Vuento, Risto; Huhtala, Heini; Hurme, Mikko

    2010-02-01

    Indoleamine 2,3-dioxygenase (IDO), which is the rate-limiting enzyme for tryptophan (trp) catabolism, may play a critical role in various inflammatory disorders. Recent studies on trauma patients have suggested that the degradation of trp is associated with the development of sepsis. The role of IDO activity in bacteremic patients is unclear. We studied IDO activity in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, beta-hemolytic streptococcae, or Eschericia coli. The serum concentrations of trp and its metabolite kynurenine (kyn) were measured by reverse-phase high-performance liquid chromatography 1 to 4 days after the positive blood culture and on recovery. The kyn-to-trp ratio (kyn/trp), reflecting the activity of the IDO enzyme, was calculated. The maximum value in the ratio for every patient during 1 to 4 days after positive blood culture was used in analysis. The maximum kyn/trp ratio was significantly higher in nonsurvivors versus those who survived (193.7 vs. 82.4 micromol/mmol; P = 0.001). The AUC(ROC) of maximal kyn/trp in the prediction of case fatality was 0.75 (95% confidence interval, 0.64-0.87), and the kyn/trp ratio at a cutoff level of 120 micromol/mmol showed 83% sensitivity and 69% specificity for fatal disease. A kyn/trp ratio greater than 120 micromol/mmol was associated with increased risk of death versus low (High IDO activity also remained an independent risk factor for case fatality in a multivariate model adjusted for potential confounders. The data in this report demonstrate that IDO activity is markedly increased in bacteremia patients, constituting an independent predictor of severe disease and case fatality.

  5. Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies.

    Science.gov (United States)

    Lusthof, K J; Bosman, I J; Kubat, B; Vincenten-van Maanen, M J

    2017-02-04

    The use of scopolamine as an incapacitating drug, in sexual crimes and robberies, has been known for many decades. However, blood concentrations and doses of scopolamine in those cases are largely unknown. Here we present the toxicological results of one fatal and two non-fatal cases in a series of scopolamine-facilitated robberies. In the fatal case, the concentration of scopolamine in heart blood was 0.30mg/L, about 3000 times higher than the average therapeutic level of 0.0001mg/L (for one dermal patch). In femoral blood, the concentration of scopolamine was much lower (0.0048mg/L), but still 50 times higher than therapeutic levels. The scopolamine concentration in the stomach was very high (20mg/kg) as compared to the heart blood and femoral blood, which explains the very high concentration in heart blood by postmortem leakage from the stomach. In the non-fatal case, the scopolamine concentration in serum, obtained 23h after the incident, was 0.00035mg/L. The estimated concentration of scopolamine at the time of the incident is 0.0035mg/L. In the other non-fatal case, scopolamine was detected in urine and in hair.

  6. Fatal case of Listeria innocua bacteremia.

    Science.gov (United States)

    Perrin, Monique; Bemer, Michel; Delamare, Catherine

    2003-11-01

    Listeria innocua is widespread in the environment and in food. This species has to date never been described in association with human disease. We report a case of fatal bacteremia caused by L. innocua in a 62-year-old patient.

  7. A fatal case of pure metaphyseal chondroblastoma.

    Science.gov (United States)

    Binesh, Fariba; Moghadam, Reza Nafisi; Abrisham, Jalil

    2013-08-23

    The chondroblastoma (CB) is a rare cartilaginous tumour; it represents less than 1% of all bone tumours. It is mostly localised at the level of the epiphysis of long bones. We report a fatal case of pure metaphyseal CB of the tibia in a 9-year-old boy whose pulmonary metastases developed soon after operative therapy of the primary tumour.

  8. Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse.

    Science.gov (United States)

    Pierce, Mary Clyde; Kaczor, Kim; Acker, Deborah; Webb, Tina; Brenzel, Allen; Lorenz, Douglas J; Young, Audrey; Thompson, Richard

    2017-10-01

    This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article "History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse" (Pierce et al., 2017) [1].

  9. Case report of fatal Mycobacterium tilburgii infection.

    Science.gov (United States)

    Akpinar, Timur; Bakkaloglu, Oguz K; Ince, Burak; Tufan, Fatih; Kose, Murat; Poda, Mehves; Tascioglu, Didem; Koksalan, O Kaya; Saka, Bulent; Erten, Nilgun; Buyukbabani, Nesimi; Kilicaslan, Zeki; Tascioglu, Cemil

    2015-07-01

    There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

  10. A fatal case of peripartum cardiomyopathy.

    Science.gov (United States)

    Cohen, Ronny; Mallet, Thierry; Mirrer, Brooks; Loarte, Pablo; Gale, Michael; Kastell, Paul

    2014-06-01

    Peripartum cardiomyopathy is a life-threatening cardiac condition affecting pregnant women either late in pregnancy or early in the post-partum period. The latest studies show a dramatic improvement in the mortality rates of women affected with this disorder, which has been correlated with advances in medical therapy for heart failure. However, patients continue to die of this condition. The following case report describes a typical patient with peripartum cardiomyopathy diagnosed on clinical grounds, along with echocardiogram findings of severe systolic dysfunction and global hypokinesis consistent with dilated cardiomyopathy. Emergency cesarean delivery had to be performed for fetal distress. There was significant improvement of the patient's condition with standard pharmacological management for heart failure at the time of discharge. However, five weeks after discharge, fatal cardiac arrest occurred. It is hoped that this article will raise awareness about this rare but potentially fatal condition and promote understanding of its main clinical features, diagnostic criteria, and conventional pharmacological management.

  11. A fatal case of oleandrin poisoning.

    Science.gov (United States)

    Wasfi, Ibrahim A; Zorob, Omar; Al katheeri, Nawal A; Al Awadhi, Anwar M

    2008-08-06

    The study presents a case of fatal poisoning with oleander leaves in an adult diabetic male. After repeated vomiting, and gastrointestinal distress the patient was admitted at the hospital with cardiac symptoms 1h after the ingestion. Urine samples were assayed immunochemically and by GC-MS for drugs of abuse and for general toxicological screen. Blood was analyzed for alcohol and volatiles by static head space GC-MS. Blood and oleander leaves were analyzed by LC-MS/MS for oleandrin and related compounds, the main cardiac glycosides of Nerium oleander. Oleandrin was detected by LC-MS/MS in the blood sample at a concentration of approximately 10 ng/ml. Another cardiac glycoside with pseudo-molecular ion of m/z 577, a likely structural isomer of oleandrin, was also detected in the blood and oleander leaves. However, by using the response as a function of concentration for oleandrin, this cardiac glycoside was roughly estimated at a concentration of approximately 10 ng/ml in the deceased blood. This would give a total fatal blood concentration of cardiac glycosides of about approximately 20 ng/ml in the deceased blood.

  12. Case Report of a Fatal Antifreeze Ingestion with a Record High Level and Impressive Renal Crystal Deposition

    Science.gov (United States)

    2016-01-01

    Ethylene glycol, methanol, and diethylene glycol are readily available in many household and commercially available products. While these alcohols are relatively nontoxic themselves, their acidic metabolites are toxic and can result in significant morbidity and mortality. Herein we report a lethal case of massive ethylene glycol ingestion in a suicide with a record high level (1254 mg/dL) and images of the histologic examination of the kidneys revealing impressive calcium oxalate crystal deposition. Autopsy findings also showed evidence of mild cerebral edema. PMID:27747109

  13. Microcephaly Case Fatality Rate Associated with Zika Virus Infection in Brazil: Current Estimates.

    Science.gov (United States)

    Cunha, Antonio José Ledo Alves da; de Magalhães-Barbosa, Maria Clara; Lima-Setta, Fernanda; Medronho, Roberto de Andrade; Prata-Barbosa, Arnaldo

    2017-05-01

    Considering the currently confirmed cases of microcephaly and related deaths associated with Zika virus in Brazil, the estimated case fatality rate is 8.3% (95% confidence interval: 7.2-9.6). However, a third of the reported cases remain under investigation. If the confirmation rates of cases and deaths are the same in the future, the estimated case fatality rate will be as high as 10.5% (95% confidence interval: 9.5-11.7).

  14. Fatal mephedrone intoxication--a case report.

    Science.gov (United States)

    Adamowicz, Piotr; Tokarczyk, Bogdan; Stanaszek, Roman; Slopianka, Markus

    2013-01-01

    A death caused by a new designer drug, 4-methylmethcathinone (mephedrone), is reported. Eight small plastic bags containing white powder were found in the jacket of a young dead male. Spot tests conducted by the police officer indicated the presence of 4-bromo-2,5-dimethoxyphenethylamine (2C-B) in the powders. Laboratory routine screening analyses of blood and vitreous humor did not reveal any positive results; therefore, 2C-B was excluded. Analysis of powders was conducted using gas chromatography-mass spectrometry and high-pressure liquid chromatography with diode array detection. The purity of mephedrone found in all powder samples was in the range of 80.4-87.3%. In connection with these findings, blood and vitreous humor samples were analyzed for mephedrone. Analyses were conducted using liquid chromatography-tandem mass spectrometry. Mephedrone was found in blood and vitreous humor at the concentrations of 5.5 and 7.1 µg/mL, respectively, revealing that this was a fatal mephedrone intoxication.

  15. Measles Case Fatality Rate in Bihar, India, 2011–12

    Science.gov (United States)

    Murhekar, Manoj V.; Ahmad, Mohammad; Shukla, Hemant; Abhishek, Kunwar; Perry, Robert T.; Bose, Anindya S.; Shimpi, Rahul; Kumar, Arun; Kaliaperumal, Kanagasabai; Sethi, Raman; Selvaraj, Vadivoo; Kamaraj, Pattabi; Routray, Satyabrata; Das, Vidya Nand; Menabde, Nata; Bahl, Sunil

    2014-01-01

    Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases. PMID:24824641

  16. Measles case fatality rate in Bihar, India, 2011-12.

    Directory of Open Access Journals (Sweden)

    Manoj V Murhekar

    Full Text Available BACKGROUND: Updated estimates of measles case fatality rates (CFR are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar-one of the north Indian states historically known for its low vaccination coverage. METHODS: We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. RESULTS: The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47-1.30. CFR was higher among under-five children (1.22% and children belonging to scheduled castes/tribes (SC/ST, 1.72%. On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. CONCLUSIONS: Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.

  17. Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report.

    Science.gov (United States)

    Park, So-Youn; Park, So Young; Moon, Soo-Youn; Son, Jun Seong; Lee, Mi Suk

    2011-01-01

    Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

  18. First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

    Science.gov (United States)

    Crawford, April; Moore, Casey V.; Gasser, Robin B.; Nelson, Renjy; Koehler, Anson V.; Bradbury, Richard S.; Speare, Rick; Dhatrak, Deepak; Weldhagen, Gerhard F.

    2015-01-01

    Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool. PMID:25694532

  19. Second Fatal Case of Infective Endocarditis caused by Gemella bergeriae

    Directory of Open Access Journals (Sweden)

    Aijan Ukudeeva

    2017-03-01

    Full Text Available Our case illustrates a fatal course of infection with Gemella bergeriae endocarditis that was complicated by cardiogenic shock due to perforation of the mitral valve with severe mitral regurgitation, extension of infection into the myocardium adjacent to the mitral valve, and coronary sinus thrombosis.

  20. A case of fatal necrotizing fasciitis arising from chronic lymphedema.

    Science.gov (United States)

    Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin

    2013-12-01

    Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

  1. Blast overpressure after tire explosion: a fatal case.

    Science.gov (United States)

    Pomara, Cristoforo; D'Errico, Stefano; Riezzo, Irene; Perilli, Gabriela; Volpe, Umberto; Fineschi, Vittorio

    2013-12-01

    Fatal blast injuries are generally reported in literature as a consequence of the detonation of explosives in war settings. The pattern of lesion depends on the position of the victim in relation to the explosion, on whether the blast tracks through air or water, and whether it happens in the open air or within an enclosed space and the distance from the explosion. Tire explosion-related injuries are rarely reported in literature. This study presents a fatal case of blast overpressure due to the accidental explosion of a truck tire occurring in a tire repair shop. A multidisciplinary approach to the fatality involving forensic pathologists and engineers revealed that the accidental explosion, which caused a series of primary and tertiary blast wave injuries, was due to tire deterioration.

  2. Fatal cold agglutinin-induced haemolytic anaemia: a case report

    Directory of Open Access Journals (Sweden)

    Reverberi Roberto

    2010-08-01

    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.

  3. Fatalities in high school and college football players.

    Science.gov (United States)

    Boden, Barry P; Breit, Ilan; Beachler, Jason A; Williams, Aaron; Mueller, Frederick O

    2013-05-01

    Fatalities in football are rare but tragic events. The purpose was to describe the causes of fatalities in high school and college football players and potentially provide preventive strategies. Descriptive epidemiology study. We reviewed the 243 football fatalities reported to the National Center for Catastrophic Sports Injury Research from July 1990 through June 2010. Football fatalities averaged 12.2 per year, or 1 per 100,000 participants. There were 164 indirect (systemic) fatalities (average, 8.2 annually [or 0.7 per 100,000 participants]) and 79 direct (traumatic) fatalities (average, 4.0 annually [or 0.3 per 100,000 participants]). Indirect fatalities were 2.1 times more common than direct fatalities. The risk of a fatality in college compared with high school football players was 2.8 (95% CI, 0.7-8.2) times higher for all fatalities, 3.6 (95% CI, 2.5-5.3) times higher for indirect events, 1.4 (95% CI, 0.6-3.0) times higher for direct injuries, 3.8 (95% CI, 1.8-8.3) times higher for heat illness, and 66 (95% CI, 14.4-308) times higher for sickle cell trait (SCT) fatalities. Most indirect events occurred in practice sessions; preseason practices and intense conditioning sessions were vulnerable periods for athletes to develop heat illness or SCT fatalities, respectively. In contrast, most brain fatalities occurred during games. The odds of a fatality during the second decade, compared with the first decade of the study, were 9.7 (95% CI, 1.2-75.9) for SCT, 1.5 (95% CI, 0.8-2.9) for heat illness, 1.1 (95% CI, 0.8-1.7) for cardiac fatalities, and 0.7 (95% CI, 0.4-1.2) for brain fatalities. The most common causes of fatalities were cardiac failure (n = 100, 41.2%), brain injury (n = 62, 25.5%), heat illness (n = 38, 15.6%), SCT (n = 11, 4.5%), asthma and commotio cordis (n = 7 each, 2.9% each), embolism/blood clot (n = 5, 2.1%), cervical fracture (n = 4, 1.7%), and intra-abdominal injury, infection, and lightning (n = 3, 1.2% each). High school and college

  4. Fatal case of acute gastroenteritis with multiple viral coinfections.

    Science.gov (United States)

    Lupo, Julien; Morel-Baccard, Christine; Michard-Lenoir, Anne-Pascale; Germi, Raphaële; Pothier, Pierre; Ambert-Balay, Katia; Morand, Patrice

    2016-01-01

    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.

  5. A Fatal Case of Brucine Poisoning

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    Basavaprabhu Achappa

    2012-08-01

    Full Text Available In some parts of India people follow a religious ritual of drinking an herbal preparation made from the bark of Alstonia scholaris tree (Blackboard tree on the day of new moon in the month of July. This tree could be easily confused with Strychnos nux vomica tree. Brucine is the predominant alkaloid present in the bark of the tree Strychnos nux vomica. Toxicological property of Brucine is similar to strychnine. Brucine is a neurotoxin. A 29-year-old male presented with a history of consumption of a herbal preparation made from the bark of the Strychnos nux vomica tree confusing it for Alstonia scholaris. Soon after, he developed convulsions and later he died in the hospital on the same day. The main aim of this case report is to highlight the fact that people must be cautious when they follow religious rituals.

  6. A fatal case of anaphylactic shock during paragliding.

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    Feltracco, Paolo; Barbieri, Stefania; Galligioni, Helmut; Pasin, Laura; Gaudio, Rosa Maria; Tommasi, Aurelio; Zucchetto, Alessandro; Trevisiol, Paride; Ori, Carlo; Avato, Francesco Maria

    2012-11-01

    The growth in popularity of flying ultralight aircraft and paragliding has been associated with an increased involvement of Emergency Medical Services because of various types of trauma suffered from both inexperienced and skilled individuals. This case presentation reports on a paraglider pilot, who was seen spinning "unusually" rapidly toward the ground, without visible attempts to regain control of the aircraft. Besides the bilateral mydriasis and the absence of any ECG activity, there was a significant swelling of face, lips, neck, and tongue. Upon opening the mouth, a dead bee was found over the tongue, underneath the palate. A fatal anaphylactic shock was the likely cause of death of the pilot while still "in mid-air." This case is certainly different from the commonly reported accidents during paragliding. An updated review of the medical literature shows no reported cases of fatal anaphylactic shock during the practice of paragliding.

  7. Stroke risk factors, subtypes, and 30‑day case fatality in Abuja, Nigeria

    African Journals Online (AJOL)

    Stroke risk factors, subtypes, and 30‑day case fatality in Abuja, Nigeria. ... as well as brain computerized tomography, magnetic resonance imaging, and carotid ... We also assessed case fatality and functional outcome at 30 days after stroke.

  8. Fatal aconitine intoxication or thyroid storm? A case report.

    Science.gov (United States)

    Arlt, E M; Keller, T; Wittmann, H; Monticelli, F

    2012-05-01

    The case of a female in the latter half of her teens found dead in her father's apartment is reported. A glass containing liquid and plant remnants was found at the death scene. There were no indications of any intervention or the application of force by a third party. Autopsy showed unremarkable findings. Toxicological investigations revealed lethal doses of aconitine, a highly poisonous alkaloid and the major active compound of Aconitum napellus, in all specimens. Plant remnants were identified as A. napellus leaves by a botanist and toxicological examination of the liquid in the glass on site showed extremely high concentrations of aconitine. Additionally, laboratory results revealed that the young female was suffering from thyrotoxicosis factitia, an uncommon form of hyperthyroidism caused by misuse or overdosing of thyroid hormones in order to loose weight. A rare but serious and often fatal complication of hyperthyroidism is thyroid storm. Eventually the condition of thyroid storm due to thyrotoxicosis factitia could have contributed to the woman's death from aconitine poisoning.

  9. A fatal case of urosepsis due to Corynebacterium riegelii

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    Gokhan Aygun

    2013-01-01

    Full Text Available Corynebacterium species other than Corynebacterium diphtheriae rarely cause infections in human but rather reside in flora, however they have been reported to cause opportunistic infections in both immunocompromised and immunecompetent patients. Here we report for the first time a case of an elderly female patient presenting with a fatal urosepsis caused by a recently defined pathogen, Corynebacterium riegelii, identified on second day after patient hospitalization leading to a progressive worsening and death of the patient on 6th day.

  10. A fatal case of urosepsis due to Corynebacterium riegelii.

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    Aygun, Gokhan; Midilli, Kenan; Cilingir, Hatice; Yilmaz, Mesut; Kutukcu, Aysegul; Eker, Engin

    2013-01-01

    Corynebacterium species other than Corynebacterium diphtheriae rarely cause infections in human but rather reside in flora, however they have been reported to cause opportunistic infections in both immunocompromised and immunecompetent patients. Here we report for the first time a case of an elderly female patient presenting with a fatal urosepsis caused by a recently defined pathogen, Corynebacterium riegelii, identified on second day after patient hospitalization leading to a progressive worsening and death of the patient on 6th day.

  11. A fatal case of melioidosis with pancytopenia in a traveler from Indonesia.

    Science.gov (United States)

    Katanami, Yuichi; Kutsuna, Satoshi; Horino, Atsuko; Hashimoto, Takehiro; Mutoh, Yoshikazu; Yamamoto, Kei; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Kato, Yasuyuki; Ohmagari, Norio

    2017-04-01

    Melioidosis, an infectious disease with high mortality, caused by Burkholderia pseudomallei, is endemic in southeast Asia and northern Australia. In Indonesia, autochthonous cases have been rarely reported, with most cases being sporadic and occurring in travelers. Herein, we report a fatal case of neurological melioidosis in a traveler from Indonesia presenting with septic shock. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. Hair analysis to document non-fatal pesticide intoxication cases.

    Science.gov (United States)

    Dulaurent, S; Gaulier, J M; Baudel, J L; Fardet, L; Maury, E; Lachâtre, G

    2008-03-21

    We reported two non-fatal cases of intoxication with pesticides namely alachlor and carbofuran. Hair stand samples were collected from two men approximately 1 year after alachlor intoxication for case 1, and 14 days after the last exposure for case 2. Hair analysis was performed using a liquid chromatography-tandem mass spectrometry method. In case 1, alachlor was detected in the 5 analysed hair segments (concentrations between 12 and 136 pg/mg) and its metabolites were not detected. In case 2, carbofuran and its main metabolite (3-hydroxycarbofuran) were detected in the hair strand (global analysis) at the concentrations of 207 and 164 pg/mg, respectively. However, additional data are required in order to interpret such results.

  13. A case of fatal aconitine poisoning by Monkshood ingestion.

    Science.gov (United States)

    Pullela, Ravi; Young, Lorraine; Gallagher, Barry; Avis, Simon P; Randell, Edward W

    2008-03-01

    Accidental aconitine poisoning is extremely rare in North America. This report describes the confirmation of a case of accidental aconitine poisoning using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The case involved a 25-year-old man who died suddenly following a recreational outing with friends where he consumed a number of wild berries and plants including one that was later identified as Monkshood (Aconitum napellus). Postmortem blood and urine samples were available for analysis. All routine urine and blood toxicology screens were negative. The LC-MS/MS method allowed sensitive quantification of aconitine, the main toxin in A. napellus, and showed 3.6 and 149 microg/L in blood and urine, respectively. These concentrations were similar to that reported in other aconitine-related deaths. This case illustrates the dangers of consuming unidentified plants, and documents concentrations of aconitine in blood and urine in a fatal case of A. napallus-related poisoning.

  14. [Case of fatal aconite poisoning, and its background].

    Science.gov (United States)

    Kazuma, Kohei; Satake, Motoyoshi; Konno, Katsuhiro

    2013-01-01

    Two people out of three who accidentally ate boiled aconite leaves died in 2012. This was a typical case of aconite poisoning in Japan: Aconite (Aconitum spp.) was mistakenly collected instead of Anemone flaccida, an edible wild plant. The leaves of these plants are quite similar to each other. Chemical analyses of the aconite plant left at the scene suggested intake of a fatal amount of aconitine alkaloids by each person. The collector, who died, had missed the botanical differences between the two plants, even though he owned a wild plant guidebook. A. flaccida should be collected with its flowers in order to aid positive indentification and avoid aconite poisoning.

  15. Fatal Cases of Bloodstream Infection by Fusarium solani and Review of Published Literature.

    Science.gov (United States)

    Dabas, Yubhisha; Bakhshi, Sameer; Xess, Immaculata

    2016-04-01

    Fusarium species are ubiquitously present in environment and are well known as human pathogens with high mortality rate in immunocompromised patients. We report here two cases where immunocompromised patients developed fatal bloodstream infections by this organism. Isolates were further identified by ITS1 region sequencing which confirmed them as Fusarium solani. Antifungal susceptibility testing was done following CLSI M38-A2 guidelines to amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, and micafungin. Both patients had a fatal outcome and expired of septic shock. Therefore, identification up to species level is of utmost importance as that helps in directing the management of the patient thereby leading to a favourable outcome.

  16. [Fatal electric arc accidents due to high voltage].

    Science.gov (United States)

    Strauch, Hansjürg; Wirth, Ingo

    2004-01-01

    The frequency of electric arc accidents has been successfully reduced owing to preventive measures taken by the professional association. However, the risk of accidents has continued to exist in private setting. Three fatal electric arc accidents caused by high voltage are reported with reference to the autopsy findings.

  17. Air pollution and case fatality of SARS in the People's Republic of China: an ecologic study

    Directory of Open Access Journals (Sweden)

    Yu Shun-Zhang

    2003-11-01

    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.

  18. Fatal parvoviral myocarditis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Zhao Richard

    2008-04-01

    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.

  19. Fatal hemolytic anemia associated with metformin: A case report

    Directory of Open Access Journals (Sweden)

    Packer Clifford D

    2008-09-01

    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.

  20. Air bag-mediated fatal craniocervical trauma: a case report.

    Science.gov (United States)

    Büyük, Yalçin; Uzün, Ibrahim; Erkol, Zerrin; Ağritmiş, Hasan; Ustündağ, Kasim T

    2010-07-01

    This case report describes a four-year-old girl (102 cm, 17 kg) who sustained fatal craniocerebral injuries as a result of an inflating automobile air bag. The car struck the lid of the sewer system, which was 15 cm above the ground level, at a low speed, and both the driver and passenger air bags inflated. Despite the fact that air bag usage has lessened both the possibility and severity of occupant injuries in frontal collisions, case reports of serious injuries and even deaths especially in children due to air bag deployment, particularly during low speed impacts, highlight the need for changes in both system design and possibly the threshold speed of air bag deployment.

  1. Fatal thrombocytopenia: A rare case with possible explanation

    Science.gov (United States)

    Barik, Ramachandra; Patnaik, A. N.; Gulati, A. S.

    2012-01-01

    A 22 year old male presented with breathlessness on exertion, ecchymosis, jaundice and features of worsening right heart failure for the last fifteen days. On physical examination, he had a mid diastolic murmur in the tricuspid area and an ejection systolic murmur in the pulmonary area. Bone marrow histopathology report showed an increased in megakaryocytes count. Routine investigations reports were normal. Echocardiography and computerized tomography (CT) revealed a single mobile large intra cardiac mass originating from the right atrium and causing dynamic obstruction of the right ventricular inflow and outflow tract. Associated fatal thrombocytopenia did not respond to intravenous steroids or platelet transfusion. Patient could not be operated because of very low platelet count, and died during hospital stay before excision biopsy could be done. Pathological autopsy was not done. This is a rare case, as the fatal thrombocytopenia observed here was the result of mechanical effects like frictional and shear force, which can be attributed to the physical presence of a large intra cardiac mass resulting in obstruction to flow. PMID:22629036

  2. Neuropathology of a fatal case of posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Kheir, John N; Lawlor, Michael W; Ahn, Edward S; Lehmann, Leslie; Riviello, James J; Silvera, V Michelle; McManus, Michael; Folkerth, Rebecca D

    2010-01-01

    The pathology of posterior reversible encephalopathy syndrome (PRES) is undefined, since it is rarely fatal and is biopsied in only exceptional circumstances. We describe rapidly progressive PRES following stem cell transplant for acute lymphoblastic leukemia. After development of altered mental status, this 8-year-old girl had T2 prolongation of the white matter in a posterior-dominant distribution, eventually developing cerebellar edema, hemorrhage, hydrocephalus, and herniation. Despite surgical and medical management, she died 36 hours later. At autopsy, the occipital and cerebellar white matter and focal occipital cortical gray matter showed a spectrum of microvascular changes, including dilated perivascular spaces containing proteinaceous exudates and macrophages, as well as fibrinoid necrosis and acute hemorrhage, in a distribution corresponding to the neuroimaging abnormalities and reminiscent of those seen in patients with acute hypertensive encephalopathy. Of note, similar microvascular changes were not seen in the kidney or other systemic sites. Thus, the findings indicate a brain-specific microvascular compromise as the substrate of PRES, at least in the rare instance of cases progressing to fatal outcome.

  3. THE RETURN OF THE STRANGLER? CASE REPORT OF A FATAL CASE OF DIPHTHERIA

    Directory of Open Access Journals (Sweden)

    Srikamakhsi Kothandaraman

    2012-11-01

    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.

  4. Smallpox virus plaque phenotypes: genetic, geographical and case fatality relationships.

    Science.gov (United States)

    Olson, Victoria A; Karem, Kevin L; Smith, Scott K; Hughes, Christine M; Damon, Inger K

    2009-04-01

    Smallpox (infection with Orthopoxvirus variola) remains a feared illness more than 25 years after its eradication. Historically, case-fatality rates (CFRs) varied between outbreaks (<1 to approximately 40 %), the reasons for which are incompletely understood. The extracellular enveloped virus (EEV) form of orthopoxvirus progeny is hypothesized to disseminate infection. Investigations with the closely related Orthopoxvirus vaccinia have associated increased comet formation (EEV production) with increased mouse mortality (pathogenicity). Other vaccinia virus genetic manipulations which affect EEV production inconsistently support this association. However, antisera against vaccinia virus envelope protect mice from lethal challenge, further supporting a critical role for EEV in pathogenicity. Here, we show that the increased comet formation phenotypes of a diverse collection of variola viruses associate with strain phylogeny and geographical origin, but not with increased outbreak-related CFRs; within clades, there may be an association of plaque size with CFR. The mechanisms for variola virus pathogenicity probably involves multiple host and pathogen factors.

  5. Fatal case of ectopic enterobiasis: Enterobius vermicularis in the kidneys.

    Science.gov (United States)

    Serpytis, Mindaugas; Seinin, Dmitrij

    2012-02-01

    Enterobius vermicularis is one of the most common intestinal parasites found in humans. They commonly infest the terminal ileum and large intestine, and are usually considered an innocuous parasite that can be easily eradicated with proper treatment. However, extraintestinal migration of worms, although very rare, may lead to severe health disorders or even death. This article, reports the first fatal case of ectopic enterobiasis known to the authors, which developed in an adult patient with E. vermicularis infection, causing perforation of the large intestine and generalized bacterial peritonitis. Despite emergency laparotomy, the patient died from septic shock on the day after surgery. During pathological examination, worms were found not only in the large intestine, but also in the renal parenchyma; worm eggs were found deposited in the lungs as well.

  6. Forensic issues in cases of water birth fatalities.

    Science.gov (United States)

    Byard, Roger W; Zuccollo, Jane M

    2010-09-01

    Birth under water has become a widely disseminated technique that is promoted to improve the quality of labor. The case of a 42-week gestation male infant is reported who died of respiratory and multiorgan failure secondary to florid pneumonia and sepsis due Pseudomonas aeruginosa following a water birth. Other infants who have been delivered underwater have drowned or have had near-drowning episodes with significant hyponatremia and water intoxication. Local and disseminated sepsis has been reported, with respiratory distress, fevers, hypoxic brain damage, and seizures. There have also been episodes of cord rupture with hemorrhage. The postmortem investigation of such cases requires a complete autopsy of the infant, with examination of the placenta. Full details of the pregnancy and delivery and inspection of the birthing unit are also needed. A septic workup of the infant and placenta should be undertaken along with sampling of water from the birthing unit and microbiological swabbing of the equipment. Vitreous sodium levels may reveal electrolyte disturbances. While fatal cases appear rare, this may change if water births gain in popularity.

  7. Schistosomiasis: a case of severe infection with fatal outcome

    Directory of Open Access Journals (Sweden)

    Cristiane Rúbia Ferreira

    2012-03-01

    Full Text Available Schistosomiasis is one of the most common parasitic diseases, stillconsidered of public health significance. Acute schistosomiasis is of difficultdiagnosis and therefore has been overlooked, misdiagnosed, underestimatedand underreported in endemic areas. The delay between the exposure tocontaminated water and the initial symptoms may explain this challengingdiagnosis. Acute schistosomiasis is frequently reported in non-immuneindividuals while reinfection cases occurring in endemic areas is scarcelydocumented. The later usually shows a benign course but fatal cases do exist.The authors report a case of a young female patient, in the late puerperium,with a three-month history of weight loss, intermittent fever, cough, thoracicand abdominal pain and increased abdominal girth. Physical examinationshowed a tachycardia, tachypnea and hypotension. Laboratory tests showeda mild anemia, eosinophilia, and a slightly elevation of liver enzymes. Thoraxand abdominal multidetector computed tomography evidenced a diffuseand bilateral pulmonary micronodules and peritoneal and intestinal wallthickening. The patient progressed rapidly to hepatic insufficiency, and deathafter respiratory insufficiency. An autopsy was performed and the findingswere compatible with acute Schistosomiasis in a patient previously exposedto Schistosoma mansoni.

  8. Fatal atypical reversible posterior leukoencephalopathy syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Golombeck Stefanie Kristin

    2013-01-01

    Full Text Available Abstract Introduction Reversible posterior leukoencephalopathy syndrome – a reversible subacute global encephalopathy clinically presenting with headache, altered mental status, visual symptoms such as hemianopsia or cortical blindness, motor symptoms, and focal or generalized seizures – is characterized by a subcortical vasogenic edema symmetrically affecting posterior brain regions. Complete reversibility of both clinical signs and magnetic resonance imaging lesions is regarded as a defining feature of reversible posterior leukoencephalopathy syndrome. Reversible posterior leukoencephalopathy syndrome is almost exclusively seen in the setting of a predisposing clinical condition, such as pre-eclampsia, systemic infections, sepsis and shock, certain autoimmune diseases, various malignancies and cytotoxic chemotherapy, transplantation and concomitant immunosuppression (especially with calcineurin inhibitors as well as episodes of abrupt hypertension. We describe for the first time clinical, radiological and histological findings in a case of reversible posterior leukoencephalopathy syndrome with an irreversible and fatal outcome occurring in the absence of any of the known predisposing clinical conditions except for a hypertensive episode. Case presentation A 58-year-old Caucasian woman presented with a two-week history of subacute and progressive occipital headache, blurred vision and imbalance of gait and with no evidence for raised arterial blood pressure during the two weeks previous to admission. Her past medical history was unremarkable except for controlled arterial hypertension. Cerebral magnetic resonance imaging demonstrated cortical and subcortical lesions with combined vasogenic and cytotoxic edema atypical for both venous congestion and arterial infarction. Routine laboratory and cerebrospinal fluid parameters were normal. The diagnosis of reversible posterior leukoencephalopathy syndrome was established. Within hours after

  9. Reduced case fatality among hospitalized children during a war in Guinea-Bissau

    DEFF Research Database (Denmark)

    Sodemann, Morten; Veirum, Jens Erik; Biai, S

    2004-01-01

    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....

  10. An oxcarbazepine-related fatality with an overview of 26 oxcarbazepine postmortem cases

    DEFF Research Database (Denmark)

    Linnet, K.; Steentoft, A.; Simonsen, Kirsten Wiese

    2008-01-01

    We present an oxcarbazepine-related fatality together with an overview of 26 postmortem cases involving oxcarbazepine observed during the period 2001-2006. The fatality case concerned a 27-year-old woman with epilepsy, who was found dead in her bed. Oxcarbazepine and its active metabolite, 10-hyd...

  11. Case-fatality rates for myocardial infarction declined in Denmark and Sweden during 1987-1999

    DEFF Research Database (Denmark)

    Rasmussen, Søren; Abildstrom, Steen Z; Rosén, Måns;

    2004-01-01

    OBJECTIVE: To evaluate trends in prognosis after acute myocardial infarction (AMI) between Denmark and Sweden using routinely collected data and different case-fatality measures. STUDY DESIGN AND SETTING: We compared three case-fatality measures during 1987-1999 using national registries in Denmark...

  12. Stroke case fatality in Denmark from 1977 to 1992: the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Grønbaek, Morten; Schnohr, Peter

    2012-01-01

    Stroke mortality rates have decreased in Denmark but little is known about the reasons for these changes. One possible explanation is decreased case-fatality, and the aim of the present investigation was to study trends in case-fatality for first-ever stroke in a large population-based cohort study...

  13. Case Report of Methylone, Oxymorphone and Ethanol in a Fatality Case with Tissue Distribution.

    Science.gov (United States)

    Shimomura, Eric T; Briones, Alice J; Warren, Wendy S; Addison, Joseph W; Knittel, Jessica L; Shoemaker, Sarah A; King, Taj D; Bosy, Thomas Z

    2016-09-01

    It is reasonable to expect the presence of multiple drugs to present a complicated picture of toxicity. We report a fatal case involving a young man who purchased illicit drugs and knowingly consumed them. After consuming these drugs and going to sleep in his friend's car, he was found unresponsive the next morning with no signs of physical violence. Drugs found in the peripheral blood at autopsy were oxymorphone, methylone and ethanol at concentrations of 0.106, 0.50 and 130 mg/dL, respectively. The levels of oxymorphone and methylone in peripheral blood were comparable to those observed in other reported fatalities. Cocaine and benzoylecgonine were detected in the urine but not in the blood. Measureable concentrations were also observed for oxymorphone and methylone in urine, liver, kidney and bile. The physical findings at autopsy included pulmonary edema. This is the only reported fatal case involving this combination of drugs encountered in our laboratory.

  14. An autopsy case of fatal repellent air freshener poisoning.

    Science.gov (United States)

    Hitosugi, Masahito; Tsukada, Chie; Yamauchi, Shinobu; Matsushima, Kazumi; Furukawa, Satoshi; Morita, Satomu; Nagai, Toshiaki

    2015-09-01

    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.

  15. Unique fatality due to claw injuries in a tiger attack: a case report.

    Science.gov (United States)

    Pathak, Hrishikesh; Dixit, Pradeep; Dhawane, Shailendra; Meshram, Satin; Shrigiriwar, Manish; Dingre, Niraj

    2014-11-01

    This paper describes a unique case of a fatal tiger attack in the wild. In the present case, a tiger fatally mauled a 34-year-old female with its claws, instead of the usual mechanism of killing by the bite injury to the neck. The autopsy revealed multiple fatal and non-fatal injuries caused by the tiger claws. The characteristic injuries due to the tooth impacts were absent as the teeth of the offending tiger were either fallen or non-functional. To the best of our knowledge, probably this rare case would be the first reported human fatality due to the tiger claw injuries in the world. The purpose of the present article is to highlight the fatal injuries due to the tiger claws, as the claw-induced fatal injuries in a tiger attack are not reported in the medico-legal literature. Moreover, this report would be an illustrative one for differentiation between the fatal injuries due to the claws and tooth impacts in a tiger attack. Furthermore, the present report establishes the importance of the tiger claws as a source of fatal injuries in a tiger attack.

  16. A fatal case of Lassa fever in London, January 2009.

    Science.gov (United States)

    Kitching, A; Addiman, S; Cathcart, S; Bischop, L; Krahé, D; Nicholas, M; Coakley, J; Lloyd, G; Brooks, T; Morgan, D; Turbitt, D

    2009-02-12

    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.

  17. Case fatality rates of different suicide methods within Ilam province of Iran

    OpenAIRE

    2012-01-01

    Background: There are few diverse studies that have reported the case fatality rates of different methods of suicide, none of them are originated from developing countries. The aim of the present article is to report the case fatality rates of different methods of suicide in Ilam province of Iran. Materials and Methods: Data on 611 cases of suicide and 1807 cases of deliberate self harm (DSH) that were recorded in a comprehensive registry during 1995 through 2002 were analyzed for both gender...

  18. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: A review of five cases

    DEFF Research Database (Denmark)

    Holm, Janni Schmidt; Brixen, Kim; Andries, Alin

    2011-01-01

    OBJECTIVE: Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD: Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency...

  19. American football and fatal exertional heat stroke: a case study of Korey Stringer.

    Science.gov (United States)

    Grundstein, Andrew; Knox, John A; Vanos, Jennifer; Cooper, Earl R; Casa, Douglas J

    2017-03-17

    On August 1, 2001, Korey Stringer, a Pro Bowl offensive tackle for the Minnesota Vikings, became the first and to date the only professional American football player to die from exertional heat stroke (EHS). The death helped raise awareness of the dangers of exertional heat illnesses in athletes and prompted the development of heat safety policies at the professional, collegiate, and interscholastic levels. Despite the public awareness of this death, no published study has examined in detail the circumstances surrounding Stringer's fatal EHS. Using the well-documented details of the case, our study shows that Stringer's fatal EHS was the result of a combination of physiological limitations, organizational and treatment failings, and extreme environmental conditions. The COMfort FormulA (COMFA) energy budget model was used to assess the relative importance of several extrinsic factors on Stringer's EHS, including weather conditions, clothing insulation, and activity levels. We found that Stringer's high-intensity training in relation to the oppressive environmental conditions was the most prominent factor in producing dangerous, uncompensable heat stress conditions and that the full football uniform played a smaller role in influencing Stringer's energy budget. The extreme energy budget levels that led to the fatal EHS would have been avoided according to our modeling through a combination of reduced intensity and lower clothing insulation. Finally, a long delay in providing medical treatment made the EHS fatal. These results highlight the importance of modern heat safety guidelines that provide controls on extrinsic factors, such as the adjustment of duration and intensity of training along with protective equipment modifications based on environmental conditions and the presence of an emergency action plan focused on rapid recognition and immediate on-site aggressive cooling of EHS cases.

  20. American football and fatal exertional heat stroke: a case study of Korey Stringer

    Science.gov (United States)

    Grundstein, Andrew; Knox, John A.; Vanos, Jennifer; Cooper, Earl R.; Casa, Douglas J.

    2017-08-01

    On August 1, 2001, Korey Stringer, a Pro Bowl offensive tackle for the Minnesota Vikings, became the first and to date the only professional American football player to die from exertional heat stroke (EHS). The death helped raise awareness of the dangers of exertional heat illnesses in athletes and prompted the development of heat safety policies at the professional, collegiate, and interscholastic levels. Despite the public awareness of this death, no published study has examined in detail the circumstances surrounding Stringer's fatal EHS. Using the well-documented details of the case, our study shows that Stringer's fatal EHS was the result of a combination of physiological limitations, organizational and treatment failings, and extreme environmental conditions. The COMfort FormulA (COMFA) energy budget model was used to assess the relative importance of several extrinsic factors on Stringer's EHS, including weather conditions, clothing insulation, and activity levels. We found that Stringer's high-intensity training in relation to the oppressive environmental conditions was the most prominent factor in producing dangerous, uncompensable heat stress conditions and that the full football uniform played a smaller role in influencing Stringer's energy budget. The extreme energy budget levels that led to the fatal EHS would have been avoided according to our modeling through a combination of reduced intensity and lower clothing insulation. Finally, a long delay in providing medical treatment made the EHS fatal. These results highlight the importance of modern heat safety guidelines that provide controls on extrinsic factors, such as the adjustment of duration and intensity of training along with protective equipment modifications based on environmental conditions and the presence of an emergency action plan focused on rapid recognition and immediate on-site aggressive cooling of EHS cases.

  1. American football and fatal exertional heat stroke: a case study of Korey Stringer

    Science.gov (United States)

    Grundstein, Andrew; Knox, John A.; Vanos, Jennifer; Cooper, Earl R.; Casa, Douglas J.

    2017-03-01

    On August 1, 2001, Korey Stringer, a Pro Bowl offensive tackle for the Minnesota Vikings, became the first and to date the only professional American football player to die from exertional heat stroke (EHS). The death helped raise awareness of the dangers of exertional heat illnesses in athletes and prompted the development of heat safety policies at the professional, collegiate, and interscholastic levels. Despite the public awareness of this death, no published study has examined in detail the circumstances surrounding Stringer's fatal EHS. Using the well-documented details of the case, our study shows that Stringer's fatal EHS was the result of a combination of physiological limitations, organizational and treatment failings, and extreme environmental conditions. The COMfort FormulA (COMFA) energy budget model was used to assess the relative importance of several extrinsic factors on Stringer's EHS, including weather conditions, clothing insulation, and activity levels. We found that Stringer's high-intensity training in relation to the oppressive environmental conditions was the most prominent factor in producing dangerous, uncompensable heat stress conditions and that the full football uniform played a smaller role in influencing Stringer's energy budget. The extreme energy budget levels that led to the fatal EHS would have been avoided according to our modeling through a combination of reduced intensity and lower clothing insulation. Finally, a long delay in providing medical treatment made the EHS fatal. These results highlight the importance of modern heat safety guidelines that provide controls on extrinsic factors, such as the adjustment of duration and intensity of training along with protective equipment modifications based on environmental conditions and the presence of an emergency action plan focused on rapid recognition and immediate on-site aggressive cooling of EHS cases.

  2. Fatal cases of gestational trophoblastic neoplasia over four decades in the Netherlands: a retrospective cohort study

    NARCIS (Netherlands)

    Lybol, C.; Centen, D.W.; Thomas, C.M.G.; ten Kate-Booij, M.J.; Verheijen, R.H.; Sweep, F.C.; Ottevanger, P.B.; Massuger, L.F.A.G.

    2012-01-01

    OBJECTIVE: To describe fatal cases of gestational trophoblastic neoplasia (GTN) over four decades and evaluate whether treatment was given according to the protocol and reveal possible implications for future management. DESIGN: Retrospective cohort study. SETTING: The Netherlands. POPULATION: Women

  3. Challenges in measuring measles case fatality ratios in settings without vital registration

    Directory of Open Access Journals (Sweden)

    Nandy Robin

    2010-07-01

    Full Text Available Abstract Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.

  4. Fatal complication after transsphenoidal surgery of pituitary adenoma: case report

    OpenAIRE

    Conceição Aparecida Dornelas; Tereza N. A. G. Nogueira; Evandro T. Alves; River A. B. Coêlho

    2015-01-01

    ABSTRACT The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma), with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fi...

  5. Review of Dengue hemorrhagic fever fatal cases seen among adults: a retrospective study.

    Science.gov (United States)

    Sam, Sing-Sin; Omar, Sharifah Faridah Syed; Teoh, Boon-Teong; Abd-Jamil, Juraina; AbuBakar, Sazaly

    2013-01-01

    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. 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. 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.

  6. Review of Dengue hemorrhagic fever fatal cases seen among adults: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Sing-Sin Sam

    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.

  7. Review of Dengue Hemorrhagic Fever Fatal Cases Seen Among Adults: A Retrospective Study

    Science.gov (United States)

    Sam, Sing-Sin; Omar, Sharifah Faridah Syed; Teoh, Boon-Teong; Abd-Jamil, Juraina; AbuBakar, Sazaly

    2013-01-01

    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. PMID:23658849

  8. A fatal mycotic sepsis after retrograde intrarenal surgery: a case report and literature review.

    Science.gov (United States)

    Cindolo, Luca; Berardinelli, Francesco; Castellan, Pietro; Castellucci, Roberto; Pellegrini, Fabrizio; Schips, Luigi

    2017-04-28

    The retrograde intrarenal surgery (RIRS) is a procedure that sees an increase in its use every day and is supported by excellent results in terms of safety and feasibility. We report the first case of fatal mycotic septic complication in a neurological patient for renal stone disease. The case of a woman 44 year-old, with left solitary kidney and history of advanced multiple sclerosis, epilepsy, bedridden and percutaneous endoscopic gastrostomy was described. She was hospitalized for the presence of recurrent lower urinary tract infections. The computed tomography (CT) scan control revealed a 1.7 cm obstructive renal pelvic stone and multiple stones in the bladder. After the refusal of a percutaneous approach, a RIRS was planned and done. No intraoperative complications were observed. In the postoperative period, she developed a urinary sepsis with progressive deterioration of the general conditions. She died 6 days after the RIRS for septic shock with a blood culture positive for Candida glabrata. A Pubmed search for fatal complications after RIRS shows only two cases not fully elucidated. The use of flexible ureteroscopes and holmium lasers has a high succes rate;nevertheless, the possibility of a major complication should be kept in mind in order to evaluate all the risk factors, to adopt all the preventive measures for the safety of the patients.

  9. Fatal complication after transsphenoidal surgery of pituitary adenoma: case report

    Directory of Open Access Journals (Sweden)

    Conceição Aparecida Dornelas

    2015-06-01

    Full Text Available ABSTRACT The objective of this study was to report a rare fatal complication in the postoperative period of transsphenoidal surgery of the pituitary gland (adenoma, with a brief review of the subject. The patient was a 54-year-old white man with acromegaly and severe heart failure, who after microsurgery developed blood pressure instability within 32 hours after the procedure and died. The autopsy revealed: hypertrophy and ventricular dilation with myocarditis, pericarditis and myocardial fibrosis; mesenteric ischemia with transmural coagulation necrosis of the intestinal loops; acute tubular necrosis; and hepatic steatosis. The findings are consistent with cardiogenic shock and abdominal sepsis due to necrosis of the intestinal loops.

  10. Rapidly fatal "congenital lung dysplasia": a case report and review of the literature.

    Science.gov (United States)

    Don, Massimiliano; Orsaria, Maria; Da Dalt, Eva; Tringali, Carmela; Sacher, Bruno

    2014-04-01

    Acinar dysplasia congenital alveolar dysplasia and alveolar capillary dysplasia with misalignment of pulmonary veins belong to the diffuse developmental disorders (congenital lung dysplasia), very rare fatal disorders of infancy that occur early in lung development. A case of quickly fatal congenital lung dysplasia in a full-term infant is presented and underlines the necessity to suspect this disease in a newborn suffering from severe and refractory respiratory distress.

  11. Mortality and case fatality due to visceral leishmaniasis in Brazil: a nationwide analysis of epidemiology, trends and spatial patterns.

    Directory of Open Access Journals (Sweden)

    Francisco Rogerlândio Martins-Melo

    Full Text Available BACKGROUND: Visceral leishmaniasis (VL is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil. METHODS: We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis. RESULTS: In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03% deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants, <1 year-olds (1.03 deaths/100,000 inhabitants and residents in Northeast region (0.30 deaths/100,000 inhabitants. Highest case fatality rates were observed in males (8.8%, ≥ 70 year-olds (43.8% and residents in South region (17.7%. Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6, and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9; and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4. Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil. CONCLUSIONS: Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment

  12. A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K. Manatakis

    2014-01-01

    Full Text Available Wernicke’s encephalopathy is an acute neuropsychiatric disorder, due to thiamine (vitamin B1 deficiency. It is traditionally described in chronic alcohol abusers; however obesity surgery is an emerging cause, as the number of bariatric procedures increases. A high index of clinical suspicion is required, since initial symptoms may be nonspecific and the classic triad of ophthalmoplegia, gait and stance disorders, and mental confusion is present only in one-third of patients. Laboratory tests can be within normal range and typical MRI brain lesions are found only in 50% of cases. Aggressive supplementation with intravenous thiamine should not be delayed until confirmation of diagnosis, as it may fully reverse symptoms, but almost half the patients will still display permanent neurological deficit. We present our experience with a fatal case of Wernicke’s encephalopathy, following laparoscopic sleeve gastrectomy for morbid obesity.

  13. HPLC-DAD determination of mepivacaine in cerebrospinal fluid from a fatal case.

    Science.gov (United States)

    Nieddu, Maria; Boatto, Gianpiero; Serra, Domenico; Soro, Aldo; Lorenzoni, Salvatore; Lubinu, Francesco

    2007-09-01

    A fatal case involving mepivacaine-induced epidural anesthesia is described. The pathological findings were typical of cardiac shock from ischemic origin. Cerebrospinal fluid (CSF) was obtained several hours after death and mepivacaine was identified by gas chromatography-mass spectrometry (GC-MS). Its concentration was determined by high performance liquid chromatography with diode array detection (HPLC-DAD). Extraction from CSF was performed by deproteinization with acetonitrile. The mepivacaine concentration in the sample was 264 microg/mL. Concentrations of mepivacaine in CSF following epidural anesthesia are not reported in literature to our knowledge. This is the first reported case of death in which the mepivacaine concentration in CSF has been determined.

  14. Trends in incidence, case-fatality and recurrence of myocardial infarction in the Danish MONICA population 1982-1991

    DEFF Research Database (Denmark)

    Davidsen, M; Brønnum-Hansen, H; Jørgensen, Torben;

    2001-01-01

    was to assess trends in the incidence, case-fatality and recurrence rate of MI and to analyse whether any changes seen were due to a period or a cohort effect. METHODS: The Danish MONICA population comprises all men and women aged 25-74 years in the period 1982-1991 living in a suburban area of Copenhagen......, Denmark. Fatal and non-fatal attacks classified as definite MI and non-fatal attacks classified as possible MI were included. The incidence rate was analysed by Poisson regression, the case-fatality rate by logistic regression, and the rate of recurrence by Cox regression. Age-period-cohort analyses were...... or cohort effect. The rate of case-fatality after a first MI was not changed significantly during the period, whereas men and women had different trends in case-fatality after recurrent MI. CONCLUSIONS: In accordance with results from other Western countries we found a decline in the incidence...

  15. Trends in incidence, case-fatality and recurrence of myocardial infarction in the Danish MONICA population 1982-1991

    DEFF Research Database (Denmark)

    Davidsen, M; Brønnum-Hansen, H; Jørgensen, Torben

    2001-01-01

    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......, Denmark. Fatal and non-fatal attacks classified as definite MI and non-fatal attacks classified as possible MI were included. The incidence rate was analysed by Poisson regression, the case-fatality rate by logistic regression, and the rate of recurrence by Cox regression. Age-period-cohort analyses were...

  16. A fatal case of bupropion (Zyban hepatotoxicity with autoimmune features: Case report

    Directory of Open Access Journals (Sweden)

    Humayun Fawwaz

    2007-09-01

    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.

  17. Eosinophillic myocarditis and coronary arteritis in a fatal case of asthma

    Directory of Open Access Journals (Sweden)

    Rupani Asha

    2010-10-01

    Full Text Available Mortality is very unusual in the case of asthma. We recently came across a fatal case of asthma which showed a rare combination of unusual complications like eosinophilic myocarditis, coronary arteritis, biventricular cardiac hypertrophy, eosinophilic pneumonitis and pulmonary hypertension.

  18. Fatal bacteremia by neisseria cinerea in a woman with myelodysplastic syndrome: a case report.

    Science.gov (United States)

    Zhu, Xiaofei; Li, Min; Cao, Huiling; Yang, Xuewen

    2015-01-01

    Neisseria cinerea has been rarely found in blood cultures. In this study, we are reporting a case of a Myelodysplastic Syndrome (MDS) patient in whose blood Neisseria cinerea was found and led a fatal consequence. This case will call our attentions to the uncommon pathogens in the pathogenicity of end-stage patients.

  19. Fatal bacteremia by neisseria cinerea in a woman with myelodysplastic syndrome: a case report

    OpenAIRE

    Zhu, Xiaofei; Li, Min; Cao, Huiling; Yang, Xuewen

    2015-01-01

    Neisseria cinerea has been rarely found in blood cultures. In this study, we are reporting a case of a Myelodysplastic Syndrome (MDS) patient in whose blood Neisseria cinerea was found and led a fatal consequence. This case will call our attentions to the uncommon pathogens in the pathogenicity of end-stage patients.

  20. Case-fatality of COPD exacerbations: a meta-analysis and statistical modeling approach

    DEFF Research Database (Denmark)

    Hoogendoorn, M; Hoogenveen, R T; Rutten-van Mölken, M P

    2010-01-01

    Objective of the study was to estimate the case-fatality of a severe exacerbation from long-term survival data presented in the literature. A literature search identified studies reporting at least 1.5 year survival after a severe COPD exacerbation resulting in hospitalization. Each study...... and was calculated as 1 minus the (backwardly) extrapolated survival during the stable period at the time of exacerbation onset. The 95% confidence intervals of the estimated case-fatalities were obtained by bootstrapping. A random effect model was used to combine all estimates into a weighted average with 95......'s survival curve was divided into a critical and a stable period. Mortality during the stable period was then estimated by extrapolating the survival curve during the stable period back to the time of exacerbation onset. Case-fatality was defined as the excess mortality that results from an exacerbation...

  1. Parental Rheumatoid Arthritis, Child Mortality and Case Fatality A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Rom, Ane L; Wu, Chunsen; Olsen, Jørn;

    2017-01-01

    OBJECTIVE: We have reported increased long term morbidity in children of parents with rheumatoid arthritis (RA). Here we assess child mortality and case fatality in the same cohort. METHODS: All singletons born in Denmark from 1977 to 2008 were identified through linkage of Danish National...... did the risk of death below the ages of 5 years, 3 years, or 1 year. Below the age of 5 years, 6,106 children of parents with RA were diagnosed with respiratory diseases and 3,320 with infectious diseases. Case fatalities in children with these diseases were not significantly higher than those...

  2. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age.

    Science.gov (United States)

    Luckmann, R

    1989-05-01

    In 1984, 24,794 appendectomies and abscess drainage procedures were performed for acute appendicitis in California hospitals. Analysis of hospital discharge abstracts revealed age- and sex-specific incidence rates and in-hospital case fatality rates for acute appendicitis lower than previously reported. In persons aged 60 years and older, the case fatality rate for nonperforating appendicitis with appendectomy was 0.7% and for perforating appendicitis and abscess 2.4%. Surgery was delayed beyond the day of admission in 21% of persons aged 40-59 years, 29% of persons aged 60-79 years, and 47% of persons aged 80 years and over. The proportion of cases with perforation increased from 22% to 75% between ages 20 and 80 years. The population incidence of perforating appendicitis changed little after age 20 years, while the incidence of nonperforating cases declined sharply. The high proportion of appendicitis cases with perforation among the elderly may be due to the decreased incidence of nonperforating appendicitis in the elderly and not to a greater propensity for perforation, as previously proposed. Most elderly in California receive timely surgery for appendicitis and tolerate it better than previously reported. Diminished tolerance for intra-abdominal infection may be the primary determinant of the increase in case fatality with age.

  3. Fatal Penetrating Injuries Sustained by High-pressure Water Jet Unit.

    Science.gov (United States)

    Radojevic, Nemanja; Radnic, Bojana; Curovic, Ivana

    2015-11-01

    The high-pressure water jet unit is a generator of frequent burst of water jets. The water jet reaches very high speeds and is able to cause wounds similar to those of high-velocity projectiles. In the presented case, unusual fatal injuries sustained by water jet are presented. Operating with the unit, an untrained worker accidentally activated a high-pressure water jet unit, and the extremely high pressure of water liberated the jet unit from his hand and whirled it around him. A jet stream of water ran across his body and caused fatal penetrating injuries in the femoral region. The edges of the wound were mainly sharp with contusion rings on the skin beyond the edges. Exploring the inside of the canals during the autopsy, the left femoral artery and vein were found to be completely transected. The resemblance to a firearm entry wound and the severity of the internal injury make it a noteworthy entity. © 2015 American Academy of Forensic Sciences.

  4. Fatal Pulmonary Embolism following Achilles Tendon Repair: A Case Report and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Asim M. Makhdom

    2013-01-01

    Full Text Available Deep venous thrombosis (DVT is a significant source of morbidity in orthopaedic surgery. It can progress to a pulmonary embolism, a significant source of mortality. Up to date, patients with Achilles tendon rupture routinely do not receive DVT chemical prophylaxis. We are presenting a case of fatal pulmonary embolism after a surgically treated Achilles tendon rupture in a forty-two-year-old male healthy patient. In the current body of the literature, the reported incidence of DVT after Achilles tendon rupture is highly variable ranging from less than 1% to 34%, and there is a disagreement in the international guidelines regarding the need of chemical DVT prophylaxis with this type of injury. Further research needs to be conducted to investigate the risks and benefits of chemical DVT prophylaxis following Achilles tendon rupture. For low-risk patients, the use of milder forms of prophylaxis such as aspirin should also be explored.

  5. Case-fatality of COPD exacerbations: a meta-analysis and statistical modeling approach

    DEFF Research Database (Denmark)

    Hoogendoorn, M; Hoogenveen, R T; Rutten-van Mölken, M P

    2010-01-01

    Objective of the study was to estimate the case-fatality of a severe exacerbation from long-term survival data presented in the literature. A literature search identified studies reporting at least 1.5 year survival after a severe COPD exacerbation resulting in hospitalization. Each study's survi...

  6. Forensic Case Reports Presenting Immersion Pulmonary Edema as a Differential Diagnosis in Fatal Diving Accidents

    DEFF Research Database (Denmark)

    Vinkel, Julie; Bak, Peter; Juel Thiis Knudsen, Peter

    2017-01-01

    Immersion Pulmonary Edema (IPE) reduces the transport of gases over the respiratory membrane due to edema in the interstitium and respiratory zones. IPE has previously been described in both swimmers and divers, with a few known fatal cases. We have reviewed 42 SCUBA and snorkeling-related drowni......, including both the autopsy findings and the circumstances regarding the accident....

  7. Thyrotoxic hypokalemic periodic paralysis is a rare but potentially fatal emergency: case report and literature review.

    Science.gov (United States)

    Gómez-Torres, Jeisa Y; Bravo-Llerena, Wilfredo E; Reyes-Ortiz, Luis M; Valderrábano-Wagner, Rodrigo J; Mariano-Mejías, Victor; Brunet-Rodríguez, Héctor; Lemos-Ramírez, Juan C

    2011-01-01

    We report a case of a 39 year-old Asian man in whom profound lower limb paralysis, along with severe hypokalemia and electrocardiographic changes, were the presenting features of Graves' disease (GD)-related thyrotoxicosis. Rapid recognition and management of the disorder were the key factors to avoid fatal hypokalemia-induced cardiac arrhythmias and promptly restore patient's capacity to ambulate.

  8. Quantification of 25C-NBOMe in a fatal poisoning case

    DEFF Research Database (Denmark)

    Andreasen, Mette Findal; Telving, Rasmus; Rosendal, Ingrid

    2015-01-01

    Quantification of 25C-NBOMe in a fatal poisoning case – identification based on a demethylated and glucuronidated metabolite of 25C-NBOMe Mette Findal Andreasen, Rasmus Telving, Ingrid Rosendal, Marlene Beyer Eg, Jørgen Bo Hasselstrøm, Ljubica Vukelic Andersen Department of Forensic Medicine....... In the future, the detection of drugs of the NBOMe class in our laboratory is improved by screening for their demethylated glucuronidated metabolites, using UPLC-HR-TOFMS. Keywords: 25C-NBOMe, fatal poisoning, HR-TOFMS...

  9. [Suicidal electric fatalities outside the bathtub (with 3 case reports)].

    Science.gov (United States)

    Leygraf, E

    1990-01-01

    Three cases of suicides due to electricity, which happened outside the bathtub, are presented. In favour of suicide there spoke farewell letters, the situation of discovery or known depressive personality changes. In all three cases it was about male persons at the age of 19, 30 and 50. Low-voltage electricity was used. The locations chosen for the employed electric cables were: right wrist/left ankle or right and left wrist. The electric marks showed a circular continuous form with different breadth, partly associated with carbonization. In one case over the normal clothes there were worn a ski suit and an integral helmet; the flow of electric current was regulated by a timer.

  10. Fatal myocarditis-associated Bartonella quintana endocarditis: a case report

    Directory of Open Access Journals (Sweden)

    Montcriol Ambroise

    2009-07-01

    Full Text Available Abstract Introduction Bartonella spp. infection is not rare and must be considered with great care in patients with suspected infective endocarditis, particularly if regular blood cultures remain sterile. Management of these infections requires knowledge of the identification and treatment of these bacteria. Case presentation A 50-year-old Senegalese man was admitted to our Department of Cardiac Surgery with a culture-negative endocarditis. Despite valvular surgery and adequate antibiotic treatment, recurrence of the endocarditis was observed on the prosthetic mitral valve. Heart failure required circulatory support. Weaning off the circulatory support could not be attempted owing to the absence of heart recovery. Bacteriological diagnosis of Bartonella quintana endocarditis was performed by molecular methods retrospectively after the death of the patient. Conclusions This case report underlines the severity and difficulty of the diagnosis of Bartonella quintana endocarditis. The clinical picture suggested possible Bartonella quintana associated myocarditis, a feature that should be considered in new cases.

  11. [Two cases of acute myelogenous leukemia with Bacillus cereus bacteremia resulting in fatal intracranial hemorrhage].

    Science.gov (United States)

    Yoshida, H; Moriyama, Y; Tatekawa, T; Tominaga, N; Teshima, H; Hiraoka, A; Masaoka, T; Yoshinaga, T

    1993-12-01

    This manuscript reports Bacillus cereus sepsis in two cases with acute myelogenous leukemia (AML) who suffered complications of fatal intracranial hemorrhage during remission induction therapy. The first case was 43-year-old male with AML (M0) receiving first consolidation chemotherapy who developed sudden diarrhea, abdominal pain and spiking fever. Two days later, he died of intracranial hemorrhage. The second case was 15-year-old male with AML (M5b) who was receiving first induction chemotherapy. He developed headache and vomiting following spiking fever and diarrhea. He died of subarachnoid hemorrhage the next day. In both cases, Bacillus cereus was isolated from blood culture. Fatal intracranial hemorrhage due to severe bleeding tendency caused rapid to death in both cases. These bleeding tendencies might have been induced by B. cereus sepsis. In addition, we should not overlook B. cereus as contamination, but rather consider it as a potential pathogen, when isolated from blood culture.

  12. Human immunodeficiency virus infection presenting as a fatal case ...

    African Journals Online (AJOL)

    MJP

    case of Guillain-Barré syndrome on a background of diabetes mellitus ... Background: Guillain-Barré syndrome (GBS), a post-infective acute .... Síndrome de Guillain-Barré. Rev Neurol 2002;34:966–976. 4. Asbury AK, Arnason BGW, Karp HR, ...

  13. [Fatal case of rickettsiosis in a toddler from southeastern Mexico].

    Science.gov (United States)

    Lugo-Caballero, César; Dzul-Rosado, Karla; Rodríguez-Moreno, Georgina; Tello-Martín, Raúl; López-Ávila, Karina; Zavala-Castro, Jorge

    2017-02-01

    Rocky Mountain spotted fever is a disease caused by Rickettsia rickettsii, a bacteria transmitted by infected ticks. It is characterized by fever, exanthema, arthralgias and myalgias; but sometimes its clinical presentation is non specific. Due to its similarities with other exanthematic diseases like dengue or chikungunya, Rocky Mountain spotted fever is not a first line diagnosis, even though countries like Mexico show the ecologic and socioeconomic characteristics that favor its transmission, with a 30% mortality rate among pediatric patients. This mortality rate has been associated to a delayed diagnosis and therapy, due to a poor knowledge among physicians regarding this disease; this favors the occurrence of atypical and fulminant cases. The objective of this work is to describe a fulminant case of Rocky Mountain spotted fever, expecting that this disease could be later considered among the differential diagnosis which could directly impact its mortality rate.

  14. A Case of Fatal Gastrointestinal Anthrax in North Eastern Iran

    Directory of Open Access Journals (Sweden)

    Seyed Ahmad Hashemi

    2015-01-01

    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.

  15. Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992

    DEFF Research Database (Denmark)

    Osler, M; Sørensen, Thorkild I.A.; Sørensen, S;

    1996-01-01

    BACKGROUND: In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred...... identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding 5 years. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410...... in disease manifestation or diagnostic drift may also contribute because more broadly defined diagnostic groups showed less or no decline in incidence....

  16. A fatal case of Naegleria fowleri meningoencephalitis in Taiwan.

    Science.gov (United States)

    Su, Mei-Yu; Lee, Ming-Shih; Shyu, Ling-Yuh; Lin, Wei-Chen; Hsiao, Pei-Ching; Wang, Chi-Ping; Ji, Dar-Der; Chen, Ke-Min; Lai, Shih-Chan

    2013-04-01

    After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.

  17. A case of alcaptonuria with fatal cardiovascular disturbance

    Directory of Open Access Journals (Sweden)

    Tsunashima,Takehiko

    1976-04-01

    Full Text Available A case of alcaptonuria combined with aortic insufficiency was found in a 28-year-old male. The patient was palpitating at admission. The daily excretion of homogentisic acid was 2.0-6.0 g. Electrocardiography indicated atrial fibrillation and left ventricular hypertrophy with a ST-T change and right axis deviation. Cartilage tissues in the knee-joints showed no pigmentation. Vertebral X-ray revealed no calcification. The patient's history disclosed a family intermarriage in his grandparents. The patient's mother noticed the presence of black stains on diapers in his infancy and brown pigmentation on the skin and sclera in childhood. No kin had similar symptoms.

  18. A Fatal Case of Metformin-associated Lactic Acidosis.

    Science.gov (United States)

    Ozeki, Toshikazu; Kawato, Rui; Watanabe, Mitsuru; Minatoguchi, Shun; Murai, Yukari; Ryuge, Akihiro; Takasugi, Koji; Hamada, Takuya; Oyama, Yukako; Nomura, Atsushi; Tomino, Tatsuhito; Shimizu, Hideaki; Fujita, Yoshiro

    2016-01-01

    A 72-year-old woman with a history of type 2 diabetes mellitus was brought to the ER with metformin-associated lactic acidosis. She received continuous hemofiltration and hemodialysis, but the laboratory analyses showed no improvement. She died 11 hours after admission. Metformin is minimally bound to proteins and is readily dialyzable, but a prolonged period of dialysis is required, because metformin has a very large distribution volume and is distributed to multiple compartments. The peak blood metformin level was 432 mg/L in this case, which is one of the highest metformin concentrations ever reported, and eight hours of hemodialysis were not sufficient to reduce the serum level.

  19. A myocarditis outbreak with fatal cases associated with adenovirus subgenera C among children from Havana City in 2005.

    Science.gov (United States)

    Savón, Clara; Acosta, Belsy; Valdés, Odalys; Goyenechea, Angel; Gonzalez, Grehete; Piñón, Alexander; Más, Pedro; Rosario, Delfina; Capó, Virginia; Kourí, Vivian; Martínez, Pedro A; Marchena, Juan J; González, Guelsys; Rodriguez, Hermis; Guzmán, María G

    2008-10-01

    Among multiple causes of acute myocarditis, viral infection, especially that due to enteroviruses and adenoviruses, is the leading cause. In the summer 2005 an outbreak of a febrile syndrome accompanied by acute cardiac decompensation occurred in infants and young children in Havana City. Eleven patients had a rapid evolution of disease and there were 8 fatalities from cardiac failure secondary to myocarditis. The aim of the present study was to determine the etiological agent responsible for this outbreak. Children admitted to the pediatric hospitals of Havana City from July 3 to August 2 with this clinical presentation were studied. Forty samples of necropsy tissue, cerebrospinal fluid, stools and serum were tested by molecular methods for 14 respiratory viruses, 6 herpesviruses and generic enteroviruses and flavirus and alfaviruses. Viral isolation was performed in A-549 cells. Isolated viruses were typed by sequence analysis. Adenovirus genome was detected in 6 of the 8 fatal cases-the lungs in 5 (63%) and the myocardium in 3 (37%). In two fatal cases, viral genome was detected in both lung and myocardium. Adenovirus was isolated in five fatal cases. In all three non-fatal cases, adenovirus genome was detected and adenovirus was isolated into two. Sequence analysis showed that adenovirus type 5 was the only isolate from fatal cases and adenovirus 1 the only isolate in non-fatal cases. No other viruses were found by PCR or isolation techniques. Adenovirus was the etiologic agent implicated in this myocarditis outbreak and adenovirus type 5 was associated with fatal outcome.

  20. Mitragynine 'Kratom' related fatality: a case report with postmortem concentrations.

    Science.gov (United States)

    McIntyre, Iain M; Trochta, Amber; Stolberg, Susan; Campman, Steven C

    2015-03-01

    A 24-year-old man whose medical history was significant for alcohol abuse and depression was found unresponsive in bed. He had several prior suicide attempts with 'pills' and had also been hospitalized for an accidental overdose on a previous occasion. Autopsy findings were unremarkable apart from pulmonary edema and congestion, and urinary retention. Postmortem peripheral blood initially screened positive for mitragynine 'Kratom' (by routine alkaline drug screen by gas chromatography-mass spectrometry, GC-MS), which was subsequently confirmed by a specific GC-MS selective ion mode analysis following solid-phase extraction. Concentrations were determined in the peripheral blood (0.23 mg/L), central blood (0.19 mg/L), liver (0.43 mg/kg), vitreous (<0.05 mg/L), urine (0.37 mg/L) and was not detected in the gastric. Therapeutic concentrations of venlafaxine, diphenhydramine and mirtazapine were also detected together with a negligible ethanol of 0.02% (w/v). The results are discussed in relation to previous cases of toxicity, and the lack of potential for mitragynine postmortem redistribution.

  1. Fatal Cerebral Air Embolism: A Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Rashmi Mishra

    2016-01-01

    Full Text Available Cerebral air embolism (CAE is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

  2. Fatal hemorrhage from AVM after DBS surgery: case report.

    Science.gov (United States)

    Fukaya, Chikashi; Shimoda, Kentaro; Watanabe, Mitsuru; Morishita, Takashi; Sumi, Koichiro; Otaka, Toshiharu; Obuchi, Toshiki; Toshikazu, Kano; Kobayashi, Kazutaka; Oshima, Hideki; Yamamoto, Takamitsu; Katayama, Yoichi

    2013-01-01

    Intracranial hemorrhage is a crucial complication of deep brain stimulation (DBS) surgery. The bleeding caused by mechanical tissue injury due to microelectrode and/or DBS electrode lead insertion has been well studied. However, hemorrhage caused by a congenital underlying disease such as vascular malformation has not been examined carefully. We encountered a case of intracerebral hemorrhage from arteriovenous malformation (AVM) after DBS surgery. Preoperative magnetic resonance (MR) imaging did not show any abnormality in the patient. Computed tomography (CT) images taken immediately after the surgery did not show any intracranial hematoma and other abnormal findings. However, the patient did not recover from the general anesthesia, and hemorrhage in the left occipital lobe was detected by CT performed a day after the surgery. The location of the hematoma was markedly distant from the trajectory of DBS leads. Evacuation of the hematoma under general anesthesia was immediately performed. As an intraoperative finding, we noted the presence of abnormal vessels inside the hematoma in the occipital lobe. Tissue specimens including the abnormal vessels were obtained for histopathological analysis, results of which led to the diagnosis was AVM. Despite its low incidence, we would like to advise that such a type of hemorrhage could occur and measures should be taken to prevent its occurrence as much as possible. Preoperative detection of abnormal vessels by MR angiography and/or CT angiography might be helpful. Moreover, paying close attention to the possible leakage of cerebrospinal fluid during surgery might be important. © 2012 International Neuromodulation Society.

  3. Fatal Cerebral Air Embolism: A Case Series and Literature Review

    Science.gov (United States)

    Reddy, Pavithra; Khaja, Misbahuddin

    2016-01-01

    Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale. PMID:27635266

  4. Prostatic stromal tumor with fatal outcome in a young man: histopathological and immunohistochemical case presentation

    Directory of Open Access Journals (Sweden)

    Massimo Roncalli

    2010-12-01

    Full Text Available Stromal tumors of the prostate are rare and only a few cases have been described in the literature, including exceptional cases of stromal tumors with unknown malignant potential (STUMP and a fatal outcome in young patients. Morphologically distinguishing a STUMP from a stromal sarcoma of the prostate (PSS is still a challenge. We describe the histopathological and immunohistochemical findings in a 34-year-old man with a malignant specialized cell stromal tumor of the prostate that was diagnosed initially as STUMP, and he developed lung metastases within a few months. The patient attended our hospital because of lower urinary tract symptoms, after having excreted tissue through the urethra a few months before. Ultrasonography and urethrocystoscopy examinations showed a mass arising from the verumontanum, and a transurethral resection (TUR revealed a high-grade spindle cell sarcoma reminiscent of a phyllode tumor of the breast. The tumor cells were immunoreactive for vimentin, progesterone receptor and, focally, CD34. The preliminary histo­logical findings were subsequently confirmed after radical prostatectomy. The patient developed bilateral lung metastases and died 25 months after the initial diagnosis. Although rare in young patients, the challenging differential diagnosis of STUMP and PSS means that a prostate STUMP diagnosis made on the basis of biopsy or TUR specimens also requires urethrocystoscopic monitoring for the early detection of any progression to PSS. Radical prostatectomy should also be carefully considered.

  5. Fatal musculoskeletal injuries of Quarter Horse racehorses: 314 cases (1990-2007).

    Science.gov (United States)

    Sarrafian, Tiffany L; Case, James T; Kinde, Hailu; Daft, Barbara M; Read, Deryck H; Moore, Janet D; Uzal, Francisco A; Stover, Susan M

    2012-10-01

    To determine major causes of death and the anatomic location of musculoskeletal injuries in Quarter Horse racehorses in California. Retrospective case series. 314 Quarter Horse racehorses with musculoskeletal injuries that were necropsied through the California Horse Racing Board Postmortem Program from 1990 to 2007. Postmortem pathology reports were retrospectively reviewed. Musculoskeletal injuries were categorized by anatomic region and described. The number of Quarter Horse starts and starters for the same period of time were obtained from a commercial database for determination of fatal injury incidence. Musculoskeletal injuries accounted for 314 of the 443 (71 %) Quarter Horse racehorses that died during the 18-year study period. Fatal musculoskeletal injuries occurred at a rate of 2.0 deaths/1,000 race starts and 18.6 deaths/1,000 horses that started a race. Musculoskeletal injuries occurred predominantly during racing (84%) and in the forelimbs (81%). The most common fatal musculoskeletal injuries were metacarpophalangeal and metatarsophalangeal joint (fetlock) support injuries (40%) and carpal (24%), vertebral (10%), and scapular (8%) fractures. Proximal interphalangeal (pastern) joint luxations resulted in death of 3% of horses. Fracture configurations of some bones were consistent with those of Thoroughbred racehorses. Evidence of preexisting stress remodeling of bone was reported for some fractures. Knowledge of common locations and types of fatal musculoskeletal injuries in racing Quarter Horses may enhance practitioners' ability to detect mild injuries early, rest horses, and help prevent catastrophic injuries.

  6. Two Fatal Intoxications Due to Tramadol Alone: Autopsy Case Reports and Review of the Literature.

    Science.gov (United States)

    Gioia, Sara; Lancia, Massimo; Bacci, Mauro; Suadoni, Fabio

    2017-08-01

    Since tramadol was marketed, it has been widely prescribed as a pain killer because of its relatively safe profile among opioids.Nevertheless, intoxication can occur: overdose can lead to fatal outcomes mostly in association with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased central nervous system (CNS) depression.Fatal outcomes only attributable to tramadol are a rare entity. In this case report, 2 fatal cases are described due to tramadol stand-alone intoxication with peculiar characteristics.In case 1, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (32 μg/mL in the heart blood, 23.9 μg/mL in the femoral blood, 3.3 μg/mL in the bile, and 1.4 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.In case 2, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (7.5 μg/mL in the heart blood, 5.8 μg/mL in the femoral blood, and 18 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.Review of the literature was performed to clarify the actual knowledge on this topic.

  7. Lyme disease: a case report of a 17-year-old male with fatal Lyme carditis.

    Science.gov (United States)

    Yoon, Esther C; Vail, Eric; Kleinman, George; Lento, Patrick A; Li, Simon; Wang, Guiqing; Limberger, Ronald; Fallon, John T

    2015-01-01

    Lyme disease is a systemic infection commonly found in the northeastern, mid-Atlantic, and north-central regions of the United States. Of the many systemic manifestations of Lyme disease, cardiac involvement is uncommon and rarely causes mortality. We describe a case of a 17-year-old adolescent who died unexpectedly after a 3-week viral-like syndrome. Postmortem examination was remarkable for diffuse pancarditis characterized by extensive infiltrates of lymphocytes and focal interstitial fibrosis. In the cardiac tissue, Borrelia burgdorferi was identified via special stains, immunohistochemistry, and polymerase chain reaction. The findings support B. burgdorferi as the causative agent for his fulminant carditis and that the patient suffered fatal Lyme carditis. Usually, Lyme carditis is associated with conduction disturbances and is a treatable condition. Nevertheless, few cases of mortality have been reported in the literature. Here, we report a rare example of fatal Lyme carditis in an unsuspected patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.

    Science.gov (United States)

    Makker, Jasbir; Bajantri, Bharat; Sakam, Sailaja; Chilimuri, Sridhar

    2016-08-21

    Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

  9. Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review

    Science.gov (United States)

    Makker, Jasbir; Bajantri, Bharat; Sakam, Sailaja; Chilimuri, Sridhar

    2016-01-01

    Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding. PMID:27610026

  10. Fatal Neonatal Peritoneal Candidiasis Mimicking Mucormycosis-A Case Report and Review of Literature.

    Science.gov (United States)

    Kashyap, Bineeta; Kusumakar, Kanupriya; Kumar Sarin, Yogesh

    2016-10-01

    Candida species have been implicated as significant contributors to morbidity in the neonatal period and are associated with 25-50% of mortality in invasive neonatal candidiasis. Peritoneal candidiasis, being paucisymptomatic, cannot often be correctly identified in a preterm neonate. The correct approach to diagnosis of neonatal peritoneal candidiasis is taking into account the epidemiology along with a strong clinical suspicion and appropriate timely diagnostic interventions. We report a case of fatal neonatal peritoneal candidiasis which was misdiagnosed as mucormycosis.

  11. Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia

    DEFF Research Database (Denmark)

    Tom, S; Galbraith, J C; Valiquette, L;

    2014-01-01

    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......-onset S. aureus bacteraemia, particularly MSSA, is associated with major disease burden. This study highlights complementary information provided by evaluating both CFR and MR....

  12. A fatal case of AIDS-defining meningoencephalitis by C. Neoformans, sensitive to antifungal therapy

    Directory of Open Access Journals (Sweden)

    Mohammad-Khani S

    2010-11-01

    Full Text Available Abstract Cryptococcus neoformans is the most common cause of life threatening meningoencephalitis in HIV-infected patients. Diagnosis is based on tests for cryptoccocal antigen in serum and cerebrospinal fluid, and on culture of the organism. We present a case of AIDS-related cryptococcal meningoencephalitis unresponsive to antifungal combination therapy, despite of evidence of fungal susceptibility in vitro. Significant decreases in cryptococcal antigen titers in serum and cerebrospinal fluid did not correlate with progress in disease and fatal outcome.

  13. A Fatal Outcome of Rhino-orbito-cerebral Mucormycosis Following Tooth Extraction: A Case Report.

    Science.gov (United States)

    Motaleb, Hesham Y Abdel; Mohamed, Mostafa S; Mobarak, Fahmy A

    2015-01-01

    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 days of admission.

  14. Predictors of early and late case-fatality in a nationwide Danish study of 26,818 patients with first-ever ischemic stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Andersen, Zorana Jovanovic; Olsen, Tom Skyhøj

    2011-01-01

    Predictors of early case-fatality (3-day, 7-day, and 30-day) in first-ever ischemic stroke were identified and compared with predictors of late case-fatality (90-day and 1-year).......Predictors of early case-fatality (3-day, 7-day, and 30-day) in first-ever ischemic stroke were identified and compared with predictors of late case-fatality (90-day and 1-year)....

  15. Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication.

    Science.gov (United States)

    Du, Yu; Jin, Hong-Nian; Zhao, Rui; Zhao, Dong; Xue, Ye; Zhu, Bao-Li; Guan, Da-Wei; Xie, Xiao-Li; Wang, Qi

    2016-11-01

    Pulmonary edema is a common finding in fatal methamphetamine intoxication. However, the underlying mechanism remains poorly understood. This study investigated the molecular pathology of alveolar damage involving pulmonary edema in forensic autopsy cases. Seven candidate reference genes (RPL13A, YWHAZ, GUSB, SDHA, GAPDH, B2M, and ACTB) were evaluated in the lung by the geNorm module in qBase(plus) software. RPL13A, YWHAZ, and GUSB were identified as the most stable reference genes. Using these validated reference genes, intrapulmonary mRNA expressions of matrix metalloproteinases (MMPs), intercellular adhesion molecule-1 (ICAM-1), claudin-5 (CLDN-5), and aquaporins (AQPs) were examined. Relative mRNA quantification using TaqMan real-time PCR assay demonstrated higher expressions of all markers except for AQP-5 in fatal METH intoxication cases. These findings suggested alveolar damage and compensatory response in fatal METH intoxication cases. Systematic analysis of gene expressions using real-time qPCR is a useful tool in forensic death investigation.

  16. Fatal cases of Chikungunya virus infection in Colombia: Diagnostic and treatment challenges.

    Science.gov (United States)

    Hoz, Juan M de la; Bayona, Brayan; Viloria, Samir; Accini, José L; Juan-Vergara, Homero San; Viasus, Diego

    2015-08-01

    Although Chikungunya infection is emerging as an important public health problem in many countries, it is not regarded as a life-threatening disease. Information dealing with fatal cases is scarce. We herein describe three patients with Chickungunya infection who presented with multiple organ failure and died within 24h of admission. Two cases had positive anti-dengue IgM, but dengue coinfection was rejected based on the clinical features and results of real-time reverse transcription polymerase chain reaction. These cases illustrate the challenges of the diagnosis and management of severe Chikungunya infection.

  17. Tuberculous myocarditis is not always fatal: Report of three confirmed cases with uneventful outcome

    Directory of Open Access Journals (Sweden)

    Fares Al-Jahdali

    2017-01-01

    Full Text Available Tuberculosis (TB is a leading cause of death worldwide. It can affect any organ. However, cardiac involvement is extremely rare. Anti-TB therapy has been proved to be effective and curative in majority of TB cases except TB myocarditis, where it is found to be fatal. We describe three cases with confirmed TB with impaired left ventricular systolic function and low ejection fraction. All three cases improved clinically and left ventricular function returned to normal within a few weeks after the commencement of TB therapy.

  18. Influence of referral pathway on ebola virus disease case-fatality rate and effect of survival selection bias

    DEFF Research Database (Denmark)

    Rudolf, Frauke; Damkjær, Mads; Lunding, Suzanne

    2017-01-01

    Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra...... Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis...

  19. Fatal adverse drug reactions of anticancer drugs detected by all-case post-marketing surveillance in Japan.

    Science.gov (United States)

    Mori, Jinichi; Tanimoto, Tetsuya; Miura, Yuji; Kami, Masahiro

    2015-06-01

    All-case post-marketing surveillance of newly approved anticancer drugs is usually conducted on all patients in Japan. The present study investigates whether all-case post-marketing surveillance identifies fatal adverse drug reactions undetected before market entry. We examined fatal adverse drug reactions identified via all-case post-marketing surveillance by reviewing the disclosed post-marketing surveillance results, and determined the time points in which the fatal adverse drug reactions were initially reported by reviewing drug labels. We additionally scanned emergency alerts on the Japanese regulatory authority website to assess the relationship between all-case post-marketing surveillance and regulatory action. Twenty-five all-case post-marketing surveillances were performed between January 1999 and December 2009. Eight all-case post-marketing surveillances with final results included information on all fatal cases. Of these, the median number of patients was 1287 (range: 106-4998), the median number of fatal adverse drug reactions was 14.5 (range: 4-23). Of the 111 fatal adverse drug reactions detected in the eight post-marketing surveillances, only 28 (25.0%) and 22 (19.6%) were described on the initial global and the initial Japanese drug label, respectively, and 58 (52.3%) fatal adverse drug reactions were first described in the all-case post-marketing surveillance reports. Despite this, the regulatory authority issued only four warning letters, and two of these were prompted by case reports from the all-case post-marketing surveillance. All-case post-marketing surveillance of newly approved anticancer drugs in Japan was useful for the rigorous compilation of non-specific adverse drug reactions, but it rarely detected clinically significant fatal adverse drug reactions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. First Reported Case of Fatal Stinging by the Large Carpenter Bee Xylocopa tranquebarica.

    Science.gov (United States)

    Kularatne, Senanayake A M; Raveendran, Sathasivam; Edirisinghe, Jayanthi; Karunaratne, Inoka; Weerakoon, Kosala

    2016-06-01

    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.

  1. A fatal case of middle east respiratory syndrome corona virus infection in South Korea: Cheat radiography and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Eun; Kim, Hyo Lim; Choi, Su Mi [Dept. of Internal Medicine, Yeouido St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    The outbreak of Middle East Respiratory Syndrome Corona Virus (MERS-CoV) infection in South Korea originated from Saudi Arabia. This virus shows high infectivity, and causes outbreaks of severe febrile respiratory infections in health care-associated settings. Herein, we reported a fatal case of MERS-CoV infection with a focus on the pulmonary radiologic findings. The initial chest computed tomography and radiographs of our patient showed ground-glass opacity in patchy distribution, followed by rapid progression of consolidation and pleural effusion in serial studies.

  2. A Fatal Case of Neuroleptic Malignant Syndrome After Paralytic Bowel in a Patient Taking Antiparkinson Medication

    Directory of Open Access Journals (Sweden)

    Domenico Campa

    2016-06-01

    Full Text Available Objectives: We report a fatal case of neuroleptic malignant-like syndrome, which occurred as a consequence of paralytic bowel in a 72-year-old woman on treatment with antiparkinson medication. Case description: Contrast enhanced computerized tomography of the chest and abdomen demonstrated the presence of paralytic bowel. Results: The patient died. Conclusions: Physicians involved in the treatment of patients affected by Parkinson’s disease should take into consideration the possibility of dopaminergic drug malabsorption due to paralytic bowel as a possible cause of neuroleptic malignant-like syndrome.

  3. Intradural spinal seeding and fatal progression of a sacrococcygeal chordoma:a case report

    Institute of Scientific and Technical Information of China (English)

    JI Tao; GUO Wei; SHEN Dan-hua; YANG Yi; TANG Shun

    2008-01-01

    @@ 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.

  4. [The determinants of the low case fatality rate of the cholera epidemic in the Littoral department of Benin in 2008].

    Science.gov (United States)

    Gbary, Akpa Raphaël; Sossou, Roch Aristide; Dossou, Jean-Paul; Mongbo, Virginie; Massougbodji, Achille

    2011-01-01

    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.

  5. Influence of Referral Pathway on Ebola Virus Disease Case-Fatality Rate and Effect of Survival Selection Bias

    Science.gov (United States)

    Damkjær, Mads; Lunding, Suzanne; Dornonville de la Cour, Kenn; Young, Alyssa; Brooks, Tim; Sesay, Tom; Salam, Alex P.; Mishra, Sharmistha; Storgaard, Merete

    2017-01-01

    Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias. PMID:28322693

  6. Socio-economic position and time trends in invasive management and case fatality after acute myocardial infarction in Denmark

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2016-01-01

    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...... patients in all socio-economic groups and how this has impacted on inequality in case fatality. METHODS: Forty three thousand eight hundred and forty three patients admitted with AMI in the period from 2001 to 2009 were included. Socio-economic position was measured using individual information...... fatality is not primarily driven by inequality in invasive management of AMI....

  7. Circular saw-related fatalities: A rare case report, review of the literature, and forensic implications.

    Science.gov (United States)

    Janík, Martin; Straka, Ľubomír; Novomeský, František; Krajčovič, Jozef; Hejna, Petr

    2016-01-01

    Fatalities attributed to powered circular saws appear to be vanishingly rare events with highly wounding and rapidly incapacitating effects. When they do occur, they are mainly self-inflicted in nature. We report the suicide committed by a 79-year-old man using a self-made circular table saw. Autopsy confirmed that the man received multiple heterogeneously distributed saw-type impacts to the head and neck resulting in complete amputation of the upper skull and partial beheading. Homemade or modified commercial sawing instruments and the resultant injuries pose a number of forensic challenges starting from the death scene investigation, continuing with technical examinations, and concluding with determining the manner of death. As with all deaths due to sharp force injuries, fatalities involving power tools such as chainsaws, circular, and band saws warrant a high degree of suspicion of criminal activity and require diligence during all phases of the death investigation.

  8. [Fatal incidences during arrest of highly agitated persons].

    Science.gov (United States)

    Pedal, I; Zimmer, G; Mattern, R; Mittmeyer, H J; Oehmichen, M

    1999-01-01

    We report on four cases of sudden circulatory arrest during the physical restraint of extremely excited and repugnant men by the police. Three persons died, and one became apallic. The excited states resulted from acute schizophrenic disorder in one case, from intoxications (ethanol and drugs including cocaine respectively) in two others, and from encephalitis in the fourth case. In only one case one of the police officers was condemned for involuntary mansloughter, responsability was excluded in the remainder. Similar lethal events in "excited delirium" are given in the American literature, the main etiologic factors being acute psychosis and cocaine intoxication. Most of these events occurred, differing from ours, under "hogtying" which is a technique of physical restraint in a prone position with the wrists and ankles bound behind the back. These events are thought to be cardiac in origin and to result from oxygen-consuming motor hyperactivity, excessive catecholamine release, and impaired breathing. Police officers are recommended to restrict all measures of restraint to a mininum in extremely excited persons, and to avoid any compression of the trunk or neck. A continuous monitoring for vital signs is postulated in order to recognize a medical incident as quick as possible.

  9. Fatal acute hepatic failure in a family infected with the hepatitis A virus subgenotype IB: A case report.

    Science.gov (United States)

    Yoshida, Yuichi; Okada, Yohei; Suzuki, Akiko; Kakisaka, Keisuke; Miyamoto, Yasuhiro; Miyasaka, Akio; Takikawa, Yasuhiro; Nishizawa, Tsutomu; Okamoto, Hiroaki

    2017-09-01

    Hepatitis A viral infection is a well-known cause of subclinical or acute self-limited hepatitis. Few cases of hepatitis A virus (HAV)-associated acute liver failure (ALF) have been reported in low HAV endemic countries annually. To investigate the possible factors that affected the severity of HAV infection, a family cluster infected with the HAV subgenotype IB strain, which is not common in Japan, was described. This family consisted of five members who all were infected with HAV. Four of the five patients hospitalized except for an asymptomatic patient. Two of the five patients, men in their 50s and 60s, developed ALF, and one patient died. Various host factors, including sex (male), age, and a high bilirubin level, may affect the outcomes. Based on viral factors, HAV RNA was higher in the fatal case compared with others, and it decreased within a short period of time. The similarity of the nucleotide sequences was 99.9% among the HAV isolates based on an entire genomic sequence. Deletions and/or insertions on the HAV protein-coding sequences that caused a frameshift were found in surviving cases but not in the fatal case. The rapid clearance of increased HAV and the absence of defective HAV might be closely associated with the onset of liver failure.

  10. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome.

    NARCIS (Netherlands)

    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)

    2004-01-01

    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

  11. Risk factors for fatality among confirmed adult dengue inpatients in Singapore: a matched case-control study.

    Directory of Open Access Journals (Sweden)

    Tun-Linn Thein

    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.

  12. Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Srinivasan Maheswari G

    2012-02-01

    the respiratory rate, temperature and oxygen saturation. However, zinc supplementation in these children significantly decreased case fatality. The difference in case fatality attributable to the protective effect of zinc therapy was greater among HIV infected than HIV uninfected children. Given these results, zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy naïve HIV infected children in our environment. Clinical trials registration number clinicaltrials.gov NCT00373100

  13. The risk of body packing: a case of a fatal cocaine overdose.

    Science.gov (United States)

    Koehler, Steven A; Ladham, Shaun; Rozin, Leon; Shakir, Abdulrezak; Omalu, Bennet; Dominick, Joseph; Wecht, Cyril H

    2005-06-30

    The process of swallowing or inserting illegal packets of drugs for the purpose of evading law enforcement officers carries risks other than criminal charges. It can be fatal. Individuals engaged in such activities are called "Body Packers" or "Mules". The most frequent cause of the death among body packers is acute drug intoxication due to rupture of the package(s) within the gastrointestinal tract. We present the first documented case of a body packer that died from cocaine intoxication following the rupture of packets of cocaine in Western Pennsylvania.

  14. Fatal Exophiala infections in China, with a report of seven cases.

    Science.gov (United States)

    Li, D-M; Li, R-Y; de Hoog, G S; Sudhadham, M; Wang, D-L

    2011-07-01

    During the past four decades, seven patients were documented in China to have died from Exophiala infections. Causative agents were Exophiala dermatitidis, Exophiala spinifera, Exophiala jeanselmei and a new Exophiala species, Exophiala asiatica. We retrospectively analysed the clinical characteristics of these infections in China and confirmed the identity of aetiological agents of Chinese fatal cases using rDNA ITS sequence analysis. While E. dermatitidis displayed neurotropism, E. spinifera showed osteotropism. The other two species, E. jeanselmei and E. asiatica had caused brain infections in China.

  15. Fatal head injury: a sequelae to electric shock - a case report.

    Science.gov (United States)

    Jayanth, S H; Hugar, Basappa S; Chandra, Y P Girish; Krishnan, A Gokula

    2015-03-01

    Deaths due to electric shock are increasing despite stringent laws and preventive measures. These shocks are a leading cause of death amongst construction workers. In about 20% of the cases, no visible injury due to electricity can be seen. In some cases, non-electrical injuries are present and at times there are no eyewitnesses to provide a detailed account of events. In such circumstances, examination of scene of death, autopsy and accident reconstruction with the help of an electrical expert are all necessary to determine the cause of death. Here, we report one such case where a mason working on the second floor of a building under construction sustained an electrical injury, following which he was thrown to the ground sustaining a fatal traumatic injury. After careful consideration, his death was attributed to the head injury.

  16. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Science.gov (United States)

    Giglio, Anna Maria; Scozzafava, Annamaria; Filippelli, Orazio; Serafino, Giuseppe; Verre, Mario

    2016-01-01

    The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe. PMID:27651958

  17. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Directory of Open Access Journals (Sweden)

    Mario Pezzi

    2016-01-01

    Full Text Available The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe.

  18. Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland Country

    DEFF Research Database (Denmark)

    Floyd, A.K.; Pedersen, L; Nielsen, GL;

    2002-01-01

    to 2000 and on certain drugs for 1991 to 1999. Results: The incidence rate of acute pancreatitis in women increased from 17.1 per 100,000 person-years in 1981 (95% confidence interval (CI), 12.6-23.2) to 37.8 per 100,000 person-years in 2000 (95% CI, 31.0-46.1). The corresponding increase in men was from...... 18 per 100,000 person-years in 1981 (95% CI, 13.3-24.2) to 27.1 per 100,000 person-years in 2000 (95% CI, 21.5-34.3). The incidence rate of acute pancreatitis increased with age in both sexes. The overall 30-day case fatality rate was 7.5% (95% CI, 6.5-8.7) increasing with age, adjusted odds ratio...... 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...

  19. Ebola virus disease: a highly fatal infectious disease reemerging in West Africa.

    Science.gov (United States)

    To, Kelvin K W; Chan, Jasper F W; Tsang, Alan K L; Cheng, Vincent C C; Yuen, Kwok-Yung

    2015-02-01

    Ebolavirus can cause a highly fatal and panic-generating human disease which may jump from bats to other mammals and human. High viral loads in body fluids allow efficient transmission by contact. Lack of effective antivirals, vaccines and public health infrastructures in parts of Africa make it difficult to health workers to contain the outbreak. Copyright © 2014 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  20. Case Fatality among Patients Hospitalized for Community-acquired Pneumonia according to Initial Antibiotic Treatment. A Comparison of Two Case Series

    Directory of Open Access Journals (Sweden)

    Luis Alberto Corona Martínez

    2016-04-01

    Full Text Available Background: community-acquired pneumonia is one of the major health problems worldwide and in the hospital of Cienfuegos.Objective: to determine the changes in the relationship between the type of antimicrobial agent used empirically at admission and case fatality for community-acquired pneumonia in two case series designed at different times.Methods: an observational, descriptive study was conducted to compare two case series of patients hospitalized due to the condition under study. The relationship between the antimicrobial agents selected (amoxicillin/sulbactam, cefuroxime, ceftriaxone and cefotaxime and case fatality was analyzed taking into account potentially confounding variables. In the statistical analysis, the Chi-square test was used to compare the proportions, and Fisher's exact test was applied, with a 95% confidence level (p <.05. Results: in the two case series, the same pattern was observed in terms of the antimicrobial agents associated with the lowest and highest case fatality: cefuroxime and cefotaxime, respectively. In contrast to the A series, the B series showed a more uniform behavior of case fatality with the use of the antimicrobials selected, which meant a considerable reduction in case fatality among patients treated initially with third-generation cephalosporins in the B series. In this sense, the most significant impact on case fatality was observed in patients receiving ceftriaxone.Conclusions: cefuroxime remains the initial empirical antimicrobial agent associated with the lowest case fatality among patients with community-acquired pneumonia. In the second case series, a clear reduction in case fatality was found in patients treated with ceftriaxone and cefotaxime.

  1. Risk factors associated with hantavirosis fatality: a regional analysis from a case-control study in Brazil

    Directory of Open Access Journals (Sweden)

    Maria Cristina Antunes Willemann

    2014-01-01

    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.

  2. Fatal Fever of Unknown Origin in Acute Cervical Spinal Cord Injury: Five Cases

    Science.gov (United States)

    Ulger, Fatma; Dilek, Ahmet; Karakaya, Deniz; Senel, Alparslan; Sarihasan, Binnur

    2009-01-01

    Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal. PMID:19810636

  3. Diagnostic features in 10 naturally occurring cases of acute fatal canine leptospirosis.

    Science.gov (United States)

    Rissi, Daniel R; Brown, Cathy A

    2014-11-01

    The current report describes the diagnostic features in 10 cases of acute fatal canine leptospirosis with minimal renal and hepatic changes that may present a diagnostic challenge for the pathologist. Most affected dogs were less than 6 months of age and had a biochemical profile consistent with hepatorenal dysfunction. Clinical signs consisted of vomiting, depression, icterus, dehydration, diarrhea, and anorexia. All dogs died or were humanely euthanized within 3-7 days after the onset of clinical disease. Necropsy findings included pulmonary edema with hemorrhages, icterus, renal and hepatic pallor and swelling, and gastric edema with hemorrhage. Despite severe azotemia, histological changes in the kidneys were subtle in all dogs, and included mild renal tubular simplification, with single-cell necrosis and attenuation, along with minimal interstitial lymphoplasmacytic inflammation, edema, and hemorrhage. Hepatic lesions included scattered hepatocellular single-cell necrosis and hepatocellular dissociation. Prominent extrarenal lesions typically associated with uremia including vascular fibrinoid necrosis in multiple organs, pulmonary mineralization with occasional fibrinosuppurative exudation, and gastric mineralization were also present. Postmortem diagnostic confirmation was based on the detection of leptospiral antigen on fresh renal samples by fluorescent antibody test and on the demonstration of intact spirochetes in sections of kidneys using immunohistochemical staining. Acute fatal canine leptospirosis occurred as a fulminant hepatorenal disease affecting mainly young dogs, and the diagnosis was dependent on the recognition of the subtle renal changes with confirmation via fluorescent antibody testing or immunohistochemical staining.

  4. Acute lyme infection presenting with amyopathic dermatomyositis and rapidly fatal interstitial pulmonary fibrosis: a case report

    Directory of Open Access Journals (Sweden)

    Nguyen Hanh

    2010-06-01

    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.

  5. A forensic diving medicine examination of a highly publicised scuba diving fatality.

    Science.gov (United States)

    Edmonds, Carl

    2012-12-01

    A high-profile diving death occurred in 2003 at the site of the wreck of the SS Yongala off the Queensland coast. The victim's buddy, her husband, was accused of her murder and found guilty of manslaughter in an Australian court. A detailed analysis of all the evidence concerning this fatality suggests alternative medical reasons for her death. The value of decompression computers in determining the diving details and of CT scans in clarifying autopsy findings is demonstrated. The victim was medically, physically and psychologically unfit to undertake the fatal dive. She was inexperienced and inadequately supervised. She was over-weighted and exposed for the first time to difficult currents. The analysis of the dive demonstrates how important it is to consider the interaction of all factors and to not make deductions from individual items of information. It also highlights the importance of early liaison between expert divers, technicians, diving clinicians and pathologists, if inappropriate conclusions are to be avoided.

  6. Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis.

    Science.gov (United States)

    Shehabi, Asem A; Abu-Al-Soud, Waleed; Mahafzah, Azmi; Khuri-Bulos, Najwa; Abu Khader, Ilham; Ouis, Ibn-Sina; Wadström, Torkel

    2004-01-01

    Over a 1-y period, 26 inpatients at the Jordan University Hospital in Amman were detected with bacteraemia (23 cases) or respiratory tract colonized with B. cepacia (3 cases). A combination of genetic identification and molecular typing has proved that all cases were caused by a single epidemic strain of B. cepacia genomovar IIIa. Nosocomial infections could be documented in 21/26 (81%) patients, mostly with severe underlying or malignant diseases other than cystic fibrosis, but the source of infection was undetected. The overall mortality related to infection with B. cepacia was 42%. All B. cepacia isolates were resistant to ampicillin, amikacin, carbenicillin and gentamicin; and mostly susceptible to piperacillin, chloramphenicol, cotri-moxazole, tetracycline, ceftazidime, and tazocin (62-88%). This study demonstrates the nosocomial and high fatality of B. cepacia genomovar IIIa in Jordanian patients suffering from diseases other than cystic fibrosis.

  7. Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia.

    Science.gov (United States)

    Tom, S; Galbraith, J C; Valiquette, L; Jacobsson, G; Collignon, P; Schønheyder, H C; Søgaard, M; Kennedy, K J; Knudsen, J D; Ostergaard, C; Lyytikäinen, O; Laupland, K B

    2014-10-01

    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, Sweden and Denmark to evaluate 30-day CFR and MR trends between 2000 and 2008. The CFR was 20.3% (MSSA 20.2%, MRSA 22.3%) and MR was 3.4 (MSSA 3.1, MRSA 0.3) per 100 000 per year. Although MSSA CFR was stable the MSSA MR increased; MRSA CFR decreased while its MR remained low during the study. Community-onset S. aureus bacteraemia, particularly MSSA, is associated with major disease burden. This study highlights complementary information provided by evaluating both CFR and MR.

  8. A fatal case of hypermagnesemia caused by ingesting magnesium chloride as a folk remedy.

    Science.gov (United States)

    Torikoshi-Hatano, Aiko; Namera, Akira; Shiraishi, Hiroaki; Maeno, Yoshitaka; Kato, Hideaki; Nagao, Masataka

    2013-11-01

    We report a fatal case of hypermagnesemia caused by oral ingestion of milk containing magnesium chloride as a folk remedy. The autopsy of the 75-year-old woman showed no injury or illness as the cause of death. Neither alcohol nor controlled drugs were found by the toxicological analysis. Her posthumous serum magnesium concentration was 10.2 mg/dL. The concentration of magnesium in serum was higher than that of the previous reports. Therefore, the cause of death was considered to be hypermagnesemia. Recently, the prescription drugs, over-the-counter drugs, and health foods containing magnesium are consumed as supplements in the world, and their potential toxicity should be recognized.

  9. Fatal splenic rupture following Heimlich maneuver: case report and literature review.

    Science.gov (United States)

    Cecchetto, Giovanni; Viel, Guido; Cecchetto, Attilio; Kusstatscher, Stefano; Montisci, Massimo

    2011-06-01

    The most effective resuscitative procedure in choking by foreign bodies is the Heimlich maneuver, described for the first time by Henry Heimlich (1974) and recognized by the US Surgeon General (1985) as the "only method that should be used for the treatment of choking from foreign body airway obstruction." If performed correctly, this lifesaving maneuver is associated with rare complications, of which the most frequent are rib fractures and gastric or esophagus perforations. Other rare traumatic injuries such as pneumomediastinum, aortic valve cusp rupture, diaphragmatic herniation, jejunum perforation, hepatic rupture, or mesenteric laceration have been described.However, we are unaware of previous reports of splenic rupture after Heimlich maneuver. We present an interesting case of fatal hemoperitoneum due to a hilar laceration of the spleen following a correctly performed Heimlich maneuver.

  10. FATAL CASE OF STREPTOCOCCUS SUIS INFECTION IN A YOUNG WILD BOAR (SUS SCROFA) FROM SOUTHWESTERN SPAIN.

    Science.gov (United States)

    Risco, David; Fernández-Llario, Pedro; Cuesta, Jesús M; García-Jiménez, Waldo L; Gonçalves, Pilar; Martínez, Remigio; García, Alfredo; Rosales, Rubén; Gómez, Luis; de Mendoza, Javier Hermoso

    2015-06-01

    Streptococcus suis is a recognized pathogen that may cause important diseases in pigs and humans. This microorganism has been repeatedly isolated from wild boar (Sus scrofa). However, its health implications for this wild species are still unknown. This article reports a detailed description of a fatal case of septicemia by S. suis affecting a young wild boar. The affected animal, about 15 days old, was found near death and exhibiting neurologic signs at a wild boar estate in southwestern Spain. Postmortem examination showed generalized congestion, brain hemorrhages and lobular pneumonia. Histopathological evaluation demonstrated the presence of meningitis and encephalitis with marked congestion and suppurative bronchopneumonia. Streptococcus suis serotype 2 isolates exhibiting important virulence factors (extracellular factor, muramidase-released protein, and suylisin) were isolated from the affected animal. This study confirms the presence of potentially virulent and zoonotic strains of S. suis in wild boar from Spain.

  11. A fatal case of hydrogen sulfide poisoning in a geothermal power plant.

    Science.gov (United States)

    Kage, S; Ito, S; Kishida, T; Kudo, K; Ikeda, N

    1998-07-01

    An adult man entered an oil separator room to remove waste oil from a vacuum pump in a geothermal power plant. He suddenly collapsed and died soon after. Since hydrogen sulfide gas was detected in the atmosphere at the scene of the accident, poisoning by this gas was suspected and toxicological analysis of sulfide and thiosulfate in blood, brain, lung, femoral muscle was made using the extractive alkylation technique combined with gas chromatography/mass spectrometry (GC/MS). The concentrations of sulfide in these tissues were similar to those previously reported for fatal cases of hydrogen sulfide gas. The concentration of thiosulfate in the blood was at least 48 times higher than the level in control samples. Based on these results, the cause of death was attributed to hydrogen sulfide gas poisoning.

  12. Fatal disseminated strongyloidiasis in patients on immunosuppressive therapy: Report of two cases

    Directory of Open Access Journals (Sweden)

    Reddy I

    2005-01-01

    Full Text Available Disseminated strongyloidiasis is a rare manifestation in patients on immunosuppressive drugs. We report two cases of fatal disseminated Strongyloides stercoralis infestation. The first was in a patient of pemphigus vulgaris who developed an exacerbation of symptoms, one year after diagnosis and was given intravenous dexamethasone and azathioprine and in the third week of hospitalization developed features of septicemia, respiratory failure and petechial hemorrhages which were proven to be due to disseminated strongyloidiasis. The second patient was diagnosed to have stage IV diffuse large cell type of non-Hodgkin lymphoma and after the second cycle of chemotherapy, developed generalized symptoms of septicemia, respiratory failure, purpuric macules and patches. This was also proven to be disseminated strongyloidiasis.

  13. Trends and inequalities in short-term acute myocardial infarction case fatality in Scotland, 1988-2004

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    Leyland Alastair H

    2010-12-01

    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.

  14. A fatal case of cor pulmonale with undetected chronic hypoventilation in an infant with a known congenital myopathy.

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    Holst, John M; Willis, Mary J

    2012-01-01

    The authors of this paper wish to present a case of fatal cor pulmonale with right ventricular hypertrophy complicated by a congenital myopathy. It is our intention to demonstrate the importance of vigilant clinical assessment of children with a congenital myopathy, regardless of the exact etiology of their disease, or family history of disease severity. This case highlights the risk for fatal complications if hypoventilation and respiratory insufficiency go unrecognized in myopathic children. Consequently, we recommend respiratory and cardiac monitoring surveillance as well as appropriate referral to specialists in the management of such children.

  15. A case of fatal late vasospasm in a patient with a recurrent, supratentorial rhabdoid primitive neuroectodermal tumor: possible molecular implications.

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    Miscusi, Massimo; Martino, Luca De; Antonelli, Manila; Mangino, Giorgio; Ricciardi, Luca; Spinelli, Gianpaolo; Forcato, Stefano; Calogero, Antonella; Petrozza, Vincenzo; Ragona, Giuseppe; Raco, Antonino

    2014-01-01

    We report the case of a 44-year-old man who experienced a fatal and untreatable delayed vasospasm after resection of a recurrent temporal IV grade primitive neuroectodermal tumor (PNET). The histological analysis demonstrated a rare rhabdoid variant of the tumor with a diffuse myxoid degeneration; molecular investigations demonstrated an upregulation of IL-1β and IL-6 expression in the recurrence. We reviewed the pathophysiology of the vasospasm that occurs after tumors resection, and due to the rarity of case, we speculated on the possibility that specific histological and molecular features of the tumor could have contributed to the delayed and fatal complication.

  16. A case of Creutzfeldt-Jakob disease: diagnostic dilemmas of a rapidly fatal disease

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    Mirza M. Baig

    2013-10-01

    Full Text Available 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.

  17. A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality.

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    Castilla, J; Barricarte, A; Aldaz, J; García Cenoz, M; Ferrer, T; Pelaz, C; Pineda, S; Baladrón, B; Martín, I; Goñi, B; Aratajo, P; Chamorro, J; Lameiro, F; Torroba, L; Dorronsoro, I; Martínez-Artola, V; Esparza, M J; Gastaminza, M A; Fraile, P; Aldaz, P

    2008-06-01

    An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

  18. Clinical and histopathological features of fatal cases with dengue and chikungunya virus co-infection in Colombia, 2014 to 2015.

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    Mercado, Marcela; Acosta-Reyes, Jorge; Parra, Edgar; Pardo, Lissethe; Rico, Angélica; Campo, Alfonso; Navarro, Edgar; Viasus, Diego

    2016-06-02

    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.

  19. A case of fatal idiosyncratic reaction to the designer drug 3,4-methylenedioxypyrovalerone (MDPV) and review of the literature.

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    Desharnais, Brigitte; Dazé, Yann; Huppertz, Laura M; Mireault, Pascal; Skinner, Cameron D

    2017-07-01

    The stimulant designer drug 3,4-methylenedioxypyrovalerone (MDPV) was first synthesized by Boehringer Ingelheim in 1969 and introduced on the black market in 2006. Only a small number of fatal intoxication cases have been reported in the literature, all with significant blood MDPV concentrations. In this report, we describe one fatality attributed to an idiosyncratic reaction to MDPV. The victim displayed agitation, violent behavior and delirium followed by cardiac arrest. Hyperthermia was observed at the hospital. The MDPV cardiac and femoral blood concentrations were 6 ng/mL. The presence of excited delirium syndrome and MDPV, a drug with a pharmacology similar to cocaine, leads to the conclusion that the victim suffered a fatal adverse reaction to MDPV. This is the first published case of idiosyncratic reaction to MDPV.

  20. Fatal Gastrointestinal Perforations in sudden death cases in Last 10 years at UMMC- Malaysia

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    Dr. Nurul Azwa binti Mohd Ismail

    2007-01-01

    Full Text Available Gastrointestinal perforation occurs when the wall of the gastro-intestinal tract like stomach, small intestine or large bowel develops a hole through its entire thickness. This retrospective study was aimed to identify pattern of GIT perforations that caused sudden deaths in this part of the world. The study was conducted in Forensic Pathology unit of University Malaya, Kuala Lumpur in the year 2006 by reviewing the autopsy reports. There were 61 cases of GIT perforation out of 5579 autopsies conducted during a period of ten years (1996-2005. The incidence rate of fatal gastrointestinal perforation was 1.09% during this period. Out of these 61 cases, there were 49 males (80.3% and 12 female (19.7%. The most common site of gastrointestinal perforation was at the stomach (45.7%, followed by duodenum (18.5%, esophagus (9.9%, small intestine (9.9%, and large intestine (16.0%. The 36.07% cases had positive correlation with at least one of the known risk factors.

  1. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia.

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    Simon Delgado

    2008-04-01

    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.

  2. Carbofuran concentrations in blood, bile and tissues in fatal cases of homicide and suicide.

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    Sakunthala Tennakoon, D A S; Karunarathna, W D V; Udugampala, U S S

    2013-04-10

    Carbofuran is a broad spectrum carbamate insecticide which inhibits cholinesterase. In the recent past several carbofuran related homicide and suicide cases were reported in Sri Lanka. The concentration of carbofuran found in blood, bile and/or tissues in eight fatal cases were presented in this paper. Liquid-liquid extraction with chloroform was carried out with tissue and beverage samples while blood and bile samples were roller mixed with n-hexane and finally extracted into acetonitrile. Qualitative analysis of carbofuran in biological specimens was carried out using TLC and GC-MS. Presence of carbofuran and its metabolite carbofuran phenol were confirmed by GC-MS. The quantitative analysis was carried out using a validated method where Zorbax Eclips XDB C18 column was used in HPLC with photo diode array detector and GC-MS. In blood, bile, liver and stomach contents/stomach and contents both carbofuran and carbofuran phenol were identified, while in certain cases only the metabolite, carbofuran phenol was identified in blood. The carbofuran levels ranged from 0.4 to 18 μg/ml in blood, 0.4 to 60 μg/ml in bile, 2.2 μg/g in liver and 0.3 to 300 μg/g in stomach contents/stomach and contents.

  3. Fatal hepatitis E viral infection in pregnant women in Ghana: a case series

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    Bonney Joseph Humphrey

    2012-09-01

    Full Text Available 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 secondary to Hepatitis E viral infection in pregnancy. Case 1 was a 31-year-old Ghanaian woman who presented with a week’s history of passing dark urine as well as yellowish discoloration of the eyes. She subsequently developed fulminant hepatitis secondary to Hepatitis E viral infection, spontaneously aborted at 24 weeks of gestation and later died. Case 2 was also a 31-year-old Ghanaian woman who was admitted with a four-day history of jaundice. She had low grade fever, but no history of abdominal pain, haematuria, pale stool or pruritus. She next developed fulminant hepatitis secondary to Hepatitis E viral infection. However, she did not miscarry but died at 28 weeks of gestation. Case 3 was a 17-year-old Ghanaian woman who was referred to the tertiary health facility on account of jaundice and anaemia. She had delivered a live male infant at maturity of 32 weeks but noticed she was jaundiced and had a presentation of active disease 3 days prior to delivery. The baby was icteric at birth and on evaluation, had elevated bilirubin (mixed type with normal liver enzymes. Hepatitis E virus infection was confirmed in both mother and baby. However, the jaundice and the hepatomegaly resolved in mother and baby after 5 and 12 days respectively. Conclusion To the best of our knowledge, these are the first documented cases of fatal fulminant hepatic failures resulting from HEV infection in Ghana.

  4. Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010

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    Kakaire Othman

    2011-09-01

    .7%. Conclusion The incidence/prevalence ratio and case fatality ratio of maternal near misses are very high in studies from sub-Saharan Africa. Large differences exist between countries on the prevalence/incidence of maternal near misses. This could be due to different contexts/settings, variation in the criteria used to define the maternal near misses morbidity, or rigor used carrying out the study. Future research on maternal near misses should adopt the WHO recommendation on classification of maternal morbidity and mortality.

  5. Seeking Information after the 2010 Haiti Earthquake: A Case Study in Mass-Fatality Management

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    Gupta, Kailash

    2013-01-01

    The 2010 earthquake in Haiti, which killed an estimated 316,000 people, offered many lessons in mass-fatality management (MFM). The dissertation defined MFM in seeking information and in recovery, preservation, identification, and disposition of human remains. Specifically, it examined how mass fatalities were managed in Haiti, how affected…

  6. Diabetes, hypertension, overweight and hyperlipidemia and 7-day case-fatality in first myocardial infarction

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    H.K. Quintana

    2016-09-01

    Conclusions: In this population-based inception cohort study, diabetes but not hypertension and hyperlipidemia were associated with MI fatality. This further emphasizes the importance of diabetes as a cardiovascular risk factor and the need for close surveillance of diabetic patients. Overweight was however associated with decreased MI fatality.

  7. A case of fatal sigmoid volvulus visualized on postmortem radiography: The importance of image optimization with multidetector computed tomography.

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    Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Ishizuka, Yuya; Ikeda, Tomoya; Saito, Haruo; Funayama, Masato

    2016-03-01

    This report describes the case of a man who developed fatal sigmoid volvulus that was identified on postmortem radiography before forensic autopsy. Postmortem radiography is useful for visualizing the body prior to autopsy. We discuss postmortem multidetector computed tomography that was tailored for optimum image quality to allow reconstruction of the fatal findings in multiple axes and in three dimensions, helping to pinpoint the anatomical sites of interest. This involves techniques such as manipulation of the scanning beam pitch and overlapping CT section acquisition. These techniques are best performed by personnel with CT technology training.

  8. Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

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    Adem Patricia

    2010-01-01

    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

  9. Four cases of fatal toxoplasmosis in three species of endemic New Zealand birds.

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    Howe, Laryssa; Hunter, Stuart; Burrows, Elizabeth; Roe, Wendi

    2014-03-01

    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.

  10. A fatal case of severe serotonin syndrome accompanied by moclobemide and paroxetine overdose

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    Sener Serkan

    2005-01-01

    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.

  11. Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case-control study.

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    Persaud, Navindra; Coleman, Emily; Zwolakowski, Dorothy; Lauwers, Bert; Cass, Dan

    2012-11-20

    The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury. We used a case-control design involving 129 fatalities using data from a coroner's review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet. Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4-8.5) and when we used a more stringent case definition (i.e., only a head injury with no other substantial injuries; adjusted OR 3.6, 95% CI 1.2-10.2). Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths.

  12. Fatal exsanguination due to ruptured vericose vein of the lower leg: Case report

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    Živković Vladimir

    2011-01-01

    Full Text Available Introduction. Lethal exanguination due to haemorrhage from ruptured peripheral varicose veins of the lower leg usually in the elderly are exceptionally rare in clinical, and particularly in forensic medicine. In persons with varicosities there are two types of lower leg ulcers (acute perforated and chronic that can be associated with spontaneous bleeding. Ulcer exanguination can occur spontaneously or after a minor injury. Injuries in the ulcer region are rarer. Case Outline. We present a case of fatal exsanguination due to a ruptured varicose vein in a 77-year-old woman. The body was found on the porch floor, beside a sink, lying on the back, with bent knees, so that the lower legs were almost in the standing position, with the feet in a pool of blood. The entire interior of the house floor was covered with various bloodstains; blood-drops in form of spilling and spattering, foot-prints, as well as larger pools of blood. Death was attributed to massive external haemorrhage due to the acute perforated ulcer of the right lower leg with the rupture of the varicose vein wall surface along the entire depth. Conclusion. Although death due to haemorrhage from ruptured peripheral varicose veins is an uncommon complication of this disease, it should be taken into consideration by the forensic medicine examiner. In such cases autopsy should determine both the origin of bleeding (varicosities and venous wall damage and other underlying conditions, primarily ischemic cardiac disease. To resolve such cases, full cooperation with investigators and police is necessary.

  13. Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting.

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    Djelantik, I G G; Gessner, Bradford D; Sutanto, Augustinus; Steinhoff, Mark; Linehan, Mary; Moulton, Lawrence H; Arjoso, Soemarjati

    2003-12-01

    Few large studies have evaluated risk factors for mortality among children hospitalized for pneumonia and this may contribute to suboptimal case management efficiency. To identify useful screening criteria for mortality among children hospitalized for pneumonia in a developing country setting, we conducted a population-based hospital cohort study among children less than 2 years of age admitted for pneumonia during 1999-2001 at one of three major hospitals on Lombok Island, Indonesia. Of 4351 children admitted for pneumonia, 12 per cent died before discharge. Case fatality proportions were seasonal, with peaks occurring immediately after peaks in the proportion of cases positive for respiratory syncytial virus. Children with an oxygen saturation < or = 85 per cent or age younger than 4 months were 5.6 times more likely to die than children with none of these predictive factors (95 per cent CI, 4.5-7.1); 83 per cent of children who died had one of these two risk factors. For children < 4 months old, mortality increased at an oxygen saturation < 88 per cent compared with < 80 per cent for older children. Laboratory, physical examination, and radiological findings were not associated with or did not contribute substantially to mortality prediction. Among children hospitalized for pneumonia, age less than 4 months and hypoxia were identified with those at high risk of death. Age influences cut-off levels for hypoxia.

  14. A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.

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    Elliott, S P

    2002-01-01

    In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. Aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of Aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK. resulting from deliberate ingestion of Aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 micrograms/L and 264 micrograms/L, respectively. The aconitine concentration in the ante mortem urine was 334 micrograms/L and was estimated to be 6 micrograms/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death.

  15. An Acute Butyr-Fentanyl Fatality: A Case Report with Postmortem Concentrations.

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    McIntyre, Iain M; Trochta, Amber; Gary, Ray D; Wright, Jennifer; Mena, Othon

    2016-03-01

    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 fentanyl, acetyl-fentanyl and cocaine intoxication, and the manner of death was certified as accident.

  16. A fatal case of a paint thinner ingestion: comparison between toxicological and histological findings.

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    Argo, Antonina; Bongiorno, David; Bonifacio, Antonino; Pernice, Valentina; Liotta, Rosa; Indelicato, Serena; Zerbo, Stefania; Fleres, Pierangela; Ceraulo, Leopoldo; Procaccianti, Paolo

    2010-06-01

    Toluene and xylene are aromatic hydrocarbons commonly used as an industrial solvent for the manufacturing of pharmaceuticals, paints, and chemicals. The Occupational Safety and Health Administration has determined that toluene levels of 2000 parts per million (ppm) are considered dangerous to life and health. Several studies have examined the absorption of toluene and xylene following inhalation and oral ingestion in humans. Volatile organic compounds that are absorbed into the blood are distributed throughout the body; in particular, distribution of absorbed toluene and xylene in humans and rodents is characterized by preferential uptake in well-perfused and lipophil tissues such as the brain, liver, lungs, and body fat and also in central nervous system. The available studies indicate that xylenes are rapidly absorbed independently from the kind of exposition. We illustrate a fatal case of self-poisoning by ingestion of varnishes diluting solvents, reporting the identification and quantification of volatile organic compounds (toluene, o-m-p xylene) from human biologic liquids and viscera samples using the Solid-Phase Microextraction-Headspace-Gas Chromatography/Mass Spectrometry to toxicological analysis, and the histopathological findings evaluated in liver, kidney, and lungs.

  17. First reported case of fatal tuberculosis in a wild African elephant with past human-wildlife contact.

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    Obanda, V; Poghon, J; Yongo, M; Mulei, I; Ngotho, M; Waititu, K; Makumi, J; Gakuya, F; Omondi, P; Soriguer, R C; Alasaad, S

    2013-07-01

    Tuberculosis is emerging/re-emerging in captive elephant populations, where it causes morbidity and deaths, although no case of TB in wild African elephants has been reported. In this paper we report the first case of fatal TB in an African elephant in the wild. The infection with Mycobacterium tuberculosis was confirmed by post-mortem and histological examinations of a female sub-adult elephant aged >12 years that died in Tsavo East National Park, Kenya, while under treatment. This case is unique in that during its lifetime the elephant had contact with both humans and wild elephants. The source of the infection was unclear because the elephant could have acquired the infection in the orphanage or in the wild. However, our results show that wild elephants can maintain human TB in the wild and that the infection can be fatal.

  18. Fatal septicemia in a patient with cerebral lymphoma and an Amplatzer septal occluder: a case report

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    Stöllberger Claudia

    2011-11-01

    Full Text Available Abstract Introduction The Amplatzer septal occluder is frequently used for percutaneous closure of an atrial septal defect. Complications include thrombosis and embolism, dislocation, cardiac perforation, and, rarely, infection. We report the case of a patient who had survived an occluder-related thromboembolism two years previously. Case presentation A 72-year-old Caucasian woman had received a septal occluder because of an atrial septal defect seven years ago. Two years ago, she underwent chemotherapy of a non-Hodgkin lymphoma, developed atrial fibrillation, and experienced a left-sided occluder thrombosis with stroke and peripheral embolism. Now, she presented with cerebral lymphoma, received glucocorticoids, and subsequently developed skin lesions. Swabs from the lesions and blood cultures were positive for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Endocarditis, however, was considered only two months later and echocardiography suggested aortic valve endocarditis. Despite antibiotic therapy, she died three days later because of septicemia, and no post-mortem investigation was carried out. It remains uncertain whether the septal occluder was endothelialized or infected and whether explantation might have changed the outcome. Conclusions If infections occur in patients with a septal occluder, endocarditis should be considered and echocardiography should be performed early. To prevent a fatal outcome, explantation of the septal occluder should be considered, especially in patients with problems that suggest delayed endothelialization. Post-mortem investigations, including bacteriologic studies, should be carried out in patients with a septal occluder in order to assess the focal and global long-term effects of these devices.

  19. Fatal cases of disseminated nocardiosis: challenges to physicians and clinical microbiologists - Case report.

    Science.gov (United States)

    Piukovics, Klára; Bertalan, Viktória; Terhes, Gabriella; Báthori, Ágnes; Hajdú, Edit; Pokorny, Gyula; Kovács, László; Urbán, Edit

    2016-12-01

    Despite the development in the identification of Nocardia spp., common challenges exist in the laboratory diagnosis and management of nocardiosis. We report two cases of disseminated nocardiosis in a patient with hematologic disorder and in a patient with systemic lupus erythematosus, where the cooperation between various specialists was essential to set up the adequate diagnosis of disseminated nocardiosis.

  20. Clinicopathologic, Immunohistochemical, and Ultrastructural Findings of a Fatal Case of Middle East Respiratory Syndrome Coronavirus Infection in the United Arab Emirates, April 2014.

    Science.gov (United States)

    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

    2016-03-01

    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.

  1. Scorpionism in Ecuador: First report of severe and fatal envenoming cases from northern Manabí by Tityus asthenes Pocock.

    Science.gov (United States)

    Borges, Adolfo; Morales, Melva; Loor, Wilmer; Delgado, Miguel

    2015-10-01

    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.

  2. Fatal child abuse: a study of 13 cases of continuous abuse

    Directory of Open Access Journals (Sweden)

    Juhani Merikanto

    2012-01-01

    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.

  3. An observation on the main factor for the high fatalities by the March 11 earthquake

    Science.gov (United States)

    Ishida, M.; Baba, T.; Ando, M.

    2011-12-01

    On 11 March 2011, Mw9.0 earthquake occurred in Tohoku district, the northeastern Japan, and caused a large tsunami which affected the greater part of the area. During 115 years prior to this event, large tsunamis have struck the Tohoku region in 1960, 1933 and 1896. Therefore, disaster mitigation efforts have been undertaken in the Tohoku region, such as the construction of incomparably strong breakwaters, the annual practice for tsunami evacuation drill, the preparation of hazard maps, etc. Despite these long-term efforts, ca. 25,000 deaths and missing persons were reported by the National Police Headquarters, Japan. In order to clarify the causes of such high number of the fatalities, we interviewed 120 tsunami survivors in 7 cities mainly in Iwate prefecture in several periods after the earthquake. Since the tsunami arrived more than 20-30 min later after the strong ground shaking stopped and highlands are within about 10 to 20 minutes on foot, residents would have been saved if people had taken an immediate action. We found several major reasons why the residents delayed their evacuation actions as follows: 1. Earthquakes that were forecast for the offshore Tohoku by the governmental committee had been much smaller than the March 11 event. Accordingly, evacuation shelters were located at the lower level than that required for the incoming tsunami; 2. The earthquake magnitude and tsunami height of the first warning issue by Japan Meteorological Agency (JMA) was significantly smaller than those of the actual events. Majority of local residents thought that breakwaters would protect them. The JMA renewed the earthquake magnitude and tsunami height step by step, but the corrected information did not reach to the local residents because of the blackout of electric power. Consequently, the residents were unable to get the renewed information through TV or radio; 3. Fifty percent of the local residents experienced the 1960 Chile tsunami that significantly smaller than

  4. Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report

    Directory of Open Access Journals (Sweden)

    Bagaglio Sabrina

    2009-11-01

    Full Text Available Abstract Introduction There seem to be no published data concerning the clinical impact of populations of hepatitis B virus (HBV in the hepatic and extrahepatic compartments of HIV-infected people with severe acute hepatitis. Case presentation A 26-year-old Caucasian man presenting to our hospital with clinical symptoms suggesting acute hepatitis was found to have an acute hepatitis B profile upon admission. He developed fatal fulminant hepatitis and was found to be heavily immunocompromised due to HIV-1 infection. He had a high plasma HBV and HIV load, and analysis of the partial pre-S1/pre-S2 domain showed the presence of mixed infection with D and F genotypes. Analysis of the point mutations within this region revealed the presence of HBV strains with amino acid substitutions at the immunodominant epitopes involved in B or T cell recognition. A homogeneous population of a pre-core mutant strain harbouring the A1896G and A1899G affecting HBeAg expression was invariably found in the liver tissue, plasma and peripheral blood mononuclear cells despite active HBeAg secretion; it was the dominant strain in the liver only, and was characterised by the presence of two point mutations in the direct repeat 1 domain involved in HBV replication activity. Taken together, these mutations are indicative of a highly replicative virus capable of evading immune responses. Conclusion This case report provides clinical evidence of a possible association between the rapid spread of highly replicative escape mutants and the development of fulminant hepatitis in a heavily immunocompromised patient. Virological surveillance of severe acute hepatitis B may be important in establishing an early treatment strategy involving antiviral drugs capable of preventing liver failure, especially in individuals for whom liver transplantation is not accepted as a standard indication.

  5. The Study of Pattern of Injuries in Fatal Cases of fall from Height

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    C.R. Vasudeva Murthy

    2012-01-01

    Full Text Available Objectives: To study the various pattern of injuries from fall from height. Background: Deaths due to fall from height, form an important area of study due to diversity of the injuries sustained, complexity of the patterns involved and various phenomenon’s associated there with. The medico-legal autopsy aims at deciding whether the death was attribute purely to the height. It also helps in ruling out the various contributing factors like drugs, alcohol and co-existing natural disease. Methods: The present study has been carried out in department of forensic medicine, M.S. Ramaiah medical college and hospital, Bangalore during the period October 2005 to May 2007, of all the cases of fall from height subjected for medico legal autopsy. Results: Fissure fracture of the skull and fracture of cervical spine was noticed when the fall occurred on to concrete from minimum height of 3 feet and on to hard soil from the height of 10 feet. Multiple rib fractures, fracture of clavicle and laceration of liver was noticed when the fall height was 7 feet on to concrete. Spleen and kidneys were damaged when height of fall was more than 20 feet on to hard surface. Fracture of upper limbs were seen in falls occurred on to concrete from height of 6 feet where as the fracture of lower limb was found when the fall height was more than 15 feet on to hard surface. Conclusion: The study of pattern of external and internal injury may together indicate the primary site of impact and height from which the fall has occurred. The determination of actual or probable anatomical site of primary impact may be useful in reconstruction of the events, which led to fatal falls. Presence of multiple blunt force injuries makes it hard to differentiate between falls induced injuries and those that have inflicted before the fall and often disagreement predominates regarding the height at which death results. Thus a careful study of total injury pattern is of vital importance in every

  6. Interstitial lung disease caused by TS-1: a case of long-term drug retention as a fatal adverse reaction.

    Science.gov (United States)

    Park, Joong-Min; Hwang, In Gyu; Suh, Suk-Won; Chi, Kyong-Choun

    2011-12-01

    TS-1 is an oral anti-cancer agent for gastric cancer with a high response rate and low toxicity. We report a case of long-term drug retention of TS-1 causing interstitial lung disease (ILD) as a fatal adverse reaction. A 65-year-old woman underwent a total gastrectomy with pathologic confirmation of gastric adenocarcinoma. She received 6 cycles of TS-1 and low-dose cisplatin for post-operative adjuvant chemotherapy followed by single-agent maintenance therapy with TS-1. After 8 months, the patient complained of a productive cough with sputum and mild dyspnea. A pulmonary evaluation revealed diffuse ILD in the lung fields, bilaterally. In spite of discontinuing chemotherapy and the administration of corticosteroids, the pulmonary symptoms did not improve, and the patient died of pulmonary failure. TS-1-induced ILD can be caused by long-term drug retention that alters the lung parenchyma irreversibly, the outcome of which can be life-threatening. Pulmonary evaluation for early detection of disease is recommended.

  7. Nitrous oxide determination in postmortem biological samples: a case of serial fatal poisoning in a public hospital.

    Science.gov (United States)

    Poli, Diana; Gagliano-Candela, Roberto; Strisciullo, Giuseppe; Colucci, Anna P; Strada, Luigi; Laviola, Domenica; Goldoni, Matteo; Mutti, Antonio

    2010-01-01

    In a public hospital, eight cases of fatal poisoning by nitrous oxide (N(2)O) occurred under oxygen administration, due to an erroneous swapping of the lines in the gas system. The aim of the study was to clarify the factors involved in asphyxia by characterizing gases from different lines and measuring N(2)O concentrations in postmortem biological samples from bodies exhumed. Analyses carried out on the gas system confirmed the erroneous substitution of O(2) line with N(2)O and air line with O(2). Consequently, high N(2)O amounts were revealed in several tissues and gaseous biological samples. All specimens were analyzed by headspace gas chromatography technique. A rigorous quantitative analysis was possible only in blood (11.29-2152.04 mg/L) and urine (95.11 mg/L) and in air samples from stomach and trachea (from 5.28 to 83.63 g/m(3)). This study demonstrates that N(2)O can be detected in biological samples even 1 month after death.

  8. Allopurinol inappropriate use in case of asymptomatic hyperuricemic patient causes fatal Allopurinol hypersensitive syndrome: lesson to all

    Directory of Open Access Journals (Sweden)

    Arvind Kumar

    2015-12-01

    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

  9. Mitragynine concentrations in two fatalities.

    Science.gov (United States)

    Domingo, Olwen; Roider, Gabriele; Stöver, Andreas; Graw, Matthias; Musshoff, Frank; Sachs, Hans; Bicker, Wolfgang

    2017-02-01

    Two cases of fatalities are reported of which the recreational use of Mitragyna speciosa ("kratom") could be confirmed. One of these cases presents with one of the highest postmortem mitragynine concentrations published to date. Our results show that even extremely high mitragynine blood concentrations following the consumption of kratom do not necessarily have to be the direct cause of death in such fatalities as a result of an acute overdose. The two cases are compared with regard to the differences in mitragynine concentrations detected and the role of mitragynine in the death of the subjects. Irrespective of the big differences in mitragynine concentrations in the postmortem blood samples, mitragynine was not the primary cause of death in either of the two cases reported here. Additionally, by rough estimation, a significant difference in ratio of mitragynine to its diastereomers in the blood and urine samples between the two cases could be seen.

  10. Fatal carbon monoxide intoxication after acetylene gas welding of pipes.

    Science.gov (United States)

    Antonsson, Ann-Beth; Christensson, Bengt; Berge, Johan; Sjögren, Bengt

    2013-06-01

    Acetylene gas welding of district heating pipes can result in exposure to high concentrations of carbon monoxide. A fatal case due to intoxication is described. Measurements of carbon monoxide revealed high levels when gas welding a pipe with closed ends. This fatality and these measurements highlight a new hazard, which must be promptly prevented.

  11. [Medico-legal certification of fatal cases after drug: abuse in the light of modern toxicological analysis].

    Science.gov (United States)

    Kłys, M; Klementowicz, W; Bujak-Gizycka, B; Kołodziej, J; Trela, F

    2000-01-01

    Introduction of modern instrumental methods for toxicological analysis make possible a detection and identification of xenobiotics in different kind of multicomponents biological samples (plant sources of narcotics, body fluids and tissues of abusers) on a low concentration level. In this way a range of possibilities for the interpretation of toxicological results was enlarged. General medicolegal trends are strictly connected with modern analytics and they can be discussed on the basis of drug--users and fatal cases of intoxications with narcotics. Toxicological findings of these cases were worked out by means of modern analytical method--liquid chromatography with mass detection (LC/MS).

  12. A Near-Fatal Infection with Oseltamivir-Resistant Seasonal Influenza A in a Previously Healthy Child: Case Report

    Directory of Open Access Journals (Sweden)

    Jesse Papenburg

    2009-01-01

    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.

  13. Can intravascular lymphomatosis mimic sinus thrombosis? A case report with 8 months' follow-up and fatal outcome

    Energy Technology Data Exchange (ETDEWEB)

    Kenez, J.; Barsi, P.; Kocher, I.; Stangl, E. [Nat. Inst. of Psychiatry and Neurology, Department of Neuroradiology, Huvoesvoelgyi st 116, 1021 Budapest (Hungary); Majtenyi, K. [Department of Neuropathology, National Institute of Psychiatry and Neurology, Budapest (Hungary); Molnar, B.; Komoly, S. [Department of Neurology, Jahn Ferenc Hospital, Budapest (Hungary)

    2000-06-01

    We report a case of intravascular lymphomatosis of the brain with 8 months' follow-up and fatal outcome. Several MRI investigations revealed variegated, rapidly changing infarct-like lesions and invasion of the walls of the superior sagittal sinus and deep veins. When disturbances of the venous outflow are detected with multifocal infarct-like lesions, intravascular lymphomatosis should be considered in the differential diagnosis. Brain biopsy may ensure the proper diagnosis ante mortem, but failure of biopsy is frequent, as in our case. (orig.)

  14. Traumatic Brain and Spinal Cord Fatalities Among High School and College Football Players - United States, 2005-2014.

    Science.gov (United States)

    Kucera, Kristen L; Yau, Rebecca K; Register-Mihalik, Johna; Marshall, Stephen W; Thomas, Leah C; Wolf, Susanne; Cantu, Robert C; Mueller, Frederick O; Guskiewicz, Kevin M

    2017-01-06

    An estimated 1.1 million high school and 75,000 college athletes participate in tackle football annually in the United States. Football is a collision sport; traumatic injuries are frequent (1,2), and can be fatal (3). This report updates the incidence and characteristics of deaths caused by traumatic brain injury and spinal cord injury (4) in high school and college football and presents illustrative case descriptions. Information was analyzed from the National Center for Catastrophic Sport Injury Research (NCCSIR). During 2005-2014, a total of 28 deaths (2.8 deaths per year) from traumatic brain and spinal cord injuries occurred among high school (24 deaths) and college football players (four deaths) combined. Most deaths occurred during competitions and resulted from tackling or being tackled. All four of the college deaths and 14 (58%) of the 24 high school deaths occurred during the last 5 years (2010-2014) of the 10-year study period. These findings support the need for continued surveillance and safety efforts (particularly during competition) to ensure proper tackling techniques, emergency planning for severe injuries, availability of medical care onsite during competitions, and assessment that it is safe to return to play following a concussion.

  15. A poor metabolizer of both CYP2C19 and CYP2D6 identified by mechanistic pharmacokinetic simulation in a fatal drug poisoning case involving venlafaxine

    DEFF Research Database (Denmark)

    Jornil, J; Nielsen, T S; Rosendal, I

    2013-01-01

    Abstract We present a fatal drug poisoning case involving venlafaxine (VEN). The deceased took his medication regularly (including 150 mg VEN twice daily), and nothing in the case or autopsy findings pointed towards suicide. The toxicological assessment concluded that the cause of death was most...... likely due to a poisoning with a combination of VEN, oxycodone and ethanol, and the manner of death was considered to be an accident. The blood concentration of VEN was high (4.5 mg/kg), and the ratio of the VEN metabolite O-desmethylvenlafaxine (ODV) to VEN was exceptionally low (0.006). Mechanistic...... would cause higher concentrations of VEN, but the simulations also suggested that there could be additional reasons to explain the high VEN concentration found in this case. Thus, it seems likely that the potentially toxic VEN concentration was caused by reduced metabolic capacity. The simulations...

  16. Metabolic acidosis: expected and fatal adverse effects of metformin and empagliflozin: a case series and literature review

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    Miriam Čupić

    2016-09-01

    Full Text Available Metformin, a well-known first-line diabetes therapy, and the recently developed sodium- glucose co-transporter 2 (SGLT2 inhibitor empagliflozin are widely used oral antihyperglycemic drugs in the long-term treatment of type 2 diabetes mellitus (T2DM. Metabolic acidosis is a potentially fatal adverse effect (AE of these drugs with a high mortality rate. However, the reported incidence of metabolic acidosis in clinical practice has been proven to be very low. Nevertheless, it should be considered that the event rates are based on confounded data and spontaneous case reports. Metformin increases plasma lactate levels by inhibiting mitochondrial respiration, which, accompanied by elevated plasma metformin concentrations (in renal impairment and a secondary event that further disrupts lactate production (e.g., hypoperfusion, sepsis, typically leads to metformin-associated lactic acidosis (MALA. At the same time, SGLT2 inhibitors are thought to promote ketogenesis and precipitate ketoacidosis by their extra-pancreatic glucuretic mode of action. The present article describes 3 patients suffering from severe metabolic acidosis caused by metformin or empagliflozin, presents similar cases reported in the literature, and assesses the possible etiopathogenesis of the metabolic derangement. Diabetic patients should be educated about the importance of regular fluid and food intake as well as regular blood and urine glucose and ketone self-checkups, whereas physicians should be more aware that the key to an effective use of all glucose-lowering medication is appropriate patient selection, counseling, and follow-up. It is a good clinical sense which will ensure that physicians are able to translate pharmaceutical advances into clinical benefits for patients with T2DM.

  17. Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

    Directory of Open Access Journals (Sweden)

    Oliver W Morgan

    2006-06-01

    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

  18. Mass Fatality Management following the South Asian Tsunami Disaster: Case Studies in Thailand, Indonesia, and Sri Lanka

    Science.gov (United States)

    Morgan, Oliver W; Sribanditmongkol, Pongruk; Perera, Clifford; Sulasmi, Yeddi; Van Alphen, Dana; Sondorp, Egbert

    2006-01-01

    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 practical guidelines

  19. Social and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: a case-control study.

    Science.gov (United States)

    Origer, Alain; Le Bihan, Etienne; Baumann, Michèle

    2014-09-01

    To investigate social and economic inequalities in fatal overdose cases related to opioid and cocaine use, recorded in Luxembourg between 1994 and 2011. Cross-examination of national data from law enforcement and drug use surveillance sources and of forensic evidence in a nested case-control study design. Overdose cases were individually matched with four controls, when available, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs 1056 controls were analysed. Conditional logistic regression analysis was performed to assess the respective impact of a series of socioeconomic variables. Being professionally active [OR=0.66 (95% CI 0.45-0.99)], reporting salary as main legal income source [OR=0.42 (95% CI 0.26-0.67)] and education attainment higher than primary school [OR=0.50 (95% CI 0.34-0.73)] revealed to be protective factors, whereas the professional status of the father or legal guardian of victims was not significantly associated to fatal overdoses. Socioeconomic inequalities in drug users impact on the occurrence of fatal overdoses. Compared to their peers, users of illicit drugs with lower socioeconomic profiles show increased odds of dying from overdose. However, actual and self-referred socioeconomic characteristics of drug users, such as educational attainment and employment, may have a greater predictive value of overdose mortality than the parental socioeconomic status. Education, vocational training and socio-professional reintegration should be part of drug-related mortality prevention policies. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. A Population-Based Study of the Incidence and Case Fatality of Intracerebral Hemorrhage of Undetermined Etiology.

    Science.gov (United States)

    Qureshi, Adnan I; Afzal, Mohammad R; Malik, Ahmed A; Qureshi, Mushtaq H; Jahangir, Nauman; Suri, M Fareed K

    2015-10-01

    There is a paucity of reliable recent data regarding epidemiology of intracerebral hemorrhage (ICH) of undetermined etiology in population-based studies. To determine the incidence and case fatality of ICH of undetermined etiology using a population-based design. Medical records and neuroimaging data of all patients with ICH from Stearns and Benton Counties, Minnesota, between June 1st, 2012 and June 30th, 2014 were reviewed. Patients with a first-time diagnosis of ICH were categorized as of undetermined etiology if ICH was without features typical of hypertensive etiology with normal or no magnetic resonance imaging (MRI)/angiograms. We calculated the incidences of [1] probable and possible hypertensive ICH; [2] related to arteriovenous malformation, cavernous malformation, or aneurysmal rupture (angiographic or MRI diagnoses); [3] secondary to anticoagulation; and [4] of undetermined etiology adjusted for age and sex based on the 2010 US census. Of the 50 identified ICHs among 136,654 resident populations, seven were true incident cases of ICH of undetermined etiology in this population-based study. The age- and sex-adjusted incidence of ICH of undetermined etiology was 2.6 [95% confidence interval (CI) 0.7-4.9] per 100, 000 person-years, which was lower than probable and possible hypertensive ICH incidence of 12.8 [95% CI 8.4-17.2] per 100,000 person-years. The age-adjusted case fatality rate at 1 month was 8.14 and 0.4 per 100,000 persons for probable and possible hypertensive ICHs and ICHs of undetermined etiology, respectively. Our results should prompt further studies into identification of causes in ICH patients presently classified as ICH of undetermined etiology to reduce the incidence and case fatality of such ICHs.

  1. Paraquat: A fatal poison

    Directory of Open Access Journals (Sweden)

    J Shashibhushan

    2015-01-01

    Full Text Available Paraquat (1, 1′-dimethyl-4, 4′-dipyridylium is a bipyridilium herbicide used widely in our country and is a highly toxic compound. This compound is very notorious to cause rapid development of renal, liver, and respiratory failure with very high mortality due to lack of specific antidote and dearth of high-quality evidence-based treatment. Respiratory system involvement is the most common cause of death in these people. We hereby report a fatal case of a 30-year-old male with a history of paraquat consumption. The patient developed oliguric renal failure, deterioration of liver function, and acute respiratory distress syndrome over next few days. Different treatment modalities were tried to manage patient′s condition. In this case, none of the strategies worked well, and death ensued due to multi-organ dysfunction syndrome.

  2. Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review.

    Science.gov (United States)

    Satlin, M J; Graham, J K; Visvesvara, G S; Mena, H; Marks, K M; Saal, S D; Soave, R

    2013-12-01

    Acanthamoeba is the most common cause of granulomatous amebic encephalitis, a typically fatal condition that is classically described as indolent and slowly progressive. We report a case of Acanthamoeba encephalitis in a kidney transplant recipient that progressed to death within 3 days of symptom onset and was diagnosed at autopsy. We also review clinical characteristics, treatments, and outcomes of all published cases of Acanthamoeba encephalitis in solid organ transplant (SOT) recipients. Ten cases were identified, and the infection was fatal in 9 of these cases. In 6 patients, Acanthamoeba presented in a fulminant manner and death occurred within 2 weeks after the onset of neurologic symptoms. These acute presentations are likely related to immunodeficiencies associated with solid organ transplantation that result in an inability to control Acanthamoeba proliferation. Skin lesions may predate neurologic involvement and provide an opportunity for early diagnosis and treatment. Acanthamoeba is an under-recognized cause of encephalitis in SOT recipients and often presents in a fulminant manner in this population. Increased awareness of this disease and its clinical manifestations is essential to attain an early diagnosis and provide the best chance of cure.

  3. Linezolid-induced near-fatal serotonin syndrome during escitalopram therapy: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Ranganath R Kulkarni

    2013-01-01

    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.

  4. Fatal tiger attack: a case report with emphasis on typical tiger injuries characterized by partially resembling stab-like wounds.

    Science.gov (United States)

    Pathak, Hrishikesh; Borkar, Jaydeo; Dixit, Pradeep; Dhawane, Shailendra; Shrigiriwar, Manish; Dingre, Niraj

    2013-10-10

    Fatalities due to attacks by tigers on humans are uncommon and are rarely described in the medico-legal literature. We herein present a forensic investigation in a unique case of a fatal tiger attack in the wild on a 35 year old female in India by an Indian Bengal tiger (Panthera tigris tigris). The attack resulted in two pairs of puncture wounds over the nape area with occult cervical spine injuries resulting from transfixing of spine due to the tiger canines; multiple puncture wounds, numerous scratches and abrasions consistent with the tiger claw injuries and injury to the right jugulocarotid vessels. This case outlines the characteristic injury pattern from such an attack along with the multiple sources of the tiger injuries. The analysis of these injuries might reveal the motivation behind the attack and the big cat species involved in the attack. A tiger injury is sometimes compared with a stab injury, as the patterned injuries due to a tiger bite are characterized by multiple penetrating, stab-like wounds. So, a special attention is paid toward establishment of the cause of death from bites by the animal teeth under unknown circumstances of trauma and to exclude the possibility of a homicide beyond reasonable doubt in such cases.

  5. A pulmonary aspergillosis case with fatal course in a patient with SIRS clinic

    Directory of Open Access Journals (Sweden)

    Nedim Çekmen

    2011-01-01

    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.

  6. Fatal Kounis syndrome with stent thrombosis secondary to amoxicillin/clavulanic acid use: A case report and literature review.

    Science.gov (United States)

    Salouage, Issam; El Aidli, Sihem; Kastalli, Sarra; Daghfous, Riadh; Lakhal, Mohamed

    2016-12-01

    Anaphylactic reactions are often induced by drugs, and the most frequent ones are penicillin derivates. The concurrence of acute coronary syndrome with hypersensitivity and anaphylactic or anaphylactoid reactions constitutes the Kounis syndrome. We report a case of a coronary stent thrombosis with a fatal outcome complicating an anaphylactic shock induced by amoxicillin-clavulanic acid association. A 58-year-old woman with a history of triple coronary stenting was treated by amoxicillin/clavulanic acid association for pharyngitis. One hour after the first drug intake, she developed an anaphylactic shock with acute constricting chest pain. She received intravenous hydrocortisone and was transferred to emergency department. The patient received epinephrine intravenously with fluid perfusion and oxygen. Electrocardiogram showed Pardee waves in the anterior precordial leads. Cardiac enzyme levels (troponin I) were disturbed. The patient was transferred to the coronary care unit with a diagnosis of acute myocardial infarction. The coronary angiography revealed anterior interventricular stent thrombosis. The patient experienced a cardiogenic shock with an important hemodynamic repercussion, and she died few hours later despite emergency care. The responsibility of amoxicillin-clavulanic acid association was retained in the genesis of this anaphylactic shock in front of a suggestive delay, a compatible evolution and a high semiotic score. Amoxicillin/clavulanic acid use may cause Kounis syndrome. The use of epinephrine is a challenging decision. We suggest that Kounis syndrome should be considered in the differential diagnosis of acute coronary syndrome. Copyright © 2016 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  7. The pathology of severe dengue in multiple organs of human fatal cases: histopathology, ultrastructure and virus replication.

    Directory of Open Access Journals (Sweden)

    Tiago F Póvoa

    Full Text Available Dengue is a public health problem, with several gaps in understanding its pathogenesis. Studies based on human fatal cases are extremely important and may clarify some of these gaps. In this work, we analyzed lesions in different organs of four dengue fatal cases, occurred in Brazil. Tissues were prepared for visualization in optical and electron microscopy, with damages quantification. As expected, we observed in all studied organ lesions characteristic of severe dengue, such as hemorrhage and edema, although other injuries were also detected. Cases presented necrotic areas in the liver and diffuse macro and microsteatosis, which were more accentuated in case 1, who also had obesity. The lung was the most affected organ, with hyaline membrane formation associated with mononuclear infiltrates in patients with pre-existing diseases such as diabetes and obesity (cases 1 and 2, respectively. These cases had also extensive acute tubular necrosis in the kidney. Infection induced destruction of cardiac fibers in most cases, with absence of nucleus and loss of striations, suggesting myocarditis. Spleens revealed significant destruction of the germinal centers and atrophy of lymphoid follicles, which may be associated to decrease of T cell number. Circulatory disturbs were reinforced by the presence of megakaryocytes in alveolar spaces, thrombus formation in glomerular capillaries and loss of endothelium in several tissues. Besides histopathological and ultrastructural observations, virus replication were investigated by detection of dengue antigens, especially the non-structural 3 protein (NS3, and confirmed by the presence of virus RNA negative strand (in situ hybridization, with second staining for identification of some cells. Results showed that dengue had broader tropism comparing to what was described before in literature, replicating in hepatocytes, type II pneumocytes and cardiac fibers, as well as in resident and circulating monocytes

  8. The pathology of severe dengue in multiple organs of human fatal cases: histopathology, ultrastructure and virus replication.

    Science.gov (United States)

    Póvoa, Tiago F; Alves, Ada M B; Oliveira, Carlos A B; Nuovo, Gerard J; Chagas, Vera L A; Paes, Marciano V

    2014-01-01

    Dengue is a public health problem, with several gaps in understanding its pathogenesis. Studies based on human fatal cases are extremely important and may clarify some of these gaps. In this work, we analyzed lesions in different organs of four dengue fatal cases, occurred in Brazil. Tissues were prepared for visualization in optical and electron microscopy, with damages quantification. As expected, we observed in all studied organ lesions characteristic of severe dengue, such as hemorrhage and edema, although other injuries were also detected. Cases presented necrotic areas in the liver and diffuse macro and microsteatosis, which were more accentuated in case 1, who also had obesity. The lung was the most affected organ, with hyaline membrane formation associated with mononuclear infiltrates in patients with pre-existing diseases such as diabetes and obesity (cases 1 and 2, respectively). These cases had also extensive acute tubular necrosis in the kidney. Infection induced destruction of cardiac fibers in most cases, with absence of nucleus and loss of striations, suggesting myocarditis. Spleens revealed significant destruction of the germinal centers and atrophy of lymphoid follicles, which may be associated to decrease of T cell number. Circulatory disturbs were reinforced by the presence of megakaryocytes in alveolar spaces, thrombus formation in glomerular capillaries and loss of endothelium in several tissues. Besides histopathological and ultrastructural observations, virus replication were investigated by detection of dengue antigens, especially the non-structural 3 protein (NS3), and confirmed by the presence of virus RNA negative strand (in situ hybridization), with second staining for identification of some cells. Results showed that dengue had broader tropism comparing to what was described before in literature, replicating in hepatocytes, type II pneumocytes and cardiac fibers, as well as in resident and circulating monocytes/macrophages and

  9. The Pathology of Severe Dengue in Multiple Organs of Human Fatal Cases: Histopathology, Ultrastructure and Virus Replication

    Science.gov (United States)

    Póvoa, Tiago F.; Alves, Ada M. B.; Oliveira, Carlos A. B.; Nuovo, Gerard J.; Chagas, Vera L. A.; Paes, Marciano V.

    2014-01-01

    Dengue is a public health problem, with several gaps in understanding its pathogenesis. Studies based on human fatal cases are extremely important and may clarify some of these gaps. In this work, we analyzed lesions in different organs of four dengue fatal cases, occurred in Brazil. Tissues were prepared for visualization in optical and electron microscopy, with damages quantification. As expected, we observed in all studied organ lesions characteristic of severe dengue, such as hemorrhage and edema, although other injuries were also detected. Cases presented necrotic areas in the liver and diffuse macro and microsteatosis, which were more accentuated in case 1, who also had obesity. The lung was the most affected organ, with hyaline membrane formation associated with mononuclear infiltrates in patients with pre-existing diseases such as diabetes and obesity (cases 1 and 2, respectively). These cases had also extensive acute tubular necrosis in the kidney. Infection induced destruction of cardiac fibers in most cases, with absence of nucleus and loss of striations, suggesting myocarditis. Spleens revealed significant destruction of the germinal centers and atrophy of lymphoid follicles, which may be associated to decrease of T cell number. Circulatory disturbs were reinforced by the presence of megakaryocytes in alveolar spaces, thrombus formation in glomerular capillaries and loss of endothelium in several tissues. Besides histopathological and ultrastructural observations, virus replication were investigated by detection of dengue antigens, especially the non-structural 3 protein (NS3), and confirmed by the presence of virus RNA negative strand (in situ hybridization), with second staining for identification of some cells. Results showed that dengue had broader tropism comparing to what was described before in literature, replicating in hepatocytes, type II pneumocytes and cardiac fibers, as well as in resident and circulating monocytes/macrophages and

  10. Fatal Candida septic shock during systemic chemotherapy in lung cancer patient receiving corticosteroid replacement therapy for hypopituitarism: a case report.

    Science.gov (United States)

    Morichika, Daisuke; Sato-Hisamoto, Akiko; Hotta, Katsuyuki; Takata, Katsuyoshi; Iwaki, Noriko; Uchida, Koji; Minami, Daisuke; Kubo, Toshio; Tanimoto, Mitsune; Kiura, Katsuyuki

    2014-05-01

    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 IIIA. 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 (i) immediate initiation of antifungal therapy soon after the careful risk assessment of Candida infection and (ii) adequate administration of both basal steroid replacement therapy and temporal steroid coverage for febrile neutropenia might have improved his fatal outcome.

  11. Sudden Death in Sauna Due to Fatal Burns: A Case Report.

    Science.gov (United States)

    Lindroos, Katarina; Keltanen, Terhi

    2016-03-01

    Sudden death during or after sauna bathing is a rare event. When occurring accidentally, it is often caused or contributed by consumption of ethanol. To accidentally burn to death because of hot air is highly uncommon without some contributing factor that lowers the person's consciousness. Hot air burns have been reported to develop in 20 to 60 minutes. We present a case of sudden death of a healthy man with rare and extensive hot air burns that developed in less than 10 minutes in the sauna. Ethanol was not a contributing factor. Substantial injuries were found at the autopsy, both external and internal, for instance, small hemorrhages in the stomach mucosa, indicating a heavy antemortem stress reaction. The most probable reason for the extensive scalds was concluded to be, apart from the high temperature, the high degree of relative humidity in the sauna.

  12. Discrimination Between Drug Abuse and Medical Therapy: Case report of a tranylcypromine overdose-related fatality

    Directory of Open Access Journals (Sweden)

    Maryam Akhgari

    2017-06-01

    Full Text Available Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs.

  13. [Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases].

    Science.gov (United States)

    Cartier R, Luis; González L, Daniela; Harán D, Jorge

    2015-11-01

    The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

  14. Unique case of fatal carbon monoxide poisoning in the absence of a combustible fossil fuel.

    Science.gov (United States)

    Morgan, D R; Poon, P; Titley, J; Jagger, S F; Rutty, G N

    2001-09-01

    A 37-year-old man died as a result of exposure to carbon monoxide within an apartment. An investigation of the apartment showed no gas appliances or gas supply to the apartment and no evidence of any combustion event to any part of the apartment or roof space. Inhalation of dichloromethane was excluded. Heating to the apartment was found to be via an electrical storage heater, the examination of which revealed that the cast-iron core and insulating material showed evidence of heat damage with significant areas devoid of carbon. This electric storage heater is hypothesized to be the source of carbon for the fatal production of carbon monoxide within the apartment.

  15. Fatal miliary Coccidioidomycosis in a patient receiving infliximab therapy: a case report

    Directory of Open Access Journals (Sweden)

    Rogan Mark P

    2007-09-01

    Full Text Available Abstract A 78-year-old white male from Iowa in the United States of America receiving the anti- tumor necrois factor (TNF agent infliximab therapy for rheumatoid arthritis developed a cheek ulcer which failed to respond to empiric antibiotic therapy. He subsequently presented with progressive respiratory failure from miliary coccidioidomycosis which proved fatal. The patient vacationed in Arizona 6 months previously and likely contracted the organism there as Iowa is not an endemic area for coccidioidomycosis. Respiratory failure from miliary infiltration is an uncommon presentation of coccidioidomycosis. Physicians should be aware of the importance of travel history and potential for life-threatening coccidioidomycosis in patients receiving tumor necrosis factor inhibitors.

  16. Review of Dengue Hemorrhagic Fever Fatal Cases Seen Among Adults: A Retrospective Study

    OpenAIRE

    Sing-Sin Sam; Sharifah Faridah Syed Omar; Boon-Teong Teoh; Juraina Abd-Jamil; Sazaly AbuBakar

    2013-01-01

    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...

  17. Rat bite fever, a fatal case of Streptobacillus moniliformis infection in a 14-month-old boy.

    Science.gov (United States)

    Banerjee, Priya; Ali, Zabiullah; Fowler, David R

    2011-03-01

    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.

  18. Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Sameer Desai

    2013-01-01

    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.

  19. Fatal nosocomial meningitis caused by Mycoplasma hominis in an adult patient: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Sophie Reissier

    2016-07-01

    Full Text Available 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.

  20. Characteristics, risk factors and case fatality rate of stroke in hospitalized patients in semi-urban South–South Nigeria

    Directory of Open Access Journals (Sweden)

    Peter O Okokhere

    2013-12-01

    Full Text Available Background: Stroke causes death and disability worldwide. Hypertension is the most prevalent risk factor. In Nigeria, studies on outcome and risk factors of stroke are from urban-based hospitals. This study aims to look at stroke outcome and the major modifiable risk factors of hospitalized stroke patients in semi-urban Nigeria. Methods: The medical records of stroke patients admitted between March 2008 and February 2010 were reviewed retrospectively. The relevant demographic, clinical and laboratory data of each patient were retrieved. Results: A total of 99 cases of stroke made up of 51 males and 48 females were reviewed. Mean age of the subjects was 66.22 ± 12.67 years. Mean systolic blood pressure and diastolic blood pressure at presentation were 171.41 ± 39.10 mmHg and 100.44 ± 21 mmHg, respectively. About 61.6% were known hypertensives, while 31.3%, not previously known to be hypertensive, had SBP ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Overall, 85.9% of the subjects had SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg. In all, 46.5% had SBP ≥ 180 mmHg, and 63% of this number had SBP ≥ 200 mmHg; 42.4% had DBP ≥ 110 mmHg. Other major risk factors were hypercholesterolaemia (34.4%, diabetes mellitus (16.6%, previous cerebrovascular accident (15.2% and smoking (9.4%. In all, 31.3% had two or more modifiable stroke risk factors. 36.4% of the subjects were comatose. Overall case fatality rate was 45.8%, 75% of the subjects with coma died, compared to 27.6% without coma (p < 0.01. Conclusion: Mortality in our stroke patients is high. Hypertension is the commonest modifiable risk factor, and the presence of coma at presentation is associated with poor prognosis.

  1. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M

    2016-01-01

    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  2. Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases.

    Science.gov (United States)

    Perdigão, Anne Carolinne Bezerra; Ramalho, Izabel Letícia Cavalcante; Guedes, Maria Izabel Florindo; Braga, Deborah Nunes Melo; Cavalcanti, Luciano Pamplona Góes; Melo, Maria Elisabeth Lisboa de; Araújo, Rafael Montenegro de Carvalho; Lima, Elza Gadelha; Silva, Luciene Alexandre Bié da; Araújo, Lia de Carvalho; Araújo, Fernanda Montenegro de Carvalho

    2016-09-01

    We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses' epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

  3. Coinfection with influenza A(H1N1pdm09 and dengue virus in fatal cases

    Directory of Open Access Journals (Sweden)

    Anne Carolinne Bezerra Perdigão

    2016-01-01

    Full Text Available Abstract We report on four patients with fatal influenza A(H1N1pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4. Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998. As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015. In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm, caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010. In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013. The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013. The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

  4. Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases

    Science.gov (United States)

    Perdigão, Anne Carolinne Bezerra; Ramalho, Izabel Letícia Cavalcante; Guedes, Maria Izabel Florindo; Braga, Deborah Nunes Melo; Cavalcanti, Luciano Pamplona Góes; de Melo, Maria Elisabeth Lisboa; Araújo, Rafael Montenegro de Carvalho; Lima, Elza Gadelha; da Silva, Luciene Alexandre Bié; Araújo, Lia de Carvalho; Araújo, Fernanda Montenegro de Carvalho

    2016-01-01

    Abstract We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará. PMID:27598244

  5. Two cases of near-fatal gamma-butyrolactone (GBL) ingestion and intoxication.

    Science.gov (United States)

    van Vugt, R; Hofhuizen, C M

    2012-01-01

    We present two cases of GBL intoxication. Patient A is a 45-year old man who lost consciousness after drinking a clear unknown liquid. He was brought to the Emergency Departement (ED) after he was intubated. His partner notified the liquid could be GBL, a prodrug for GHB. He regained consciousness 16 hours later in the intensive care unit (ICU) where he could be successfully extubated. Patient B is a 25-year old man who was found unconscious at home with next to him an empty bottle of GBL. He was intubated in the intensive care unit. He could be extubated after 12 hours. GBL intoxication is becoming a more frequent problem and overdosage of GBL can rapidly occur because of its rapid onset and high potency when compared to GHB. We discuss the clinical course and complications after GBL ingestion and intoxication.

  6. Femme fatale

    Directory of Open Access Journals (Sweden)

    Francisco Javier Tardío Gastón

    2011-12-01

    Full Text Available Our history is full of myths and topics. Therefore the image of femme fatale is frequent in the works of all periods and places. The author of this article first analyzes how the history and literature consistently showed and defined these women, and then presents examples that come from ancient Greece. The art is powered by their power of seduction and the article explains how this femme fatale appeared in literature and film. The article concludes with a brief overview of various arguments concerning women and feminism, present in the literary criticism.

  7. CD206+ Cell Number Differentiates Influenza A (H1N1pdm09 from Seasonal Influenza A Virus in Fatal Cases

    Directory of Open Access Journals (Sweden)

    Heidi G. Rodriguez-Ramirez

    2014-01-01

    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.

  8. CD206+ Cell Number Differentiates Influenza A (H1N1)pdm09 from Seasonal Influenza A Virus in Fatal Cases

    Science.gov (United States)

    Rodriguez-Ramirez, Heidi G.; Salinas-Carmona, Mario C.; Barboza-Quintana, Oralia; Melo-de la Garza, Americo; Ceceñas-Falcon, Luis Angel; Rangel-Martinez, Lilia M.; Rosas-Taraco, Adrian G.

    2014-01-01

    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 (H1N1)pdm09 and seasonal influenza virus. We investigated these possible biomarkers in the lung of fatal cases of confirmed influenza A (H1N1)pdm09. Cytokines (inflammatory and anti-inflammatory) and cellular markers (macrophages and lymphocytes subpopulation markers) were analyzed in lung tissue from both influenza A (H1N1)pdm09 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 (H1N1)pdm09 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 (H1N1)pdm09 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 (H1N1)pdm09 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 (H1N1)pdm09 (P < 0.05). In conclusion, CD206+ cells differentiate between influenza A (H1N1)pdm09 and seasonal influenza virus in lung tissue of fatal cases. PMID:25614715

  9. Fatal recto-sigmoid rupture by compressed air

    Directory of Open Access Journals (Sweden)

    Varun Pai

    2016-12-01

    Full Text Available Compressed air is a concentrated stream of air at high pressure and high speed that can cause fatal injury to the operator and the people around him when handled inappropriately. The case herein reported is that of a victim of a practical joke, who suffered a fatal recto – sigmoid rupture due to transanal insufflation of compressed air at his workplace. The case highlights the need for implementation of guidelines for safe handling of compressed gases and it also calls for appropriate work place etiquette to avoid such fatal practical jokes at work.

  10. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication

    Directory of Open Access Journals (Sweden)

    Bikash Bhattarai

    2015-09-01

    Full Text Available Obstruction of the thoracic duct may lead to accumulation of a lymphatic fluid rich in triglycerides named chyle. When chyle accumulates in the pleural cavity, it becomes a chylothorax. Malignancy, particularly lymphoma, is the most common cause of chylothorax; however, any pathology leading to obstruction or destruction of the thoracic duct can lead to a chylothorax. This particular case investigates an incidence of chylothorax in sarcoidosis. A 54-year-old African American woman with a medical history of sarcoidosis, congestive heart failure, and smoking presented to the emergency department with complaints of bilateral foot swelling and exertional shortness of breath 3 days in duration. Physical examination was positive for bilateral crepitations with decreased air entry, abdominal ascites, and bilateral 2+ pitting edema. Both chest X-ray and chest CT were positive for stable bilateral pleural effusions (when compared to imaging done 3 years previously, and thoracocentesis and paracentesis were positive for chylous fluid accumulation. Chylothorax was diagnosed, and based on the previous medical history, the lymphadenopathy of sarcoidosis was determined to cause the occlusion of the thoracic duct. Lymphoscintigraphy and surgical intervention were advised; however, the family decided on conservative management and the patient expired intubated in the ICU. Chylothorax is a rare manifestation of sarcoidosis and high index of suspicion should be there to diagnose this, as there is high morbidity and mortality associated with it.

  11. Significant decline in case fatality after acute myocardial infarction in Denmark--a population-based study from 1994 to 2001

    DEFF Research Database (Denmark)

    Abildstrom, Steen Z; Rasmussen, Søren; Madsen, Mette

    2002-01-01

    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...... from 1994 to 2001. RESULTS: The annual relative decline in case-fatality rate was constant at 10.5% (95% confidence interval (CI) 9.5-11.5%). The decline was similar for both genders at all ages. The hospitalization rate decreased from 1994 to 1999 at an annual average of 4.3% (95% CI 3...

  12. Comparison of genotypic and phenotypic characterization methods for Pasteurella multocida isolates from fatal cases of bovine respiratory disease.

    Science.gov (United States)

    Taylor, Jared D; Fulton, Robert W; Dabo, S Mady; Lehenbauer, Terry W; Confer, Anthony W

    2010-05-01

    Bovine respiratory disease (BRD) is the most costly disease of beef cattle in North America. Because Pasteurella multocida is a commensal of the upper respiratory tract, it is generally considered an opportunistic pathogen. However, studies in swine indicated that there may be a limited number of strains associated with disease, suggesting that some are more virulent than others. Although this may also be true of isolates from cattle, appropriate typing methods must be established before this possibility can be investigated. The purpose of this study was to compare effectiveness of polymerase chain reaction (PCR) fingerprinting to more traditional approaches for typing bovine P. multocida isolates. Isolates were obtained from 41 cases of fatal BRD and subjected to random amplified polymorphic DNA PCR (RAPD-PCR), whole cell protein (WCP) profiles, outer membrane protein (OMP) profiles, and serotyping. The discrimination index was calculated for each typing method and combinations of each using Simpson's index of diversity. Correlation coefficients were calculated to assess concordance between classification results achieved through genotypic (RAPD-PCR) and phenotypic (WCP, OMP, and serotyping) approaches. All characterization methods were capable of discriminating between isolates. However, there was poor concordance between techniques. There were also few significant associations between typing results and epidemiologic data. Random amplified polymorphic DNA PCR was validated as being a repeatable and reliable means of discriminating between P. multocida isolates obtained from cattle. Isolates obtained from fatal cases of BRD in calves in a commercial feedlot demonstrated significant diversity, justifying additional investigation into whether P. multocida is a strictly opportunistic pathogen in cattle.

  13. Estimation of postmortem interval using vitreous potassium levels in cases of fatal road traffic collision

    Directory of Open Access Journals (Sweden)

    Suzanne N. Foster

    2016-11-01

    Full Text Available Aim of the study : To produce a formula that can accurately predict postmortem interval (PMI based on vitreous potassium levels using road traffic collision fatalities. Material and methods: Vitreous humour samples were taken from 78 individuals who had died following road traffic collisions between 2010 and 2015. Samples were obtained from both eyes and were sent for on-site analysis. Measurement of potassium was by an indirect ion-specific electrode Siemens diagnostics ADVIA 2400 chemistry system. Exact time of death was known from police reports, the time of postmortem was recorded and the postmortem interval was calculated. Linear regression was then used to analyse the relationship between the two. The impact of age was also assessed. Results: PMI was between 6 and 162 hours. As vitreous potassium increases, the PMI also increases; exhibiting a linear relationship. This is illustrated by a regression equation of PMI = 6.42[K+] – 40.94, R = 0.67 (p < 0.001. This produced a formula closely comparable with three other studies proposed in previous literature and produces estimates that may exceed one calendar day. When both age and medical intervention are accounted for there is an insignificant improvement in prediction. Conclusions : Validated methods have been used to produce a formula for prediction of PMI using vitreous potassium. Although this is specific to road traffic collisions, the methods are transferable and can be seen to be comparable with other recently published methods. Nonetheless, if greater levels of accuracy are required it is suggested that biomarkers delivering a higher level of precision should still be sought.

  14. Prenatal diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency in a family with a previous fatal case of sudden unexpected death in childhood

    DEFF Research Database (Denmark)

    Gregersen, N; Winter, V; Jensen, P K;

    1995-01-01

    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......) in the MCAD gene has been characterized, thus rendering diagnosis easy in the majority of cases. Since the clinical spectrum of MCAD deficiency ranges from death in the first days of life to an asymptomatic life, there are probably other genetic factors--in addition to MCAD mutations......--involved in the expression of the disease. Thus, families who have experienced the death of a child from MCAD deficiency might have an increased risk of a seriously affected subsequent child. In such a family we have therefore performed a prenatal diagnosis on a chorionic villus sample by a highly specific and sensitive...

  15. Non specific drug distribution in an autopsy case report of fatal caffeine intoxication.

    Science.gov (United States)

    Ishikawa, Takaki; Yuasa, Isao; Endoh, Minoru

    2015-11-01

    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.

  16. Pathological and toxicological findings in glyphosate-surfactant herbicide fatality: a case report.

    Science.gov (United States)

    Sribanditmongkol, Pongruk; Jutavijittum, Prapan; Pongraveevongsa, Pattaravadee; Wunnapuk, Klintean; Durongkadech, Piya

    2012-09-01

    Glyphosate herbicide is promoted by the manufacturer as having no risks to human health, with acute toxicity being very low in normal use. In Thailand, however, poisoning from glyphosate agricultural herbicides has been increasing. A case of rapid lethal intoxication from glyphosate-surfactant herbicide involved a 37-year-old woman, who deliberately ingested approximately 500 mL of concentrated Roundup formulation (41% glyphosate as the isopropylamine salt and 15% polyoxyethylene amine; Mosanto Company). The postmortem examination revealed that the stomach contained 550 mL of yellow fluid. The gastric mucosa of anterior fundus revealed hemorrhage and the small intestines had marked dilatation and thin walls. We used the high-performance liquid chromatography method for determination of serum and gastric content levels of glyphosate. The glyphosate levels of serum and gastric content were 3.05 and 59.72 mg/mL, respectively. Toxic effects of polyoxyethylene amine and Roundup were caused by their ability to erode tissues including mucous membranes and linings of the gastrointestinal and respiratory tracts. A mild degree of pulmonary congestion and edema was observed in both lungs. We proposed that the characteristic picture of microvesicular steatosis of the hepatocytes, seen predominantly in centrilobular zones of the liver, resembled drug-induced hepatic toxicity or secondary hypoxic stress.

  17. Fatal liver failure caused by reactivation of lamivudine-resistant hepatitis B virus: A case report

    Institute of Scientific and Technical Information of China (English)

    Yuka Suzuki; Fumio Itoh; Hiroshi Yotsuyanagi; Chiaki Okuse; Yoshihiko Nagase; Hideaki Takahashi; Kyoji Moriya; Michihiro Suzuki; Kazuhiko Koike; Shiro lino

    2007-01-01

    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.

  18. A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection

    Directory of Open Access Journals (Sweden)

    Nupur Sinha

    2014-01-01

    Full Text Available Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

  19. Fatal Granulomatous Amebic Encephalitis Due to Balamuthia mandrillaris in New Mexico: A Case Report.

    Science.gov (United States)

    Pindyck, Talia N; Dvorscak, Lauren E; Hart, Blaine L; Palestine, Michael D; Gallant, Joel E; Allen, Sarah E; SantaCruz, Karen S

    2014-09-01

    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.

  20. A 10-year review of fatal community assault cases at a regional ...

    African Journals Online (AJOL)

    South Africa (SA), accounting for more than one- third of all unnatural .... available and completed by the treating medical practitioner in cases where the deceased was hospitalised .... with a view to providing insight into the injuries sustained.

  1. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J;

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  2. Fatal Case of Trichoderma harzianum Infection in a Renal Transplant Recipient

    OpenAIRE

    1999-01-01

    We describe the second known case of human infection by Trichoderma harzianum. A disseminated fungal infection was detected in the postmortem examination of a renal transplant recipient and confirmed in culture. The only other reported infection by this fungus caused peritonitis in a diabetic patient. The in vitro antifungal susceptibilities of the clinical strain and three other strains of Trichoderma species to six antifungal drugs are provided. This case illustrates the widening spectrum o...

  3. Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases.

    Science.gov (United States)

    Sporkert, Frank; Brunel, Christophe; Augsburger, Marc P; Mangin, Patrice

    2012-02-10

    Tolperisone (Mydocalm) is a centrally acting muscle relaxant with few sedative side effects that is used for the treatment of chronic pain conditions. We describe three cases of suicidal tolperisone poisoning in three healthy young subjects in the years 2006, 2008 and 2009. In all cases, macroscopic and microscopic autopsy findings did not reveal the cause of death. Systematic toxicological analysis (STA) including immunological tests, screening for volatile substances and blood, urine and gastric content screening by GC-MS and HPLC-DAD demonstrated the presence of tolperisone in all cases. In addition to tolperisone, only the analgesics paracetamol (acetaminophen), ibuprofen and naproxen could be detected. The blood ethanol concentrations were all lower than 0.10 g/kg. Tolperisone was extracted by liquid-liquid extraction using n-chlorobutane as the extraction solvent. The quantification was performed by GC-NPD analysis of blood, urine and gastric content. Tolperisone concentrations of 7.0 mg/l, 14 mg/l and 19 mg/l were found in the blood of the deceased. In the absence of other autopsy findings, the deaths in these three cases were finally explained as a result of lethal tolperisone ingestion. To the best of our knowledge, these three cases are the first reported cases of suicidal tolperisone poisonings.

  4. Whole-Exome Sequencing Reveals Mutations in Genes Linked to Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Fatal Cases of H1N1 Influenza.

    Science.gov (United States)

    Schulert, Grant S; Zhang, Mingce; Fall, Ndate; Husami, Ammar; Kissell, Diane; Hanosh, Andrew; Zhang, Kejian; Davis, Kristina; Jentzen, Jeffrey M; Napolitano, Lena; Siddiqui, Javed; Smith, Lauren B; Harms, Paul W; Grom, Alexei A; Cron, Randy Q

    2016-04-01

    Severe H1N1 influenza can be lethal in otherwise healthy individuals and can have features of reactive hemophagocytic lymphohistiocytosis (HLH). HLH is associated with mutations in lymphocyte cytolytic pathway genes, which have not been previously explored in H1N1 influenza. Sixteen cases of fatal influenza A(H1N1) infection, 81% with histopathologic hemophagocytosis, were identified and analyzed for clinical and laboratory features of HLH, using modified HLH-2004 and macrophage activation syndrome (MAS) criteria. Fourteen specimens were subject to whole-exome sequencing. Sequence alignment and variant filtering detected HLH gene mutations and potential disease-causing variants. Cytolytic function of the PRF1 p.A91V mutation was tested in lentiviral-transduced NK-92 natural killer (NK) cells. Despite several lacking variables, cases of influenza A(H1N1) infection met 44% and 81% of modified HLH-2004 and MAS criteria, respectively. Five subjects (36%) carried one of 3 heterozygous LYST mutations, 2 of whom also possessed the p.A91V PRF1 mutation, which was shown to decrease NK cell cytolytic function. Several patients also carried rare variants in other genes previously observed in MAS. This cohort of fatal influenza A(H1N1) infections confirms the presence of hemophagocytosis and HLH pathology. Moreover, the high percentage of HLH gene mutations suggests they are risk factors for mortality among individuals with influenza A(H1N1) infection. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  5. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature

    NARCIS (Netherlands)

    Meek, I.L.; Vonkeman, H.E.; Laar, M.A. van der

    2014-01-01

    BACKGROUND: Previous studies found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. The RA associated CV risk might be explained by the combined effects of chronic systemic inflammation and increased lifestyle associated c

  6. Fatal Case of Polymicrobial Meningitis Caused by Cryptococcus liquefaciens and Mycobacterium tuberculosis Complex in a Human Immunodeficiency Virus-Infected Patient.

    Science.gov (United States)

    Conde-Pereira, César; Rodas-Rodríguez, Lia; Díaz-Paz, Manuel; Palacios-Rivera, Hilda; Firacative, Carolina; Meyer, Wieland; Alcázar-Castillo, Myriam

    2015-08-01

    We describe a fatal case of polymicrobial meningitis in a human immunodeficiency virus-infected patient from Guatemala caused by Cryptococcus liquefaciens and Mycobacterium tuberculosis complex. Central nervous system infections caused concurrently by these species are extremely rare. This is also the first report of disseminated disease caused by C. liquefaciens.

  7. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case.

    Science.gov (United States)

    Cope, Jennifer R; Conrad, Dennis A; Cohen, Naiomi; Cotilla, Manuel; DaSilva, Alexandre; Jackson, Jonathan; Visvesvara, Govinda S

    2016-03-15

    Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine.

  8. [2 fatal cases of acute myeloid leukemia (M3, M4) during pregnancy].

    Science.gov (United States)

    Aragona, M; Asmundo, A

    1995-04-01

    Two cases of unexpected post-partum death of women with acute leukemia are described. In the first case (1st pregnancy) the diagnosis (acute promyelocytic leukemia: M3) was performed one week before delivery and death occurred 3 days later, because of hemorrhagic and renal DIC complication. Since one month before hospitalization, laboratory exams indicated a serious hematological pathology and no further exams were carried out by the physicians, elements of professional fault were recognized in them, considering that because of the diagnostic omission it was impossible to make an early diagnosis and thus perform to specific therapy, adopted only in the terminal phase. This specific therapy is able to determine remission from most cases of acute promyelocytic leukemia. In the second case (2nd pregnancy) the diagnosis (acute myelomonocytic leukemia: M4) was performed only postmortem because, during the whole pregnancy, no signs of disease were evident. After a few hours from the spontaneous delivery, death occurred as a result of an intractable + hemorrhagic syndrome caused by primary hyperfibrinolysis and repeated episodes of cardiac arrest, without possibility of recognizing it. The medical procedures for this case, both throughout pregnancy and terminal phases, appeared free of censure.

  9. Phylogenetic characterisation of the G(L) sequences of equine arteritis virus isolated from semen of asymptomatic stallions and fatal cases of equine viral arteritis in Denmark

    DEFF Research Database (Denmark)

    Larsen, Lars Erik; Storgaard, Torben; Holm, Elisabeth

    2001-01-01

    The study describes for the first time the phylogenetic relationship between equine arteritis virus (EAV) isolated from asymptomatic virus-shedding stallions and fatal cases of equine viral arteritis (EVA) in an European country. EAV was isolated from three dead foals and an aborted foetus during...... 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...

  10. A Fatal Case of Congenital Langerhans Cell Histiocytosis with Disseminated Cutaneous Lesions in a Premature Neonate

    Directory of Open Access Journals (Sweden)

    Michio Inoue

    2016-01-01

    Full Text Available Background. The outcome of neonates with congenital cutaneous Langerhans cell histiocytosis (LCH is variable. Observations. We report a case of LCH in a female premature neonate born at 33-week gestation. She had disseminated cutaneous lesions, which consisted of hemorrhagic papules and vesicles, with sparse healthy skin areas, and the hands and feet were contracted with scarring and blackened. She was in respiratory failure although no apparent pulmonary or bone lesions on X-rays were noted. Skin biopsy confirmed a diagnosis of LCH due to observation of CD1a+ Langerhans cells, which lacked expression of E-cadherin and CD56. The patient died 57 hours after birth. Conclusions. Based on this case and the literature survey, the outcome of premature babies with congenital cutaneous LCH lesions is noted to be unfavorable, with the majority of such cases suffering from multisystem disease.

  11. Fatal case of Trichoderma harzianum infection in a renal transplant recipient.

    Science.gov (United States)

    Guarro, J; Antolín-Ayala, M I; Gené, J; Gutiérrez-Calzada, J; Nieves-Díez, C; Ortoneda, M

    1999-11-01

    We describe the second known case of human infection by Trichoderma harzianum. A disseminated fungal infection was detected in the postmortem examination of a renal transplant recipient and confirmed in culture. The only other reported infection by this fungus caused peritonitis in a diabetic patient. The in vitro antifungal susceptibilities of the clinical strain and three other strains of Trichoderma species to six antifungal drugs are provided. This case illustrates the widening spectrum of opportunistic Trichoderma spp. in immunocompromised patients and emphasizes the problems in diagnosing invasive fungal diseases.

  12. Fatal stroke after Bothrops snakebite in the Amazonas state, Brazil: A case report.

    Science.gov (United States)

    Silva de Oliveira, Sâmella; Freitas-de-Sousa, Luciana Aparecida; Alves, Eliane Campos; de Lima Ferreira, Luiz Carlos; da Silva, Iran Mendonça; de Lacerda, Marcus Vinícius Guimarães; Fan, Hui Wen; Moura-da-Silva, Ana Maria; Monteiro, Wuelton Marcelo

    2017-08-24

    Bothrops atrox is the snake responsible for the majority of snakebites in the Brazilian Amazon. Patients generally evolve to local manifestations such as edema, pain and ecchymoses. Systemic effects of B. atrox venom are usually restricted to blood incoagulability and spontaneous bleeding. However, in a few cases, bleeding in the central nervous system may occur, which can lead to sequels and deaths. Here, we report a case of a 59 year-old woman who presented edema, pain and ecchymoses on the right foot, headache, nausea, diarrhea, hypertension and blood incoagulability after the bite by Bothrops snake in the Brazilian Amazon. This case evolved with stroke resulting in death despite the antivenom and conservative therapy employed. In addition, we were able to identify the presence of venom in the patient's brain tissue after death. Direct action of toxins present in the snake's venom in the induction of systemic hemorrhage allied to blood incoagulability and hypertension presented by the patient could be involved in the mechanism of stroke in this case. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Fatal Varicella Myocarditis in a Child with Down Syndrome-A Case Report.

    Science.gov (United States)

    Sawardekar, Kiran P

    2016-06-01

    A 12-year-old male child with Down syndrome, who had recovered from congenital heart disease, succumbed to severe varicella myocarditis. His clinical presentation at admission mimicked acute coronary syndrome. Analysis of this case throws insight into several aspects of varicella myocarditis. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Primary pleural leiomyosarcoma with rapid progression and fatal outcome: a case report

    Directory of Open Access Journals (Sweden)

    Rais Ghizlane

    2012-04-01

    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.

  15. A fatal case of Nocardia otitidiscaviarum pulmonary infection and brain abscess: taxonomic characterization by molecular techniques

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    Aranaz Carlos

    2009-04-01

    Full Text Available Abstract We report on a rare case of pulmonary Nocardiosis and brain abscess caused by Nocardia otitidiscaviarum in an elderly woman with chronic obstructive pulmonary disease. Taxonomic identification involved phenotypic testing, restriction fragment length polymorphism (RFLP, and complete 16S rRNA gene sequencing.

  16. Fatal injuries caused by guns using shotshell: case reports and ballistic studies.

    Science.gov (United States)

    Rougé, D; Telmon, N; Alengrin, D; Marril, G; Bras, P M; Arbus, L

    1994-05-01

    The authors present six cases of homicide and suicide in which the weapon involved was a handgun using shotshell. The injuries caused are described and the ballistic characteristics of the weapons are studied. Such weapons, which are relatively easy to obtain, are not as innocuous as they may appear, since they may be modified either by changing the barrel or by removal of the device inside the barrel which is intended to prevent the firing of solid slugs.

  17. Acute Myocardial Infarction in a Young Man; Fatal Blow of the Marijuana: A Case Report

    OpenAIRE

    Yurtdaş, Mustafa; Aydın, Mehmet Kasım

    2012-01-01

    Marijuana is known to have been used for medicinal and recreational purposes for thousands of years. Although marijuana has some diverse effects on cardiovascular system, there is insufficient knowledge concerning acute myocardial infarction (AMI) associated with marijuana and its underlying mechanism. We report the case of a 26 year-old young man suffering from ST-elevated AMI caused by marijuana abuse, which was successfully treating with percutaneous coronary intervention. It should be kep...

  18. Clinical and epidemiological investigation of a fatal anthrax case in China.

    Science.gov (United States)

    Chen, Haiying; Bao, Wanguo; Wang, Yang; Zhang, Kaiyu; Wang, Feng

    2015-02-19

    Anthrax is a recessive infectious disease caused by the bacterium Bacillus anthracis, and is primarily a zoonotic disease. Until recently, Bacillus anthracis infections were relatively infrequent and confined to agrarian communities in underdeveloped countries. No anthrax cases were reported in Changchun City in the past few decades until a male patient from the Inner Mongolia Autonomous Region presented the anthrax disease manifestation. This paper describes an anthrax patient's diagnosis, isolation and treatment which involved institutions in two different Chinese provinces; the foci epidemiological investigation alongside with the outbreak management process, which is of great significance to control the spread of the recessive infection is also described.

  19. Hypereosinophilic syndrome as a cause of fatal thrombosis: two case reports with histological study.

    Science.gov (United States)

    Fujita, Kumi; Ishimaru, Hiroyasu; Hatta, Kazuhiro; Kobashi, Yoichiro

    2015-08-01

    Herein we present two cases of hypereosinophilic syndrome with a unique clinical presentation. One patient showed severe systemic thrombosis with splenic rupture and the other patient showed finger gangrene with various systemic symptoms. Both patients were examined histologically, and several characteristics were noted. First, fresh or organized thrombosis with marked eosinophilic infiltration was observed in the cavity and walls of the thrombosed vessels. Second, many eosinophils showed degranulation and were positive for eosinophilic cationic protein on immunohistological examination. Third, the structures of thrombosed vessels were well preserved, which is not observed in systemic vasculitis. These patients exhibited no neoplastic features and were treated with prednisolone with excellent therapeutic results.

  20. A Case of Fatal Bacterial Meningitis Caused by Enterococcus Faecalis: Postmortem Diagnosis

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    Gülhan Yağmur

    2015-10-01

    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.

  1. Two fatal cases of melioidosis on the Thai-Myanmar border [v1; ref status: indexed, http://f1000r.es/2os

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    Cindy S. Chu

    2014-01-01

    Full Text Available Melioidosis is endemic in areas of Southeast Asia, however, there are no published reports from the Thai-Myanmar border.  We report the first two cases of fatal melioidosis in this region. This is of great public health importance and highlights the need to increase clinical awareness of melioidosis on the Thai-Myanmar border and to assess the true burden of disease in the area through improved case detection and Burkholderia pseudomallei prevalence studies.

  2. Two fatal cases of melioidosis on the Thai-Myanmar border [v2; ref status: indexed, http://f1000r.es/373

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    Cindy S. Chu

    2014-03-01

    Full Text Available Melioidosis is endemic in areas of Southeast Asia, however, there are no published reports from the Thai-Myanmar border. We report the first two documented cases of fatal melioidosis in this region. This is of great public health importance and highlights the need to both increase clinical awareness of melioidosis on the Thai-Myanmar border, and to assess the true burden of disease in the area through improved case detection and Burkholderia pseudomallei prevalence studies.

  3. The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

    Science.gov (United States)

    Chuang, Alice; Munz, Stephanie M.; Dabiri, Darya

    2016-01-01

    Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients. PMID:27847654

  4. Fatal varicella pneumonia in an unvaccinated child with Down Syndrome: a case report.

    Science.gov (United States)

    Valentini, Diletta; Bianchi, Simona; Di Camillo, Chiara; Vittucci, Anna Chiara; Gonfiantini, Michaela Veronika; De Vito, Rita; Villani, Alberto

    2016-11-17

    Varicella is an acute infectious disease common during childhood. It has mostly an uncomplicated course in early childhood. Neverthless, it may result in severe complications, especially in particular age groups and clinical conditions. Down Syndrome represents a risk factor for developing complications, because of the frequent comorbidities and their immunodeficiency. A 2-year-old white Caucasian female affected by Down Syndrome was referred to our hospital for cardiac arrest in course of varicella disease. After cardiopulmonary resuscitation and stabilization, her clinical conditions didn't improve and she developed a massive pulmonary hemorrage, which led her to exitus. Mortality due to varicella infection is rare, but it is more common in subjects with immune deficit or chronic pathologies, and in particular age-groups. The importance of the vaccine for preventable infectious diseases is stressed in this paper, in which we present a case of death in an unvaccinated cardiopathic child with Down Syndrome affected by varicella.

  5. The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

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    Sarah K. Y. Lee

    2016-01-01

    Full Text Available Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients.

  6. The Clinical Course of Late Diagnosed Fatal Cases of A (H1N1 Influenza in Poland 

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    Marta Rorat

    2013-06-01

    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.

  7. Fatal asbestosis 50 years after brief high intensity exposure in a vermiculite expansion plant.

    Science.gov (United States)

    Wright, Robert S; Abraham, Jerrold L; Harber, Philip; Burnett, Bryan R; Morris, Peter; West, Phil

    2002-04-15

    The authors report the case of a 65-year-old accountant whose only asbestos exposure was during a summer job 50 years earlier in a California vermiculite expansion plant. Vermiculite is a silicate material that is useful in building and agriculture as a filler and insulating agent. He developed extensive fibrocalcific pleural plaques and end-stage pulmonary fibrosis, with rapidly progressive respiratory failure. Careful occupational and environmental history revealed no other source of asbestos exposure, and the initial clinical diagnosis was idiopathic pulmonary fibrosis; open lung biopsy shortly before his death confirmed asbestosis. Electron microscopic lung fiber burden analysis revealed over 8,000,000 asbestos fibers per gram dry lung, 68% of which were tremolite asbestos. Additional asbestiform fibers of composition not matching any of the standard asbestos varieties were also present at over 5,000,000 fibers per gram dry lung. Comparison analysis of a sample of Libby, Montana, vermiculite showed a similar mix of asbestiform fibers including tremolite asbestos. This case analysis raises several concerns: risks of vermiculite induced disease among former workers of the more than 200 expansion plants throughout the United States; health effects of brief but very high-intensity exposures to asbestos; and possible health effects in end-users of consumer products containing vermiculite.

  8. Characterization In Vitro and In Vivo of a Pandemic H1N1 Influenza Virus from a Fatal Case

    Science.gov (United States)

    Cuevas, Maria Teresa; Pozo, Francisco; Guerra, Susana; García-Barreno, Blanca; Martinez-Orellana, Pamela; Pérez-Breña, Pilar; Montoya, Maria; Melero, Jose Antonio; Pizarro, Manuel; Ortin, Juan; Casas, Inmaculada; Nieto, Amelia

    2013-01-01

    Pandemic 2009 H1N1 (pH1N1) influenza viruses caused mild symptoms in most infected patients. However, a greater rate of severe disease was observed in healthy young adults and children without co-morbid conditions. Here we tested whether influenza strains displaying differential virulence could be present among circulating pH1N1 viruses. The biological properties and the genotype of viruses isolated from a patient showing mild disease (M) or from a fatal case (F), both without known co-morbid conditions were compared in vitro and in vivo. The F virus presented faster growth kinetics and stronger induction of cytokines than M virus in human alveolar lung epithelial cells. In the murine model in vivo, the F virus showed a stronger morbidity and mortality than M virus. Remarkably, a higher proportion of mice presenting infectious virus in the hearts, was found in F virus-infected animals. Altogether, the data indicate that strains of pH1N1 virus with enhanced pathogenicity circulated during the 2009 pandemic. In addition, examination of chemokine receptor 5 (CCR5) genotype, recently reported as involved in severe influenza virus disease, revealed that the F virus-infected patient was homozygous for the deleted form of CCR5 receptor (CCR5Δ32). PMID:23326447

  9. Cases of fatal accidents and violence among children, adolescents and young people: perception of the family and associated factors

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    Christine Baccarat de Godoy Martins

    2014-10-01

    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.

  10. Epidemiological and Environmental Investigations of Legionella pneumophila Infection in Cattle and Case Report of Fatal Pneumonia in a Calf

    Science.gov (United States)

    Fabbi, Massimo; Pastoris, Maddalena Castellani; Scanziani, Eugenio; Magnino, Simone; Di Matteo, Luigi

    1998-01-01

    A fatal pneumonia due to Legionella pneumophila was diagnosed in a young calf reared in a dairy herd located in northern Italy. Clinical symptoms consisted of watery diarrhea, hyperthermia, anorexia, and severe dyspnea. The pathological and histological findings were very similar to those observed in human legionellosis. Legionella pneumophila serogroup 1 (SG1) and SG10 were isolated from the calf’s lung, and L. pneumophila SG1 was isolated from the calf’s liver. L. pneumophila SG1 was also demonstrated in the lung tissue by immunofluorescence and immunohistochemical examinations. Nine of 10 L. pneumophila SG1 isolates belonged to the Olda subtype, and 1 belonged to the Camperdown subtype. A very low prevalence of antibodies to Legionella was detected in cows and calves reared in the same herd. Cultures of aqueous sediment of an old electric water heater which supplied hot water for the feeding of the calves yielded L. pneumophila SG1. Four of the colonies tested belonged to the Olda subtype. Ten clinical and four environmental isolates were examined for the presence of plasmids. Nine of them were also examined by pulsed-field gel electrophoresis assay, and the same patterns were found for L. pneumophila SG1 Olda strains isolated from the calf and from the electric heater. This is the first report of a documented case of a naturally occurring Legionella pneumonia in an animal. Cattle probably act as accidental hosts for legionellae, much the same as humans. PMID:9650941

  11. Iatrogenic catheter-related cardiac tamponade: a case report of fatal hydropericardium following subcutaneous implantation of a chemotherapeutic injection port.

    Science.gov (United States)

    Shields, Lisa B E; Hunsaker, Donna M; Hunsaker, John C

    2003-03-01

    The need to obtain dependable access to the vascular system constitutes a significant component in the treatment and management of critically ill patients. Intravenous chemotherapy administered to cancer patients over an extended period of time often results in loss of peripheral vascular access due to vein sclerosis, "exhaustion" or tissue necrosis. Medical investigators have designed and steadily upgraded a variety of devices constructed to improve venous access for long-term utilization. As with the introduction of any foreign object into the body, each of these devices has complications which may be life threatening and occasionally fatal. We present an unusual case of iatrogenic acute hydropericardium and cardiac tamponade caused by the percutaneous infusion of chemotherapeutic fluid via a right subclavian central venous implant system (Port-a-Cath). Failure to implant and monitor the device with a radiograph following placement according to manufacturer's guidelines and accepted standards of medical practice were causally related to an unusual complication, namely, perforation of the right cardiac ventricle by the catheter tip, resulting in sudden and unexpected cardiac death.

  12. Methamphetamine in hair and interpretation of forensic findings in a fatal case.

    Science.gov (United States)

    Beránková, Katerina; Habrdová, Vilma; Balíková, Marie; Strejc, Premysl

    2005-10-04

    Hair analysis for drugs has been developing and is considered a significant tool for distinguishing between recent and long-term drug abuse in forensic and clinical toxicology. Chronic consumption of drugs can gradually induce certain harmful effects on the human organism and can exacerbate some pre-existing diseases. Analysis for drugs in blood or urine in isolation does not provide sufficient information about the history of drug-use by a person and their results cannot be correlated directly with the toxic effects displayed. The chronic abuse of methamphetamine is known to be associated with cardiovascular diseases. During or after autopsy certain types of morphologic alterations are found in the hearts of stimulant addicts. The rapid increase in blood pressure after an intravenous methamphetamine dose can be risky for addicts with arteriosclerosis. However, the anamnestic data about a deceased person may not always be available to explain the pathological findings and to classify the cause of death correctly. The aim of this study was to demonstrate the value of hair analysis for drugs in the context of explaining pathological cardiovascular alterations observed during the autopsy in a case where methamphetamine consumption was involved. In this case, only methamphetamine and metabolites were detected with traces of ephedrine. Ephedrine is the precursor chemical in the illicit synthesis of methamphetamine (known in the Czech Republic as "Pervitin"). The femoral blood level of methamphetamine was 1500 ng/ml. It was documented by a witness that the 31-year-old man died within 1h after an intravenous injection of the drug. The cause of death was established as cerebral edema due to cerebellar bleeding shortly after an intravenous dose of methamphetamine. Findings of methamphetamine in the first three 2-cm hair segments (numbered from the roots) were nearly equal (132+/-9 ng/mg). In the fourth 2-cm segment, it was approximately one-half of previous values. In the

  13. Parvovirus B19 1A complete genome from a fatal case in Brazil

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    Liliane Costa Conteville

    2015-09-01

    Full Text Available Parvovirus B19 (B19V infects individuals worldwide and is associated with an ample range of pathologies and clinical manifestations. B19V is classified into three distinct genotypes, all identified in Brazil. Here, we report a complete sequence of a B19V genotype 1A that was obtained by high-throughput metagenomic sequencing. This genome provides information that will contribute to the studies on B19V epidemiology and evolution.

  14. Levamisole-adulterated cocaine: Two fatal case reports and evaluation of possible cocaine toxicity potentiation.

    Science.gov (United States)

    Indorato, Francesca; Romano, Guido; Barbera, Nunziata

    2016-08-01

    Levamisole has been identified as a cocaine adulterant in the United States since 2002. Although there is a variation in the percentage of levamisole in cocaine samples between European countries, measurement of levamisole in human samples of cocaine users has become increasingly important. To our best knowledge, only five deaths are reported (one twice) as a result of complications secondary to levamisole-tainted cocaine and none of these cases reports the post-mortem levamisole concentration. In this article, we present the post-mortem levamisole concentrations in fluids and tissues in two young cocaine users, dead after levamisole-adulterated cocaine intake. With the dearth of levamisole reported concentrations in literature, this particular report is of interest to the forensic toxicological and pathological communities. This article aims to be a supplementary alert to aware the risk that may occur using levamisole-adulterated cocaine and an incentive to publication of toxicity reports and new researches involving the combination of levamisole and cocaine.

  15. Apoptotic and necrotic brain lesions in a fatal case of carbon monoxide poisoning.

    Science.gov (United States)

    Uemura, K; Harada, K; Sadamitsu, D; Tsuruta, R; Takahashi, M; Aki, T; Yasuhara, M; Maekawa, T; Yoshida, K

    2001-02-15

    A 41-year-old man was accidentally exposed to carbon monoxide (CO) gas and found in a state of cardiopulmonary arrest while he took bath. After admission, he was resuscitated and underwent artificial ventilation in a comatose state and died about 19h later. Computed tomography (CT) examination disclosed bilateral low density area in the basal ganglia and the thalamus, a well-known finding in the CO intoxication. Necropsy, histological examination, DNA ladder assay gave the first line of evidence for the presence of apoptosis as well as necrosis in the human case of CO intoxication. TdT-mediated dUTP-biotin nick-end labeling (TUNEL) positive apoptotic cells were more predominant in the CA2 area than in CA1 area. There is general co-relation between the ratio of TUNEL-positive cells and the DNA laddering on the agarose gel. Basal ganglia and thalamus, which showed bilateral low density area in CT, were revealed to be severe edema. The two types of cell death occurred in the cortex, basal ganglia, hippocampus, thalamus, and cerebellum. Hypoxia caused by CO-hemoglobin formation alone cannot explain the phenomena.

  16. Fatal snake bite in a brown bear (Ursus arctos L.: A case report

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    Romel Velev

    2015-03-01

    Full Text Available Poisoning from snake venom in animals is an emergency which requires immediate attention or otherwise, the delayed and inadequate treatment leads to untoward consequences and death. The present paper describes a case of venomous snakebite in a brown bear cub (Ursus arctos L. and its therapeutic management. The brown bear cub of which was found alone on the slopes of a mountain in the southwest part of the country was presented to the peripheral veterinary practice in Ohrid with a history of dullness, disorientation and excessive swelling around the left forepaw. It was diagnosed for snakebite based on the history and physical examination. The hematological parameters showed reduced values of hemoglobin, packed cell volume and increased total leukocyte count. The biochemical values showed elevated levels of alanine aminotransferase and creatinine. After immobilization of the animal, the treatment was conducted with fluids, corticosteroid and broad spectrum antibiotic with careful monitoring. Despite the treatment which was initiated immediately, it was only partially effective, and the animal died one hour after the beginning of its course. Poisonous snakes are common in the mountainous part of Macedonia and, just like humans, wild bears especially their cubs are susceptible to the deadly venom of some species. The severity of the reaction to snake venom and prognosis in animals depends on a number of factors: on the type and species of snake, on how much venom was injected, on the location of the bite, on the age, health and body weight of the animal and crucially, the time interval between the snakebite and the application of the treatment.

  17. End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

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    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.

  18. Acute methoxetamine and amphetamine poisoning with fatal outcome: A case report

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    Marek Wiergowski

    2014-08-01

    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.

  19. A fatal case of air-bag-mediated liver injury in an unrestrained driver.

    Science.gov (United States)

    Uemura, Koichi; Uchida, Kyoko; Nara, Akina; Ochiai, Eriko

    2009-04-01

    A middle-aged man, who drove a small vehicle while drunken and not wearing a seat belt, crashed head on into a pier wall at a high speed. The rapid air-bag deployment caused abdominal compression of the driver, who was found dead 2 m away from the car. There were facial front-glass injuries and multiple rib fractures, but no head injury. Autopsy disclosed liver laceration with intra-abdominal hemorrhage (2,000 mL), resulting in hemorrhagic shock. This is the first autopsy report of liver laceration caused by the rapid expansion of an air-bag during an automobile crash.

  20. Age, transvestism, bondage, and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia.

    Science.gov (United States)

    Blanchard, R; Hucker, S J

    1991-09-01

    Autoerotic asphyxia is the practice of self-inducing cerebral anoxia, usually by hanging, strangulation, or suffocation, during masturbation. This study investigated the relationships between: asphyxiators' ages; two paraphilias commonly accompanying autoerotic asphyxia, bondage and transvestism; and various other types of simultaneous sexual behaviour. Subjects were two concurrent series totalling 117 males aged 10-56 who died accidentally during autoerotic asphyxial activities. Data concerning sexual paraphernalia at the scene of death or among the deceased's effects were extracted from coronors' files using standardised protocols. Anal self-stimulation with dildos, etc., and self-observation with mirrors or cameras were correlated with transvestism. Older asphyxiators were more likely to have been simultaneously engaged in bondage or transvestism, suggesting elaboration of the masturbatory ritual over time. The greatest degree of transvestism was associated with intermediate rather than high levels of bondage, suggesting that response competition from bondage may limit asphyxiators' involvement in a third paraphilia like transvestism.

  1. Association of clinical signs and symptoms of Ebola viral disease with case fatality: a systematic review and meta-analysis

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    Harsha Moole

    2015-09-01

    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.

  2. Case Report About Fatal or Near-Fatal Hypersensitivity Reactions to Cetuximab: Anticetuximab IgE as a Valuable Screening Test.

    Science.gov (United States)

    Dupont, Benoît; Mariotte, Delphine; Moldovan, Cristian; Grellard, Jean-Michel; Vergnaud, Marie-Claude; Laroche, Dominique; Gervais, Radj

    2014-01-01

    Hypersensitivity reactions are a classic side effect of cetuximab. We report the cases of three patients who developed life-threatening hypersensitivity to cetuximab, which could have been predicted by assessing the concentration of serum anticetuximab immunoglobulin (Ig)E. The anticetuximab IgE concentration could be an interesting test to predict which patients are at risk of experiencing severe hypersensitivity reactions to cetuximab.

  3. Case Report About Fatal or Near-Fatal Hypersensitivity Reactions to Cetuximab: Anticetuximab IgE as a Valuable Screening Test

    Science.gov (United States)

    Dupont, Benoît; Mariotte, Delphine; Moldovan, Cristian; Grellard, Jean-Michel; Vergnaud, Marie-Claude; Laroche, Dominique; Gervais, Radj

    2014-01-01

    Hypersensitivity reactions are a classic side effect of cetuximab. We report the cases of three patients who developed life-threatening hypersensitivity to cetuximab, which could have been predicted by assessing the concentration of serum anticetuximab immunoglobulin (Ig)E. The anticetuximab IgE concentration could be an interesting test to predict which patients are at risk of experiencing severe hypersensitivity reactions to cetuximab. PMID:25089092

  4. Alcohol, psychoactive substances and non-fatal road traffic accidents - a case-control study

    Directory of Open Access Journals (Sweden)

    Bogstrand Stig

    2012-09-01

    Full Text Available Abstract Background The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups. Methods Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses. Results In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5% and stimulants eg. cocaine or amphetamines (9.4%. This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9% and benzodiazepines (0.8%. The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p  Conclusion The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.

  5. Clinical Experiences of Bronchopleural Fistula-related Fatal Hemoptysis after 
the Resection of Lung Cancer: A Report of 7 Cases

    Directory of Open Access Journals (Sweden)

    Zhenming ZHANG

    2012-01-01

    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.

  6. RETRACTED ARTICLE: Fatal factitious Cushing syndrome (Münchhausen's syndrome) in a patient with macroprolactinoma and silent corticotrophinoma: case report and literature review.

    Science.gov (United States)

    Minanni, Carlos André; De Almeida Cardoso, Ana Luiza; de Albuquerque Albuquerque, Edoarda Vasco; Brito, Luciana Pinto; Lopes, Ludmilla Malveira Lima; Glezer, Andrea; Verduguez, Elisa Del Rosario Ugarte; De Mendonça, Berenice Bilharinho; Bronstein, Marcello Delano; Machado, Marcio Carlos; Fragoso, Maria Candida Barisson Villares

    2015-01-01

    Münchhausen's syndrome (MS) is a chronic factitious disorder characterized by the intentional production of clinical symptoms without external incentive. One type of MS is factitious Cushing syndrome, an extremely rare clinical situation in which the diagnosis is challenging mainly due to interference of the exogenous medication in cortisol immunoassays. We described a 26-year-old woman who was originally diagnosed with a macroprolactinoma and during follow-up developed clinical and laboratorial hypercortisolism. A transsphenoidal surgery was performed and immunohistochemistry revealed positive and diffuse staining for both hormones. Four years later, her hypercortisolism recurred and the confirmation of factitious Cushing syndrome was delayed due to conflicting laboratorial results. There are few cases in the literature of factitious Cushing syndrome, and only one had a fatal outcome. The diagnosis of this condition is complex and includes cyclic Cushing syndrome in the differential diagnosis. These patients have high morbidity and increased mortality risk and are likely to have other psychiatric disorders. Prednisone was identified as the culprit in the majority of the cases.

  7. A step-by-step diagnosis of exclusion in a twin pregnancy with acute respiratory failure due to non-fatal amniotic fluid embolism: a case report

    Directory of Open Access Journals (Sweden)

    Papaioannou Vasilios E

    2008-05-01

    Full Text Available Abstract Introduction Respiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome. Case presentation We present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis (ritodrine, due to preterm premature rupture of the membranes. Her chest discomfort was significantly ameliorated after the ritodrine infusion was stopped and a Cesarean section was performed 48 hours later under spinal anesthesia; however, 2 hours after surgery she developed severe hypoxemia, hypotension, fever and mild coagulopathy. The patient was intubated and transferred to the intensive care unit where she made a quick and uneventful recovery within 3 days. As there was no evidence for drug- or infection-related thromboembolic or myocardial causes of respiratory failure, we conclude that our patient experienced a rare type of non-fatal amniotic fluid embolism. Conclusion In spite of the lack of solid scientific support for our diagnosis, we conclude that our patient suffered an uncommon type of amniotic fluid embolism syndrome and we believe that this report highlights the need for extreme vigilance and a high index of suspicion for such a diagnosis in any pregnant individual.

  8. Traffic fatalities and economic growth.

    Science.gov (United States)

    Kopits, Elizabeth; Cropper, Maureen

    2005-01-01

    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.

  9. Fatal asthma or anaphylaxis?

    OpenAIRE

    Rainbow, J; Browne, G

    2002-01-01

    The incidence of anaphylaxis is under-reported. Children with asthma are frequently atopic and prone to allergic reactions. Parents and clinicians may attribute wheeze of rapid onset to acute severe asthma, rather than recognising an anaphylactic event. Two cases of fatal anaphylaxis are reported who were initially diagnosed as acute severe asthma, and responded poorly to bronchodilator treatment. Survivors of "acute asphyxic asthma" should be screened for reactions to common allergens that p...

  10. Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patients of different age groups

    Directory of Open Access Journals (Sweden)

    Lopes Antonio Alberto

    2004-01-01

    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.

  11. Right-sided infective endocarditis as a potentially fatal complication in patients with long-term refractory severe bradyarrhythmia after cervical spinal cord injury: A case report

    Directory of Open Access Journals (Sweden)

    Naoki Miura

    2015-08-01

    Full Text Available Bradyarrhythmia is usually a spontaneously subsiding complication of cervical spinal cord injury. However, in severe cases, it can lead to cardiac arrest. We report a case of cervical spinal cord injury, complicated by right-sided infective endocarditis after the placement of a temporary pacing catheter in the right ventricle for severe bradyarrhythmia that led to cardiac arrest. Although the patient׳s condition was successfully treated by pacing catheter removal and pharmacological therapy, right-sided infective endocarditis would be a fatal complication in cases of cervical spinal cord injury where cardiac pacing is required for long-term refractory severe bradyarrhythmia.

  12. A Fatal Case of Acute Myeloid Leukaemia-Methotrexate Related or Primary Autoimmune Disease Related: A Rare Case Report.

    Science.gov (United States)

    Agarwal, Saurabh; Kaeley, Nidhi; Gupta, Priyanka; Gupta, Vibha; Bhatia, Rohan

    2016-03-01

    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.

  13. Acute necrotizing myopathy and podophyllin toxicity: report of a fatal case Miopatia necrotizante aguda e toxicidade por podofilina: relato de caso fatal

    Directory of Open Access Journals (Sweden)

    Acary Souza Bulle Oliveira

    1996-06-01

    Full Text Available A 21 year old male ingested podophyllin in a suicide attempt. The disorder was marked by seizures, coma, peripheral neuropathy, renal failure and acute necrotizing myopathy, an unusual finding. The coma and systemic disturbances resolved within three weeks. The myopathy resolved in 7 weeks, demonstrating a high capacity of muscle recuperation. The sensorimotor peripheral neuropathy persisted until the patient's death 9 weeks after the ingestion, due to septicemia. This report confirms the transient central neurotoxicity of podophyllin and persistent peripheral neurotoxicity of podophyllin, and describes a reversible necrotizing myopathy associated to mitochondrial abnormalities, a still unreported feature of podophyllin toxicity.Paciente de 21 anos, sexo masculino, ingeriu 20 mL de podofilina a 25% como tentativa de suicídio. O quadro clínico caracterizou-se por crises convulsivas, coma, neuropatia periférica, insuficiência renal e miopatia necrotizante aguda. O estado de coma e os distúrbios sistêmicos resolveram-se em 3 semanas. A miopatia resolveu-se em 7 semanas, demonstrando uma alta capacidade de recuperação muscular. A neuropatia periférica sensitivo-motora persistiu até o óbito do paciente, por septicemia, 9 semanas após a ingestão da podofilina. Esta descrição confirma os achados de literatura com alterações transitórias do sistema nervoso central e persistentes do nervo periférico relacionadas à podofilina, e descreve uma miopatia necrotizante associada com anormalidades mitocondriais, mas de caráter reversível, característica até então não reportada de toxicidade pela podofilina.

  14. Fatal meningococcemia

    Directory of Open Access Journals (Sweden)

    John Tabacco

    2012-01-01

    Full Text Available Within the past six years, a case of bothWaterhouse-Freidrichsen Syndrome and fulminant meningococcemia have presented to Union Memorial Hospital. Both cases presented in markedly different fashions, differed in microbiologic serogrouping, showed minimal histopathologic similarities; however achieved ultimately the same outcome through two different pathological pathways. The following case reports illustrate two mechanisms through which N. Meningitis may pathogenize a host, both leading to complete cardiovascular collapse in less than 12 hours.

  15. Estimating the proportion of Danes at high risk of fatal cardiovascular disease

    DEFF Research Database (Denmark)

    Holm, Ann-Sofie Sonne; Olsen, Gitte Stentebjerg; Borglykke, Anders;

    2011-01-01

    It has been recommended by several intervention studies to use a high risk approach for cardiovascular disease (CVD) prevention, and the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (ESC Guidelines) provide a method to identify high risk individuals. Furthermore...

  16. Terrorist attacks escalate in frequency and fatalities preceding highly lethal attacks.

    Science.gov (United States)

    Martens, Andy; Sainudiin, Raazesh; Sibley, Chris G; Schimel, Jeff; Webber, David

    2014-01-01

    Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates--both in the number of people killed per attack and in the frequency of attacks--leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.

  17. 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?

    DEFF Research Database (Denmark)

    Martensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva;

    2016-01-01

    AIMS: Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial...... infarction (NSTEMI) in Denmark. METHODS AND RESULTS: All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary...... artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality. CONCLUSIONS: Despite...

  18. Terrorist attacks escalate in frequency and fatalities preceding highly lethal attacks.

    Directory of Open Access Journals (Sweden)

    Andy Martens

    Full Text Available Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates--both in the number of people killed per attack and in the frequency of attacks--leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.

  19. Terrorist Attacks Escalate in Frequency and Fatalities Preceding Highly Lethal Attacks

    Science.gov (United States)

    Martens, Andy; Sainudiin, Raazesh; Sibley, Chris G.; Schimel, Jeff; Webber, David

    2014-01-01

    Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates–both in the number of people killed per attack and in the frequency of attacks–leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack. PMID:24755753

  20. Highway Safety: Trends in Highway Fatalities 1975-1987

    Science.gov (United States)

    1990-03-01

    pattern of fatalities as the overall trend. This pattern applies to many of the general fatality statis- tics we present, and, in all cases, it serves as a...Fatalities 1975-87 Appemfx IV Vehicle-Related Statistics Figure IV.17: Vehicle Fatalities by Direction of Principal Impacto NNNumber of PddUlsils lwam 0 1975

  1. Fatalities in high altitude mountaineering: a review of quantitative risk estimates.

    Science.gov (United States)

    Weinbruch, Stephan; Nordby, Karl-Christian

    2013-12-01

    Quantitative estimates for mortality in high altitude mountaineering are reviewed. Special emphasis is placed on the heterogeneity of the risk estimates and on confounding. Crude estimates for mortality are on the order of 1/1000 to 40/1000 persons above base camp, for both expedition members and high altitude porters. High altitude porters have mostly a lower risk than expedition members (risk ratio for all Nepalese peaks requiring an expedition permit: 0.73; 95 % confidence interval 0.59-0.89). The summit bid is generally the most dangerous part of an expedition for members, whereas most high altitude porters die during route preparation. On 8000 m peaks, the mortality during descent from summit varies between 4/1000 and 134/1000 summiteers (members plus porters). The risk estimates are confounded by human and environmental factors. Information on confounding by gender and age is contradictory and requires further work. There are indications for safety segregation of men and women, with women being more risk averse than men. Citizenship appears to be a significant confounder. Prior high altitude mountaineering experience in Nepal has no protective effect. Commercial expeditions in the Nepalese Himalayas have a lower mortality than traditional expeditions, though after controlling for confounding, the difference is not statistically significant. The overall mortality is increasing with increasing peak altitude for expedition members but not for high altitude porters. In the Nepalese Himalayas and in Alaska, a significant decrease of mortality with calendar year was observed. A few suggestions for further work are made at the end of the article.

  2. A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal Salmonella (iNTS) Disease in Africa (1966 to 2014)

    Science.gov (United States)

    Uche, Ifeanyi Valentine; MacLennan, Calman A.

    2017-01-01

    This study systematically reviews the literature on the occurrence, incidence and case fatality rate (CFR) of invasive nontyphoidal Salmonella (iNTS) disease in Africa from 1966 to 2014. Data on the burden of iNTS disease in Africa are sparse and generally have not been aggregated, making it difficult to describe the epidemiology that is needed to inform the development and implementation of effective prevention and control policies. This study involved a comprehensive search of PubMed and Embase databases. It documents the geographical spread of iNTS disease over time in Africa, and describes its reported incidence, risk factors and CFR. We found that Nontyphoidal Salmonella (NTS) have been reported as a cause of bacteraemia in 33 out of 54 African countries, spanning the five geographical regions of Africa, and especially in sub-Saharan Africa since 1966. Our review indicates that NTS have been responsible for up to 39% of community acquired blood stream infections in sub-Saharan Africa with an average CFR of 19%. Salmonella Typhimurium and Enteritidis are the major serovars implicated and together have been responsible for 91%% of the cases of iNTS disease, (where serotype was determined), reported in Africa. The study confirms that iNTS disease is more prevalent amongst Human Immunodeficiency Virus (HIV)-infected individuals, infants, and young children with malaria, anaemia and malnutrition. In conclusion, iNTS disease is a substantial cause of community-acquired bacteraemia in Africa. Given the high morbidity and mortality of iNTS disease in Africa, it is important to develop effective prevention and control strategies including vaccination. PMID:28056035

  3. Fatal Case of Probable Invasive Aspergillosis after Five Years of Heart Transplant: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Toufik Mahfood Haddad

    2015-01-01

    Full Text Available Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient’s past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes.

  4. Fatal and Non-Fatal Electrocution Injuries at U.S. Marine Corps Forward Medical Facilities During Operation Enduring Freedom and Operation Iraqi Freedom.

    Science.gov (United States)

    Williams, Bradley; Deaton, Travis; Galarneau, Mike; Dye, Judy; Zieber, Tara; Auten, Jonathan

    2017-09-01

    Death from electrocution is rare and generally an accidental occurrence. In contrast to civilian patterns of electrocution injury, the military work environment suffers from a greater percentage of fatal high-voltage electrocutions. This study compared U.S. and international electrocution case fatality rates to rates among deployed military personnel presenting for care at expeditionary medical care facilities. We also sought to identify potential risk factors for fatal electrocution injury among deployed military personnel. A retrospective analysis was performed on electrocution injuries presenting to U.S. Marine Corps forward deployed medical facilities in Iraq and Afghanistan between January 2004 and December 2012. Descriptive statistics were used to describe the study population and compare fatal and nonfatal electrocutions. Fatality rates were reported in cases per 1,000,000 people per year. A total of 38 patients were identified; all were males with a mean (SD) age of 25.3 (5.3) years. Most electrocutions occurred on base (68%), whereas a smaller number (21%) occurred while conducting operations outside of the base. A majority of fatal cases (80%) occurred while outside of base on foot or vehicle mounted patrol. The rate of fatal electrocutions among U.S. Marine Corps personnel during this period was 37 per 1,000,000 people per year, 7-fold higher than the international electrocution fatality rate of 5.4 per 1,000,000 people per year and nearly three-fold above the U.S. utility and construction worker's fatality rate of 14 per 1,000,000 people per year. Electrocution injuries occurring during foot or vehicle mounted patrols seem to account for findings of higher case fatality rates among deployed military personnel than those found in international or high risk civilian occupational settings. Basic life support training for medical and nonmedical military personnel is critical to optimizing care delivered at the scene of these injuries. Reprint & Copyright

  5. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

    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...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  6. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie

    2005-01-01

    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...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  7. Modelling of risk factors, case-fatalities, survival and functional health status for stroke in Kelantan, Malaysia

    OpenAIRE

    Musa, Kamarul Imran

    2017-01-01

    Stroke is an important public health problem worldwide. It is a non-communicable disease of increasing importance in the ageing population. There are four major types of stroke: a) ischaemic stroke, b) primary intracerebral haemorrhage, c) subarachnoid haemorrhage and d) undetermined stroke (no computed tomography [CT], magnetic resonance imaging [MRI], autopsy or cerebral angiography). The risk factors and fatalities for stroke vary worldwide and stroke accounts for about 9.7% of all deaths ...

  8. Mechanisms of Fatal Cardiotoxicity following High-Dose Cyclophosphamide Therapy and a Method for Its Prevention.

    Directory of Open Access Journals (Sweden)

    Takuro Nishikawa

    Full Text Available Observed only after administration of high doses, cardiotoxicity is the dose-limiting effect of cyclophosphamide (CY. We investigated the poorly understood cardiotoxic mechanisms of high-dose CY. A rat cardiac myocardial cell line, H9c2, was exposed to CY metabolized by S9 fraction of rat liver homogenate mixed with co-factors (CYS9. Cytotoxicity was then evaluated by 3-(4,5-dimethyl-2-thiazolyl¬2,5-diphenyl¬2H-tetrazolium bromide (MTT assay, lactate dehydrogenase release, production of reactive oxygen species (ROS, and incidence of apoptosis. We also investigated how the myocardial cellular effects of CYS9 were modified by acrolein scavenger N-acetylcysteine (NAC, antioxidant isorhamnetin (ISO, and CYP inhibitor β-ionone (BIO. Quantifying CY and CY metabolites by means of liquid chromatography coupled with electrospray tandem mass spectrometry, we assayed culture supernatants of CYS9 with and without candidate cardioprotectant agents. Assay results for MTT showed that treatment with CY (125-500 μM did not induce cytotoxicity. CYS9, however, exhibited myocardial cytotoxicity when CY concentration was 250 μM or more. After 250 μM of CY was metabolized in S9 mix for 2 h, the concentration of CY was 73.6 ± 8.0 μM, 4-hydroxy-cyclophosphamide (HCY 17.6 ± 4.3, o-carboxyethyl-phosphoramide (CEPM 26.6 ± 5.3 μM, and acrolein 26.7 ± 2.5 μM. Inhibition of CYS9-induced cytotoxicity occurred with NAC, ISO, and BIO. When treated with ISO or BIO, metabolism of CY was significantly inhibited. Pre-treatment with NAC, however, did not inhibit the metabolism of CY: compared to control samples, we observed no difference in HCY, a significant increase of CEPM, and a significant decrease of acrolein. Furthermore, NAC pre-treatment did not affect intracellular amounts of ROS produced by CYS9. Since acrolein seems to be heavily implicated in the onset of cardiotoxicity, any competitive metabolic processing of CY that reduces its transformation to acrolein

  9. The association between high-risk behavior and central nervous system injuries: analysis of traffic-related fatalities in a large coroner's series.

    Science.gov (United States)

    Pakula, Andrea; Shaker, Adel; Martin, Maureen; Skinner, Ruby

    2013-10-01

    High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

  10. Genome sequences of Human Adenovirus 14 isolates from mild respiratory cases and a fatal pneumonia, isolated during 2006-2007 epidemics in North America

    Directory of Open Access Journals (Sweden)

    Houng Huo-Shu H

    2010-08-01

    Full Text Available Abstract Background Human adenovirus 14 (HAdV-14 is a recognized causative agent of epidemic febrile respiratory illness (FRI. Last reported in Eurasia in 1963, this virus has since been conspicuously absent in broad surveys, and was never isolated in North America despite inclusion of specific tests for this serotype in surveillance methods. In 2006 and 2007, this virus suddenly emerged in North America, causing high attack rate epidemics of FRI and, in some cases, severe pneumonias and occasional fatalities. Some outbreaks have been relatively mild, with low rates of progression beyond uncomplicated FRI, while other outbreaks have involved high rates of more serious outcomes. Methodology and Findings In this paper we present the complete genomic sequence of this emerging pathogen, and compare genomic sequences of isolates from both mild and severe outbreaks. We also compare the genome sequences of the recent isolates with those of the prototype HAdV-14 that circulated in Eurasia 30 years ago and the closely related sequence of HAdV-11a, which has been circulating in southeast Asia. Conclusions The data suggest that the currently circulating strain of HAdV-14 is closely related to the historically recognized prototype throughout its genome, though it does display a couple of potentially functional mutations in the fiber knob and E1A genes. There are no polymorphisms that suggest an obvious explanation for the divergence in severity between outbreak events, suggesting that differences in outcome are more likely environmental or host determined rather than viral genetics.

  11. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis

    Science.gov (United States)

    Min, Jin-na; Mannam, Praveen; Srivastava, Anup; Yao, Yi; Hacker, Kathryn P.; Raddassi, Khadir; Montgomery, Ruth R.; Shaw, Albert C.; Araújo, Guilherme C.; Nery, Nivison; Relman, David A.; Reis, Mitermayer G.; Ko, Albert I.

    2016-01-01

    Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10–50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis. PMID:27812211

  12. Histopathological features and distribution of EV71 antigens and SCARB2 in human fatal cases and a mouse model of enterovirus 71 infection.

    Science.gov (United States)

    Yu, Pin; Gao, Zifen; Zong, Yuanyuan; Bao, Linlin; Xu, Lili; Deng, Wei; Li, Fengdi; Lv, Qi; Gao, Zhancheng; Xu, Yanfeng; Yao, Yanfeng; Qin, Chuan

    2014-08-30

    Enterovirus 71 (EV71) is a neurotropic pathogen that causes hand, foot, and mouth disease. While infection is usually self-limiting, a minority of patients infected with EV71 develop severe neurological complications. In humans, EV71 has been reported to utilize the scavenger receptor class B, member 2 (SCARB2) as a receptor for infectious cellular entry. In this study, we define the pathological features of EV71-associated disease as well as the distribution of EV71 antigen and SCARB2 in human fatal cases and a mouse model. Histopathologically, human fatal cases showed severe central nervous system (CNS) changes, mainly in the brainstems, spinal cords, and thalamus. These patient further exhibited pulmonary edema and necrotic enteritis. Immunohistochemical analysis of human fatal cases demonstrated that EV71 antigen and SCARB2 were observed mainly in neurons, microglia cells and inflammatory cells in the CNS, and epithelial cells in the intestines. However, skeletal muscle tissue was negative for EV71 antigen. In a mouse model of EV71 infection, we observed massive necrotic myositis, different degrees of viral diseases in CNS, and extensive interstitial pneumonia. In mice, EV71 exhibits strong myotropism compared to the neurotropism seen in humans. EV71 antigen was detected in the spinal cord and brainstem of mice. However, there was no clear correlation between mouse SCARB2 and EV71 antigen distribution in the mouse model, consistent with previous results that SCARB2 functions as a receptor for EV71 in humans but not mice. The EV71-induced lesions seen in the mouse model resembled the pathological changes seen in human samples. These results increase our understanding of EV71 pathogenesis and will inform further work developing a mouse model for EV71 infection.

  13. Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study.

    Directory of Open Access Journals (Sweden)

    Fernando Agüero

    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.

  14. Late-form hemorrhagic disease of the newborn: a fatal case report with illustration of investigations that may assist in avoiding the mistaken diagnosis of child abuse.

    Science.gov (United States)

    Rutty, G N; Smith, C M; Malia, R G

    1999-03-01

    Hemorrhagic disease of the newborn (HDN) is usually a self-limiting hemorrhagic disorder of childhood that occurs as a result of vitamin K deficiency. It may be defined as early or late form depending on the time of onset related to birth. HDN is recognized as one of several bleeding disorders that can mimic the findings of nonaccidental head injury and may lead to a mistaken diagnosis of child abuse. We present a single fatal case of late-onset HDN with illustration of hematologic assays that can be performed to assist the pathologist in making the correct diagnosis of HDN.

  15. High plasma level of long pentraxin 3 (PTX3 is associated with fatal disease in bacteremic patients: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Reetta Huttunen

    Full Text Available INTRODUCTION: Long pentraxin 3 (PTX3 is an acute-phase protein secreted by various cells, including leukocytes and endothelial cells. Like C-reactive protein (CRP, it belongs to the pentraxin superfamily. Recent studies indicate that high levels of PTX3 may be associated with mortality in sepsis. The prognostic value of plasma PTX3 in bacteremic patients is unknown. METHODS: Plasma PTX3 levels were measured in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, β-hemolytic streptococcae and Escherichia coli, using a commercial solid-phase enzyme-linked immunosorbent assay (ELISA. Values were measured on days 1-4 after positive blood culture, on day 13-18 and on recovery. RESULTS: The maximum PTX3 values on days 1-4 were markedly higher in nonsurvivors compared to survivors (44.8 vs 6.4 ng/ml, p15 ng/ml was associated with hypotension (MAP 15 ng/ml remained an independent risk factor for case fatality in a logistic regression model adjusted for potential confounders. CONCLUSIONS: PTX3 proved to be a specific independent prognostic biomarker in bacteremia. PTX3 during the first days after diagnosis showed better prognostic value as compared to CRP, a widely used biomarker in clinical settings. PTX3 measurement offers a novel opportunity for the prognostic stratification of bacteremia patients.

  16. Genetic variants in loci 1p13 and 9p21 and fatal coronary heart disease in a Norwegian case-cohort study.

    Science.gov (United States)

    Jansen, Mona Dverdal; Knudsen, Gun Peggy; Myhre, Ronny; Høiseth, Gudrun; Mørland, Jørg; Næss, Øyvind; Tambs, Kristian; Magnus, Per

    2014-05-01

    Single nucleotide polymorphisms (SNPs) in loci 1p13 and 9p21 have previously been found to be associated with incident coronary heart disease (CHD). This study aimed to investigate whether these SNPs show associations with fatal CHD in a population-based cohort study after adjustment for socioeconomic- and lifestyle-related CHD risk factors not commonly included in genetic association studies. Using the population-based Cohort of Norway (CONOR), a nested case-cohort study was set up and DNA from 2,953 subjects (829 cases and 2,124 non-cases) were genotyped. The association with fatal CHD was estimated for four SNPs, three from locus 1p13 and one from locus 9p21. Multivariable Cox regression was used to estimate unstratified and gender-stratified hazard ratios while adjusting for major CHD risk factors. The associations between three SNPs from locus 1p13 and non-HDL cholesterol levels were also estimated. Men homozygous for the risk alleles on rs1333049 (9p21) and rs14000 (1p13) were found to have significantly increased hazard ratios in crude and adjusted models, and the hazard ratios remained statistically significant when both genders were analyzed together. Adjustment for additional socioeconomic- and lifestyle-related CHD risk factors influenced the association estimates only slightly. No significant associations were observed between the other two SNPs in loci 1p13 (rs599839 and rs646776) and CHD mortality in either gender. Both rs599839 and rs646776 showed significant, gradual increases in non-HDL cholesterol levels with increasing number of risk alleles. This study confirms the association between 9p21 (rs1333049) and fatal CHD in a Norwegian population-based cohort. The effect was not influenced by several socioeconomic- and lifestyle-related risk factors. Our results show that 1p13 (rs14000) may also be associated with fatal CHD. SNPs at 1p13 (rs599839 and rs646776) were associated with non-HDL cholesterol levels.

  17. Takotsubo cardiomyopathy associated with rupture of the left ventricular apex: assessment of histopathological features of a fatal case and literature review.

    Science.gov (United States)

    Indorato, Francesca; Akashi, Yoshihiro J; Rossitto, Carlo; Raffino, Cataldo; Bartoloni, Giovanni

    2015-12-01

    Takotsubo cardiomyopathy, also known as "broken heart syndrome," is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo cardiomyopathy. Ventricular rupture with Takotsubo cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options.

  18. A fatal case of acute pulmonary embolism caused by right ventricular masses of acute lymphoblastic lymphoma-leukemia in a 13 year old girl

    Directory of Open Access Journals (Sweden)

    Yu Mi Ko Ko

    2012-07-01

    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.

  19. Erlotinib Induced Fatal Interstitial Lung Disease in a Patient with Metastatic Non-Small Cell Lung Cancer: Case Report and Review of Literature.

    Science.gov (United States)

    Mangla, Ankit; Agarwal, Nikki; Carmel, Chou; Lad, Thomas

    2016-09-05

    Erlotinib is one of the most widely used tyrosine kinase inhibitor targeting human epidermal growth factor receptor. Since its introduction, it has revolutionized the treatment of advanced non-small cell lung cancer. Skin rashes and diarrhea are the most often reported side effects of erlotinib however it is also associated with interstitial pneumonitis or interstitial lung disease, which often turns out to be fatal complication of using this medicine. Though reported scarcely in the western world, the association of interstitial lung disease with epidermal growth factor receptor has attracted a lot of attention in the recent times. Various researches working with murine models of bleomycin-induced pulmonary fibrosis have found a pro and con role of the receptor in development of the interstitial lung disease. We present the case of a patient diagnosed with stage IV adenocarcinoma of the lung with metastasis to brain. He was found to be positive for the human epidermal growth factor mutation and was hence started on erlotinib. Within a few weeks of starting the medicine the patient was admitted with diarrhea. During the course of this admission he developed acute shortness of breath diagnosed as interstitial pneumonitis. The purpose of this case report is to review the literature associated with erlotinib induced interstitial pneumonitis and make the practicing oncologists aware of this rare yet fatal complication of erlotinib. Here we will also review literature, pertaining to the role of epidermal growth factor receptor in development of interstitial lung disease.

  20. Fatal diving accidents in western Norway 1983-2007.

    Science.gov (United States)

    Ramnefjell, M P; Morild, I; Mørk, S J; Lilleng, P K

    2012-11-30

    Despite efforts to reduce their number, fatal diving accidents still occur. The circumstances and post-mortem findings in 40 fatal diving accidents in western Norway from 1983 through 2007 were investigated. Diving experience, medical history and toxicology reports were retrieved. The material consisted of recreational divers, professional saturation divers and professional divers without experience with saturation. In 33 cases the diving equipment was examined as part of the forensic investigation. In 27 cases defects in the diving equipment were found. For six divers such defects were responsible for the fatal accidents. Eighteen divers died on the surface or less than 10 m below surface. Five divers reached below 100 msw, and two of them died at this depth. The fatalities were not season-dependent. However, wave-height and strength of currents were influential factors in some cases. Twelve divers were diving alone. Twenty divers had one buddy, 9 of these divers were alone at the time of death. The cause of death was drowning in 31 out of 40 divers; one of them had a high blood-ethanol concentration, in two other divers ethanol was found in the urine, indicating previous ethanol consumption. Nine divers died from sudden decompression, pulmonary barotraumas, underwater trauma and natural causes. The study shows that most of the fatal diving accidents could be avoided if adequate diving safety procedures had been followed.

  1. Motorcycle fatalities in Malaysia

    OpenAIRE

    Muhammad Marizwan Abdul Manan; András Várhelyi

    2012-01-01

    Malaysia has the highest road fatality risk (per 100,000 population) among the ASEAN countries and more than 50% of the road accident fatalities involve motorcyclists. This study has collected and analysed data from the police, government authorities, and national and international research institutes. Only fatality data are used due to the severe underreporting of severe injuries (up to 600%) and slight injuries (up to 1400%). The analysis reveals that the highest numbers of motorcycle fatal...

  2. A fatal case of Trichosporon asahii fungemia and pneumonia in a kidney transplant recipient during caspofungin treatment

    Directory of Open Access Journals (Sweden)

    Yang MF

    2014-09-01

    Full Text Available Mei-fang Yang,1,2 Hai-nv Gao,1,2 Lan-juan Li1,2 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University; 2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China Abstract: Trichosporon asahii is an emerging opportunistic pathogen that is life-threatening particularly for immunosuppressed patients. Only a few studies have described Trichosporon infection in kidney transplant recipients. This study reports a 67-year-old male kidney transplant recipient who developed fatal fungemia and pneumonia caused by T. asahii during caspofungin treatment. Although funguria is benign, kidney transplant recipients are still at risk of T. asahii fungemia and invasive T. asahii infection even if they are under antifungal therapy, particularly echinocandins. Keywords: funguria, organ transplant, opportunistic infection, invasive fungal infection, antifungal therapy

  3. A case of fatal systemic toxoplasmosis in a cat being treated with cyclosporin A for feline atopy.

    Science.gov (United States)

    Last, Robert D; Suzuki, Yasuhiro; Manning, Thomas; Lindsay, David; Galipeau, Laura; Whitbread, Trevor J

    2004-06-01

    Acute systemic toxoplasmosis was diagnosed in a 4-5-year-old, male, Domestic Short Hair cat, which had been on cyclosporine A immunomodulatory therapy for feline atopy, over an 8-month period. Cyclosporin A (CsA) has shown promising results as a immunosuppressive agent in the cat for the treatment of eosinophilic plaque and granulomas, allergic cervico-facial pruritus, feline atopy and other immune-mediated dermatoses. However, inhibition of T-lymphocyte function by CsA is believed to have predisposed this cat to the development of a newly acquired, acute Toxoplasma gondii infection, as characterized by severe hepatic and pancreatic pathology in conjunction with the heavy parasite load demonstrated on immunohistochemical (IHC) stains for T. gondii. Cats on CsA therapy appear to be at risk of developing fatal systemic toxoplasmosis.

  4. [Fatal poisonings with propoxur].

    Science.gov (United States)

    Pfordt, J; Magerl, H; Vock, R

    1987-01-01

    The insecticide propoxur (2-isopropoxyphenyl-N-methylcarbamate) acts by blocking cholinesterase. This inhibition is fast and, unlike that brought about by organophosphorus compounds, reversible. The toxicity of propoxur to man is stated to be low compared with that of parathion. Only a small number of fatal intoxications have been published; at the Würzburg University Institute of Legal Medicine eight cases have been observed since 1978. In seven cases death occurred after deliberate oral ingestion of solutions of propoxur with suicidal intent, while in the other, intoxication was accidental, following inhalation of an aerosol containing propoxur. Organs and body fluids were investigated toxicologically and histologically. The results are presented and discussed. Special attention is paid to the combination of propoxur and alcohol.

  5. Molecular identification of poisonous mushrooms using nuclear ITS region and peptide toxins: a retrospective study on fatal cases in Thailand.

    Science.gov (United States)

    Parnmen, Sittiporn; Sikaphan, Sujitra; Leudang, Siriwan; Boonpratuang, Thitiya; Rangsiruji, Achariya; Naksuwankul, Khwanruan

    2016-02-01

    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.

  6. [Fatal motorcycle, motorbike and bicycle accidents. Cases from the medico-legal sector of Parma (1973-82)].

    Science.gov (United States)

    Gennari, M; Laudano, M

    1986-01-01

    The data of the Institute of Legal Medicine and Insurance of the University of Parma regarding mortal motorcycle, motorbicycle and cycling accidents for a ten year period is cited (1973-1982) (296 cases). The data show a very high incidence of cranio-facial lesions (83.5%) which is the absolute most frequent cause of death (58.5%). The appeal for the promulgation of a rider's helmet as obligatory in Italy thus becomes an urgency. The high percentage of mortal accidents amongst cyclists and the substantial correspondence to the traumatology of motorcyclists senders towards this category of road users the need for similar preventive measures, if these can't be resolved with helmets for practical reasons, it is necessary to solicit more severe and drastic control for the respect of circulation regulations by them. On the other hand it is necessary to take measures capable of guaranteeing a way (lane for cyclists).

  7. Fatal Lemierre's syndrome as a complication of chronic otitis media ...

    African Journals Online (AJOL)

    Fatal Lemierre's syndrome as a complication of chronic otitis media with cholesteatoma. ... South African Journal of Child Health ... This case report illustrates that untreated chronic middle ear infection can lead to potentially fatal complications ...

  8. Campylobacter jejuni Fatal Sepsis in a Patient with Non-Hodgkin’s Lymphoma: Case Report and Literature Review of a Difficult Diagnosis

    Directory of Open Access Journals (Sweden)

    Maria Teresa Gallo

    2016-04-01

    Full Text Available 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.

  9. Skull fracture and hemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis

    Directory of Open Access Journals (Sweden)

    Chandrabhal Tripathi

    2010-07-01

    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.

  10. Nsp9 and Nsp10 contribute to the fatal virulence of highly pathogenic porcine reproductive and respiratory syndrome virus emerging in China.

    Directory of Open Access Journals (Sweden)

    Yan Li

    2014-07-01

    Full Text Available Atypical porcine reproductive and respiratory syndrome (PRRS, which is caused by the Chinese highly pathogenic PRRS virus (HP-PRRSV, has resulted in large economic loss to the swine industry since its outbreak in 2006. However, to date, the region(s within the viral genome that are related to the fatal virulence of HP-PRRSV remain unknown. In the present study, we generated a series of full-length infectious cDNA clones with swapped coding regions between the highly pathogenic RvJXwn and low pathogenic RvHB-1/3.9. Next, the in vitro and in vivo replication and pathogenicity for piglets of the rescued chimeric viruses were systematically analyzed and compared with their backbone viruses. First, we swapped the regions including the 5'UTR+ORF1a, ORF1b, and structural proteins (SPs-coding region between the two viruses and demonstrated that the nonstructural protein-coding region, ORF1b, is directly related to the fatal virulence and increased replication efficiency of HP-PRRSV both in vitro and in vivo. Furthermore, we substituted the nonstructural protein (Nsp 9-, Nsp10-, Nsp11- and Nsp12-coding regions separately; or Nsp9- and Nsp10-coding regions together; or Nsp9-, Nsp10- and Nsp11-coding regions simultaneously between the two viruses. Our results indicated that the HP-PRRSV Nsp9- and Nsp10-coding regions together are closely related to the replication efficiency in vitro and in vivo and are related to the increased pathogenicity and fatal virulence for piglets. Our findings suggest that Nsp9 and Nsp10 together contribute to the fatal virulence of HP-PRRSV emerging in China, helping to elucidate the pathogenesis of this virus.

  11. Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; CHEN Sheng-yun; CHEN Qi-dong; QU Hui; LU Jing-jing; ZHANG Jing; MA Rui-hua; ZHANG Yu-mei; WANG Yong-jun; ZHAO Xing-quan; YANG Zhong-hua; WANG An-xin; WANG Chun-xue; LIU Li-ping; WANG Yi-long; WANG Xin-gao; JU Yi

    2012-01-01

    Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset.However,few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke.In this prospective work,the China National Stroke Registry Study,we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.Methods From September 2007 to August 2008,we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China.Medical complications,case fatality and other information recorded at baseline,during hospitalisation,and at 3,6,and 12 months after stroke onset.Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.Results There were 39741 patients screened,14526 patients with acute ischemic stroke recruited,and 11560 ischemic stroke patients without missing data identified during the 12-month follow-up.Of the 11560 ischemic patients,15.8% (1826)had in-hospital medical complications.The most common complication was pneumonia (1373;11.9% of patients),followed by urinary tract infection and gastrointestinal bleeding.In comparison with patients without complications,stroke patients with complications had a significantly higher risk of death during their hospitalization,and at 3,6 and 12 months post-stroke.Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR=6.946;95% CI 5.181 to 9.314),at 3 months (adjusted OR=3.843;95% Cl 3.221 to 4.584),6 months (adjusted OR=3.492;95% CI 2.970 to 4.106),and 12 months (adjusted OR=3.511;95% Cl 3.021 to 4.080).Having multiple complications strongly increased the death risk of patients.Conclusion Short-term and long-term outcomes of acute stroke patients

  12. Peripheral Organs of Dengue Fatal Cases Present Strong Pro-Inflammatory Response with Participation of IFN-Gamma-, TNF-Alpha- and RANTES-Producing Cells.

    Science.gov (United States)

    Póvoa, Tiago F; Oliveira, Edson R A; Basílio-de-Oliveira, Carlos A; Nuovo, Gerard J; Chagas, Vera L A; Salomão, Natália G; Mota, Ester M; Paes, Marciano V

    2016-01-01

    Dengue disease is an acute viral illness caused by dengue virus (DENV) that can progress to hemorrhagic stages leading to about 20000 deaths every year worldwide. Despite many clinical investigations regarding dengue, the immunopathogenic process by which infected patients evolve to the severe forms is not fully understood. Apart from differences in virulence and the antibody cross reactivity that can potentially augment virus replication, imbalanced cellular immunity is also seen as a major concern in the establishment of severe dengue. In this context, the investigation of cellular immunity and its products in dengue fatal cases may provide valuable data to help revealing dengue immunopathogenesis. Here, based in four dengue fatal cases infected by the serotype 3 in Brazil, different peripheral organs (livers, lungs and kidneys) were studied to evaluate the presence of cell infiltrates and the patterns of local cytokine response. The overall scenario of the studied cases revealed a considerable systemic involvement of infection with mononuclear cells targeted to all of the evaluated organs, as measured by immunohistochemistry (IHC). Quantification of cytokine-expressing cells in peripheral tissues was also performed to characterize the ongoing inflammatory process by the severe stage of the disease. Increased levels of IFN-γ- and TNF-α-expressing cells in liver, lung and kidney samples of post-mortem subjects evidenced a strong pro-inflammatory induction in these tissues. The presence of increased RANTES-producing cell numbers in all analyzed organs suggested a possible link between the clinical status and altered vascular permeability. Co-staining of DENV RNA and IFN-γ or TNF-α using in situ hibridization and IHC confirmed the virus-specific trigger of the pro-inflammatory response. Taken together, this work provided additional evidences that corroborated with the traditional theories regarding the "cytokine storm" and the occurrence of uneven cellular

  13. Peripheral Organs of Dengue Fatal Cases Present Strong Pro-Inflammatory Response with Participation of IFN-Gamma-, TNF-Alpha- and RANTES-Producing Cells

    Science.gov (United States)

    Basílio-de-Oliveira, Carlos. A.; Nuovo, Gerard J.; Chagas, Vera L. A.; Salomão, Natália G.; Mota, Ester M.; Paes, Marciano V.

    2016-01-01

    Dengue disease is an acute viral illness caused by dengue virus (DENV) that can progress to hemorrhagic stages leading to about 20000 deaths every year worldwide. Despite many clinical investigations regarding dengue, the immunopathogenic process by which infected patients evolve to the severe forms is not fully understood. Apart from differences in virulence and the antibody cross reactivity that can potentially augment virus replication, imbalanced cellular immunity is also seen as a major concern in the establishment of severe dengue. In this context, the investigation of cellular immunity and its products in dengue fatal cases may provide valuable data to help revealing dengue immunopathogenesis. Here, based in four dengue fatal cases infected by the serotype 3 in Brazil, different peripheral organs (livers, lungs and kidneys) were studied to evaluate the presence of cell infiltrates and the patterns of local cytokine response. The overall scenario of the studied cases revealed a considerable systemic involvement of infection with mononuclear cells targeted to all of the evaluated organs, as measured by immunohistochemistry (IHC). Quantification of cytokine-expressing cells in peripheral tissues was also performed to characterize the ongoing inflammatory process by the severe stage of the disease. Increased levels of IFN-γ- and TNF-α-expressing cells in liver, lung and kidney samples of post-mortem subjects evidenced a strong pro-inflammatory induction in these tissues. The presence of increased RANTES-producing cell numbers in all analyzed organs suggested a possible link between the clinical status and altered vascular permeability. Co-staining of DENV RNA and IFN-γ or TNF-α using in situ hibridization and IHC confirmed the virus-specific trigger of the pro-inflammatory response. Taken together, this work provided additional evidences that corroborated with the traditional theories regarding the “cytokine storm” and the occurrence of uneven cellular

  14. Analysis of strychnine and brucine in postmortem specimens by RP-HPLC: a case report of fatal intoxication.

    Science.gov (United States)

    Wang, Zhaohong; Zhao, Jingzhen; Xing, Junbo; He, Yi; Guo, Dean

    2004-03-01

    A sensitive method for the identification and quantitation of the toxic alkaloids strychnine and brucine from postmortem specimens has been established. After solid-phase extraction using Oasis MCX cartridges the extracts were analyzed by high-performance liquid chromatography with diode-array detection. The limit of detection was 0.5 ng/mL blood for strychnine and brucine, and the limit of quantitation was 5 ng/mL blood for strychnine and brucine. The method was applied for the analysis of blood and gastric contents of a 34-year-old female who died after ingestion of a packet of herbal medicine powder containing the seeds of Strychnos nux-vomica L. Strychnine and brucine were detected in all the samples. The concentration in our case is consistent with that in previous reports.

  15. 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

    Directory of Open Access Journals (Sweden)

    C. Mendieta

    2009-10-01

    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

  16. Fatal diquat intoxication

    Directory of Open Access Journals (Sweden)

    Jović-Stošić Jasmina

    2009-01-01

    Full Text Available Background. Since the introduction of diquat in agriculture practice in 1960's, about 40 cases of poisoning have been described in detail in medical literature. Case report. We presented two cases. A case one, a 35-year-old, previously healthy, woman ingested 14% diquat solution. The poisoning had fulminant course, consisted of severe stomachache, vomiting, cardiocirculatory shock, respiratory failure and cardiac arrest 20 hours post-ingestion. Autopsy revealed myocardial infarction, bronchopneumonia and incipient renal damage. A case two, a 64-year-old man developed severe gastroenteritis, corrosive lesions of mucosal surfaces, acute renal injury, arrhythmias, brain stem infarction and bronchopneumonia. The diagnosis of diquat poisoning was made retrospectively upon the clinical picture and identification of pesticides he had been exposed to. The patient died 18 days post-exposure. The most prominent findings on autopsy were pontine hemorrhage and infarction, bronchopneumonia, left ventricle papillary muscle infarction and renal tubular damage. Conclusion. Cardiocirculatory disturbances led to fatal complications, the heart and brain infarction. We pointed out the heart as one of the most severely affected organs in diquat poisoning.

  17. Fatal outcome in bacteremia is characterized by high plasma cell free DNA concentration and apoptotic DNA fragmentation: a prospective cohort study.

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    Reetta Huttunen

    Full Text Available INTRODUCTION: Recent studies have shown that apoptosis plays a critical role in the pathogenesis of sepsis. High plasma cell free DNA (cf-DNA concentrations have been shown to be associated with sepsis outcome. The origin of cf-DNA is unclear. METHODS: Total plasma cf-DNA was quantified directly in plasma and the amplifiable cf-DNA assessed using quantitative PCR in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, ß-hemolytic streptococcae or Escherichia coli. The quality of cf-DNA was analyzed with a DNA Chip assay performed on 8 survivors and 8 nonsurvivors. Values were measured on days 1-4 after positive blood culture, on day 5-17 and on recovery. RESULTS: The maximum cf-DNA values on days 1-4 (n = 132 were markedly higher in nonsurvivors compared to survivors (2.03 vs 1.26 ug/ml, p1.52 ug/ml remained an independent risk factor for case fatality in a logistic regression model. Qualitative analysis of cf-DNA showed that cf-DNA displayed a predominating low-molecular-weight cf-DNA band (150-200 bp in nonsurvivors, corresponding to the size of the apoptotic nucleosomal DNA. cf-DNA concentration showed a significant positive correlation with visually graded apoptotic band intensity (R = 0.822, p<0.001. CONCLUSIONS: Plasma cf-DNA concentration proved to be a specific independent prognostic biomarker in bacteremia. cf-DNA displayed a predominating low-molecular-weight cf-DNA band in nonsurvivors corresponding to the size of apoptotic nucleosomal DNA.

  18. Fatal Strongyloides Hyperinfection Complicating a Gram-Negative Sepsis after Allogeneic Stem Cell Transplantation: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Isabel Izquierdo

    2013-01-01

    Full Text Available Strongyloides stercoralis is an intestinal nematode that causes strongyloidiasis, which affects 30 to 100 million people worldwide. Risk factors for hyperinfection and disseminated disease include immunosuppressive drug therapy, human T-lymphotropic virus-1 (HTLV-1 infection, solid organ and bone marrow transplantation, hematologic malignant diseases, hypogammaglobulinemia, and severe malnutrition and associated conditions. The diagnosis can be difficult because a single stool examination fails to detect larvae in up to 70% of the cases, and the symptoms are nonspecific. Although eosinophilia is a common finding in patients with chronic Strongyloides infection, it is an unreliable predictor of hyperinfection. Furthermore, the lack of eosinophilia while receiving immunosuppressive therapy cannot reliably exclude the underlying chronic Strongyloides infection. We report here a fatal Strongyloides hyperinfection in a patient receiving allogeneic stem cell transplantation; risk factors and outcome in this clinical setting are discussed.

  19. [Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part I. Segmental hair analysis in cases of fatal opioids and amphetamines poisoning].

    Science.gov (United States)

    Rojek, Sebastian; Kłys, Małgorzata; Konopka, Tomasz

    2009-01-01

    The present experimental investigations were inspired by the necessity of standardizing the procedures and analytical methods employed in hair analysis aiming at a retrospective evaluation of ingestion of various xenobiotics. Thus, in keeping with the principal premises, the main objective of the study was development of unique, novel chemico-toxicological procedures for analyzing hair content of psychoactive substances in two basic groups of substances of abuse: opioids (morphine, 6-monoacetylmorphine, codeine) and amphetamines (amphetamine, methamphetamine, MDA, MDMA, MDEA) by HPLC-APCI-MS-MS, followed by verification of the thus worked out procedures in medico-legal practice through opinionating in selected group of patients deceased due to fatal psychoactive substance poisoning (cause of death determination). Determinations of opioids and amphetamines in the hair biological matrix were performed using high performance liquid chromatography - atmospheric pressure chemical ionization - tandem mass spectrometry (HPLC-APCI-MS-MS). In the group of fatal poisonings by ,,Polish heroine", hair segmental analysis confirmed the abuse profile of the opiate or mixed (opiate-amphetamine) type, which to some measure is characteristic of Polish drug addiction, indicating the presence of these xenobiotics in the investigating hair samples in the premortem period.

  20. [Fatalities in the bathtub].

    Science.gov (United States)

    Trübner, K; Püschel, K

    1991-01-01

    A retrospective analysis concerning deaths in the bathtub was carried out in the Institute of Legal Medicine in Hamburg. The study includes 245 death cases between 1971 and 1988 (1% of all autopsies). 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides; 51 fatalities remained unclear with respect to one of these groups. Among the natural deaths sudden cardiac deaths were dominating (n = 39), among the suicides the intoxications (n = 37) and electrocutions (n = 20), and among the accidents the intoxications by carbon monoxide (n = 17) and electrocutions (n = 12). Out of 13 homicides only 2 were committed directly in the bathtub: One by drowning of a child and one by electric current via a hair dryer; in the other cases the dead body was put into the bathtub post mortem. About 50% of the victims were alcoholized. Signs of drowning were present in about 40% of all cases; the most frequent finding was emphysema aquosum.

  1. A case-control study of physical activity patterns and risk of non-fatal myocardial infarction

    Directory of Open Access Journals (Sweden)

    Gong Jian

    2013-02-01

    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.

  2. The fatal case of a cocaine body-stuffer and a literature review - towards evidence based management.

    Science.gov (United States)

    Norfolk, G A

    2007-01-01

    The case of a 50-year old female body-stuffer who collapsed and died more than 10h after swallowing a plastic wrap of cocaine is reported. The case is discussed together with a review of the literature in order that guidelines on managing body-stuffers in police custody can be evidence based.

  3. Chernobyl Accident Fatalities and Causes

    Science.gov (United States)

    1990-06-01

    died shortly after hospital admission from symptorns of acute radiation sickness, CVA must have been the Kiev fatality on suffered a cerebrovascular ... cerebrovascular acci- unfavorable prognosis IState Committee dent victim with anl estimated close of 3 G\\. 19861. the four bone marrow transplant...ber 1987. Aledical Handling of Skin Lesions Folloti- ing High Level Accidental Irradiation, UNSCEAR (United Nations Scientific Institute Curie, Paris

  4. Prenatal diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency in a family with a previous fatal case of sudden unexpected death in childhood

    DEFF Research Database (Denmark)

    Gregersen, N; Winter, V; Jensen, P K;

    1995-01-01

    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......--involved in the expression of the disease. Thus, families who have experienced the death of a child from MCAD deficiency might have an increased risk of a seriously affected subsequent child. In such a family we have therefore performed a prenatal diagnosis on a chorionic villus sample by a highly specific and sensitive...... polymerase chain reaction (PCR) assay for the G985 mutation. The analysis was positive and resulted in abortion. We verified the diagnosis by direct analysis on blood spots and other tissue material from the aborted fetus and from family members....

  5. Fatalities in Swedish skydiving.

    Science.gov (United States)

    Westman, Anton; Björnstig, Ulf

    2005-11-01

    Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964-2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994-2003 had a fatality rate 11 times lower than 1964-1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work.

  6. Motorcycle fatalities in Malaysia

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    Muhammad Marizwan Abdul Manan

    2012-07-01

    Full Text Available Malaysia has the highest road fatality risk (per 100,000 population among the ASEAN countries and more than 50% of the road accident fatalities involve motorcyclists. This study has collected and analysed data from the police, government authorities, and national and international research institutes. Only fatality data are used due to the severe underreporting of severe injuries (up to 600% and slight injuries (up to 1400%. The analysis reveals that the highest numbers of motorcycle fatalities occur in rural locations (61%, on primary roads (62% and on straight road sections (66%. The majority are riders (89%, 16 to 20 years old (22.5%, and 90% of the motorcycles are privately owned. Of those involved in fatal accidents, 75% of the motorcyclists wear helmets, and 35% do not have proper licences. The highest number of fatalities by type of collision is ‘angular or side’ (27.5%. Although fatal motorcyclist crashes mostly involve ‘passenger cars’ (28%, motorcyclists are responsible for 50% of the collisions either by crashing singly (25% or with other motorcyclists (25%. While male motorcyclists predominate (94% of fatalities, female motorcyclists aged 31 to 70, possessing ‘no licence’, not wearing helmets and travelling during the day, account for a higher percentage than male motorcyclists. Malaysia must acquire more motorcycle exposure data and establish an injury recording system and database based on hospital-records. To reduce motorcycle fatalities, it first has to understand why young male motorcyclists are prone to fatal crashes in the evenings and on weekends on rural primary roads, especially on straight road sections.

  7. A Fatal Case of Necrotizing Fasciitis Caused by a Highly Virulent Escherichia coli Strain

    Directory of Open Access Journals (Sweden)

    Sadjia Bekal

    2016-01-01

    Full Text Available Necrotizing fasciitis is a serious disease characterized by the necrosis of the subcutaneous tissues and fascia. E. coli as the etiologic agent of necrotizing fasciitis is a rare occurrence. A 66-year-old woman underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. She rapidly developed necrotizing fasciitis which led to her death 68 hours following surgery. An E. coli strain was isolated from blood and fascia cultures. DNA microarray revealed the presence of 20 virulence genes.

  8. Novel ALOX12B mutation identified in parents following single nucleotide polymorphism microarray testing of banked DNA from a fatal case of congenital ichthyosis

    Directory of Open Access Journals (Sweden)

    Smrithi Salian

    2016-01-01

    Full Text Available In genetically and phenotypically heterogeneous conditions like ichthyosis, it is clinically not possible to predict mutation in a specific gene. Sequential testing of all the causative genes is time consuming and expensive. In consanguineous families with autosomal recessive genetically heterogeneous disorders, it is possible to narrow down the candidate gene/genes by recognizing the regions of homozygosity by a single nucleotide polymorphism (SNP array. Here, we present a fatal case of autosomal recessive severe congenital ichthyosis born to a consanguineous couple. Two candidate genes were recognized by SNP array on banked DNA of the subject. Sequencing of these candidate genes in parents found them to be carriers of the same variation, a novel heterozygous deletion of single nucleotide in exon 8 (c. 1067delT of ALOX12B gene. The present case illustrates the utility of DNA banking, SNP array and testing of parents to arrive at a definitive molecular diagnosis, essential for genetic counseling, and prenatal testing.

  9. A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report

    Directory of Open Access Journals (Sweden)

    Shanti Virupannavar

    2013-01-01

    Full Text Available Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011. In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011. Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

  10. A Patient with Fatal Necrotizing Fasciitis following the Use of Intra-Articular Sodium Hyaluronate Injections: A Case Report.

    Science.gov (United States)

    Virupannavar, Shanti; Guggenheim, Carla

    2013-01-01

    Introduction. Osteoarthritis, a degenerative joint disease, is a key cause of disability around the world and an ever-growing public health concern. Intra-articular hyaluronic acid viscosupplementation is used as a conservative option for osteoarthritis knee pain relief (McArthur et al., 2012; Hootman and Helmick, 2006; Huang el al., 2011). In general, the literature has shown an excellent safety profile for this treatment modality (McArthur et al., 2012; Clegg et al., 2013; Hammesfahr et al., 2003; Neustadt et al., 2005; Cohen et al., 2008; Neustadt, 2003; Jüni et al., 2007; Peterson and Hodler, 2011). Case Presentation. In this report, we describe a case of a woman who had received multiple sodium hyaluronate injections and developed severe necrotizing fasciitis near the injection site. Conclusion. We recommend that clear guidelines for clean technique be put in place for use with sodium hyaluronate injections and consideration of full sterile technique in immunosuppressed patients.

  11. A fatal case of seronegative, late-onset systemic lupus erythematosus presenting with motor sensory axonal polyneuropathy.

    Science.gov (United States)

    Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K; Barbounakis, Emmanouil; Kastanakis, Miltiades; Athanasakis, Evangelos; Blevrakis, Evangelos; Kastanakis, Serafeim

    2014-09-01

    Systemic lupus erythematosus is a multisystemic, autoimmune, inflammatory disorder predominantly affecting young females. Its onset may be abrupt or insidious, presenting with a broad range of clinical and immunological features. We report an unusual case of elderly-onset systemic lupus erythematosus in a woman initially diagnosed with discoid lupus, and subsequently admitted to hospital due to a progressive psycho-motor deficit. Electrophysiological measurements suggested a diagnosis of acute motor sensory axonal neuropathy. Unusual clinical features and negative serology led to diagnostic uncertainty. This case report offers information on the course of the disease through the entire chain of the health care delivery (from primary to tertiary). Despite the efforts of the hospital staff, it was not possible to save the life of the woman.

  12. Clinical and analytical problems of sodium azide poisonings as exemplified by a case of fatal suicidal poisoning

    Directory of Open Access Journals (Sweden)

    Sebastian Rojek

    2016-03-01

    Full Text Available Aim of the study: To present clinical and analytical aspects associated with sodium azide poisoning. The problems were verified on the basis of a case of sodium azide poisoning which was unique due to its circumstances and the development of an analytical method applied for medico-legal practice. Material and methods : The object of the study was a toxicological analysis of biological specimens collected from a woman who ingested two doses of sodium azide purchased over the Internet, in a suicide attempt. After the ingestion of the first dose, the clinical management in the form of symptomatic treatment indicated a possibility of recovery. However, the ingestion of a second dose of the xenobiotic, already in the hospital, caused death. Toxicological findings were obtained with the dedicated technique of gas chromatography-mass spectrometry (GC-EI-MS-MS after extraction combined with derivatization using pentafluorobenzyl bromide (PFBBr. Results : Post-mortem toxicological studies demonstrated sodium azide in the blood (0.18 mg/l and urine (6.50 mg/l samples collected from the woman. Conclusions : Cases of sodium azide poisoning are rare and difficult to treat, but a review of the literature over a longer interval of time shows that they continue to occur. Therefore, case studies of sodium azide poisoning, together with descriptions of research methodology, can be useful both in clinical terms and in the preparation of toxicological expert opinions for medico-legal purposes.

  13. A Fatal Case of Immune Hyperhemolysis with Bone Marrow Necrosis in a Patient with Sickle Cell Disease

    Science.gov (United States)

    Singavi, Arun; Johnson, Susan T.; Field, Joshua J.

    2017-01-01

    In patients with sickle cell disease, hyperhemolysis is a rare but life-threatening complication of transfusion. In this case report, we describe a 61 year-old woman with hemoglobin sickle cell (SC) disease and history of alloimmunization who developed hyperhemolysis associated with a transfusion. She was found to have a warm and a clinically-significant cold autoantibody. Severe anemia (Hb 2.7 g/dL) with reticulocytopenia and thrombocytopenia prompted a bone marrow biopsy, which demonstrated extensive bone marrow necrosis. Despite treatment, the bone marrow failure did not improve and the patient died on hospital day 38. This case illustrates the potential risks of transfusion in a patient with sickle cell disease, especially one with previous hemolytic reactions. While uncommon, hyperhemolysis can cause death, in this case by extensive bone marrow necrosis. In patients with sickle cell disease, judicious use of red cell transfusions with phenotypically-matched units can diminish, but never completely abrogate, the risks associated with transfusion. PMID:28286630

  14. Identification methods of key contributing factors in crashes with high numbers of fatalities and injuries in China.

    Science.gov (United States)

    Chen, Yikai; Li, Yiming; King, Mark; Shi, Qin; Wang, Changjun; Li, Pingfan

    2016-11-16

    In China, serious road traffic crashes (SRTCs) are those in which there are 10-30 fatalities, 50-100 serious injuries, or a total cost of 50-100 million RMB (U.S.$8-16 M), and particularly serious road traffic crashes (PSRTCs) are those that are more severe or costly. Due to the large number of fatalities and injuries as well as the negative public reaction they elicit, SRTCs and PSRTCs have become of great concern to China during recent years. The aim of this study is to identify the main factors contributing to these road traffic crashes and to propose preventive measures to reduce their number. 49 contributing factors of the SRTCs and PSRTCs that occurred from 2007 to 2013 were collected from the database "In-depth investigation and analysis system for major road traffic crashes" (IIASMRTC) and were analyzed through the integrated use of principal component analysis and hierarchical clustering to determine the primary and secondary groups of contributing factors. Speeding and overloading of passengers were the primary contributing factors, featuring in up to 66.3 and 32.6% of accidents, respectively. Two secondary contributing factors were road related: lack of or nonstandard roadside safety infrastructure and slippery roads due to rain, snow, or ice. The current approach to SRTCs and PSRTCs is focused on the attribution of responsibility and the enforcement of regulations considered relevant to particular SRTCs and PSRTCs. It would be more effective to investigate contributing factors and characteristics of SRTCs and PSRTCs as a whole to provide adequate information for safety interventions in regions where SRTCs and PSRTCs are more common. In addition to mandating a driver training program and publicization of the hazards associated with traffic violations, implementation of speed cameras, speed signs, markings, and vehicle-mounted Global Positioning Systems (GPS) are suggested to reduce speeding of passenger vehicles, while increasing regular checks by

  15. Transmesenteric hernia due to double-loop formation in the small intestine: a fatal case involving a toddler.

    Science.gov (United States)

    Kakimoto, Yu; Abiru, Hitoshi; Kotani, Hirokazu; Ozeki, Munetaka; Tsuruyama, Tatsuaki; Tamaki, Keiji

    2012-01-10

    We report a unique case of transmesenteric hernia resulting in death, which went undiagnosed during a recent hospital visit. The victim was a 2.5-year-old girl who - with the exception of chronic constipation - had no medical history. One night she complained of abdominal pains and was taken to a pediatric hospital where doctors performed an abdominal X-ray and echography. No significant findings suggesting bowel obstruction (e.g. air-fluid levels or dilation of the bowel) were obtained on examinations and bloody feces were not observed in this particular episode. As her abdominal pain gradually attenuated, the doctor allowed her to return home. A few hours later, she lost consciousness and expired despite resuscitation efforts attempted at an emergency hospital. A subsequent autopsy revealed that the small bowel had herniated through a defect in the mesentery resulting in two consecutive and inversely forming loops, in which each loop protruded on either side of the mesentery. This rare morphological anatomy seems to have progressed in a two-step process. The girl's mild abdominal pain was likely induced by herniation and formation of the first intestinal loop, followed by severe shock occurring when the subsequent intestinal segment invaginated into the same defect forming the second loop on the opposite side of the mesentery. This case illustrates the difficulty of diagnosing transmesenteric hernia due to the presentation of unspecific symptoms; especially in infants and toddlers. Furthermore, this report demonstrates the value of a complete autopsy in cases of sudden and unexpected deaths involving children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Fatal hemorrhage following trans--sphenoidal resection of a pituitary adenoma: a case report and review of the literature.

    Science.gov (United States)

    Kepron, C; Cusimano, M; Pollanen, M S

    2010-12-01

    A 58-year-old woman with acromegaly developed massive epistaxis 7 days following trans-sphenoidal resection of a growth hormone-secreting pituitary adenoma. At autopsy, it was determined that the source of the hemorrhage was a rupture of the intracavernous segment of the internal carotid artery secondary to a bacterial arteritis. We describe the gross dissection and histologic examination undertaken in this unusual case, discuss the possible etiology of the infection and review the potential complications of this surgical approach with a view to improving forensic examination of these patients.

  17. Glucocorticoid hypersensitivity as a rare but potentially fatal side effect of paediatric asthma treatment: a case report

    Directory of Open Access Journals (Sweden)

    Lehmann Sylvia

    2008-06-01

    Full Text Available Abstract Introduction Immediate-type hypersensitivity to glucocorticosteroids is rare but well known among allergists. Surprisingly, very few reports of glucocorticosteroid hypersensitivity in children exist although glucocorticosteroid treatment is particularly common in this age group. Case presentation We report the case of a 2-year-old boy who developed generalized urticaria, facial angio-oedema, nausea and severe dyspnoea after intravenous application of prednisolone-21-hydrogen succinate. Skin prick testing with prednisolone-21-hydrogen succinate elicited a positive result; no reactions were observed to prednisone, betamethasone or dexamethasone. While fluorescence enzyme immunoassay analysis revealed no specific IgE antibodies against prednisolone-21-hydrogen succinate, CD63-based basophil activation testing with the culprit drug prednisolone-21-hydrogen succinate was positive. In contrast, additional incubation of basophils with prednisone, betamethasone and dexamethasone did not elicit any significant response. Hence, we performed an oral provocation test with betamethasone and a titrated intravenous dexamethasone challenge. As both drugs were tolerated without any complications they were recommended for future treatment. Conclusion In a child with confirmed immediate-type hypersensitivity to glucocorticosteroids, it is still not possible to predict which glucocorticosteroid might be tolerated by solely relying on clinical history or results of skin and in vitro testing. Therefore, incremental glucocorticosteroid challenges under standardized clinical conditions remain necessary in order to facilitate a patient-tailored emergency treatment and to avoid severe reactions to glucocorticosteroids in these patients.

  18. Fatal hypothermia: an analysis from a sub-arctic region

    Directory of Open Access Journals (Sweden)

    Helge Brändström

    2012-05-01

    Full Text Available Objectives. To determine the incidence as well as contributing factors to fatal hypothermia. Study design. Retrospective, registry-based analysis. Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992–2008. Police reports, medical records and autopsy protocols were studied. Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40% were found within approximately 100 meters of a building. The majority (75% occurred during the colder season (October to March. Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma. Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying citizens.

  19. Fatal Bacillus cereus endocarditis masquerading as an anthrax-like infection in a patient with acute lymphoblastic leukemia: case report.

    Science.gov (United States)

    Cone, Lawrence A; Dreisbach, Luke; Potts, Barbara E; Comess, Barbara E; Burleigh, William A

    2005-01-01

    A 38-year-old male farm worker with relapsing acute lymphoblastic leukemia spontaneously developed an ulcerating ulcer on his anterior thigh which was surrounded by a non-tender area of erythema. Bacillus cereus was isolated from the ulcer and blood, and the patient received intravenous penicillin and vancomycin for one week. When sensitivity studies were returned he was treated with gatifloxacin orally. After two weeks of combined antimicrobial therapy and negative blood cultures, the patient received combination chemotherapy with vincristine, prednisone, doxorubicin and cyclophosphamide. He was hospitalized a day after completing chemotherapy with neutropenic sepsis due to B. cereus. He received similar antimicrobial therapy as previously, but died three days later. At autopsy, the patient was found to have acute mitral valve endocarditis and bilateral brain abscesses. This was the first case of B. cereus endocarditis reported in a patient with acute lymphoblastic leukemia.

  20. Characterization of rickettsia rickettsii in a case of Fatal Brazilian spotted fever in the city of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Cristiane Lamas

    Full Text Available A lethal case of Brazilian spotted fever (BSF is presented. Clinical features were initially of gastrointestinal involvement and evolved with progression to septic shock, meningoencephalitis and death on the 6th day of illness. Indirect immunofluorescence assay (IFA for spotted fever group rickettsia (SFGR was non-reactive. Diagnosis was confirmed by the polymerase chain reaction (PCR and the nucleotide sequencing of a fragment of the ompA gene showed 100% homology to Rickettsia rickettsii. BSF has not been reported in the city of Rio de Janeiro in the last three decades, and the present description should alert the clinicians to its presence in urban Rio de Janeiro, and to the differential diagnosis with dengue fever, gastroenteritis, leptospirosis and bacterial septic shock, among others.

  1. [Fatal electrocution in prison].

    Science.gov (United States)

    Grellner, Wolfgang

    2008-01-01

    The clarification of deaths from electric current can be difficult when electric skin marks are missing or overlooked. In the following, the fatal electric accident of a 21-year-old man in prison is reported with a scene which primarily seemed to be inconspicuous. The autopsy disclosed typical electric marks in the skin of the left thumb and the corresponding part of the left index finger. A second inspection of the jail room, which was large enough for three men, but occupied by the deceased alone, led to the finding of widely spread utensils (two forks with signs of corrosion and deformation of the prongs, radio cable with socket, water container) for the self-construction of a kind of "immersion heater" for the heating of water. The man must have suffered electrocution when touching the prongs of the forks. Death supposedly occurred due to disturbances of the cardiac rhythm after a longer interval of maintained ability to act. The case again proves the difficulties in the detection and examination of possible electric deaths in which unusual sources of electricity must be considered.

  2. Fatal Fusarium solani species complex infections in elasmobranchs: the first case report for black spotted stingray (Taeniura melanopsila) and a literature review.

    Science.gov (United States)

    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

    2015-07-01

    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.

  3. Complete genome characterization of Rocio virus (Flavivirus: Flaviviridae), a Brazilian flavivirus isolated from a fatal case of encephalitis during an epidemic in Sao Paulo state.

    Science.gov (United States)

    Medeiros, Daniele B A; Nunes, Márcio R T; Vasconcelos, Pedro F C; Chang, Gwong-Jen J; Kuno, Goro

    2007-08-01

    The flaviviruses of major medical importance in South American countries are yellow fever, dengue, Saint Louis encephalitis, West Nile and Rocio viruses. Rocio virus (ROCV) has been responsible for epidemics of severe encephalitis in Brazil with a case-fatality rate of 10 % and development of sequelae in 20 % of the survivors. We have sequenced and characterized the entire genome of ROCV for the first time, by determining the general traits of the open reading frame and the characteristics of viral genes including the potential cleavage sites, conserved or unique motifs, cysteine residues and potential glycosylation sites. The conserved sequences in the 3'-non-coding region were identified, and the predicted secondary structures during cyclization between 5'- and 3'-non-coding regions were studied. Multiple protein and phylogenetic analyses based on antigenically important and phylogenetically informative genes confirmed a close relationship between ROCV and Ilheus virus (ILHV), together constituting a unique and distinct phylogenetic subgroup as well as the genetic relationship of ROCV with several members of the Japanese encephalitis group. Although ROCV is phylogenetically related to ILHV, our study shows that it is still a virus distinct from the latter virus. This is the first flavivirus uniquely indigenous to Brazil that has been sequenced completely and the genome characterized. The data should be useful for further studies at the molecular level, including construction of infectious clone, identification of gene function, improved disease surveillance based on molecular diagnostic tools and vaccine development.

  4. Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims – a critical analysis

    Science.gov (United States)

    Chattopadhyay, Saurabh; Tripathi, Chandrabhal

    2010-01-01

    Abstract: 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 haemorrhage 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 haemorrhage 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. PMID:21483205

  5. Fatal cases of Theileria annulata infection in calves in Portugal associated with neoplastic-like lymphoid cell proliferation

    Science.gov (United States)

    Orvalho, João; Leitão, Alexandre; Pereira, Isadora; Malta, Manuel; Mariano, Isabel; Carvalho, Tânia; Baptista, Rui; Shiels, Brian R.; Peleteiro, Maria C.

    2010-01-01

    This study was carried out to investigate fifteen cases of acute lethal infection of calves (≤ 4 months of age) by the protozoan parasite Theileria (T.) annulata in the south of Portugal. Calves developed multifocal to coalescent nodular skin lesions, similar to multicentric malignant lymphoma. Infestation with ticks (genus Hyalomma) was intense. Theileria was seen in blood and lymph node smears, and T. annulata infection was confirmed by isolation of schizont-transformed cells and sequencing of hypervariable region 4 of the 18S rRNA gene. At necropsy, hemorrhagic nodules or nodules with a hemorrhagic halo were seen, particularly in the skin, subcutaneous tissue, skeletal and cardiac muscles, pharynx, trachea and intestinal serosa. Histologically, nodules were formed by large, round, lymphoblastoid neoplastic-like cells. Immunohistochemistry (IHC) identified these cells as mostly CD3 positive T lymphocytes and MAC387 positive macrophages. A marker for B lymphocytes (CD79αcy) labeled very few cells. T. annulata infected cells in these nodules were also identified by IHC through the use of two monoclonal antibodies (1C7 and 1C12) which are diagnostic for the parasite. It was concluded that the pathological changes observed in the different organs and tissues were caused by proliferation of schizont-infected macrophages, which subsequently stimulate a severe uncontrolled proliferation of uninfected T lymphocytes. PMID:20195062

  6. Disenfranchised grief following a non-fatal road traffic incident: a case study exploring a mother's experience.

    Science.gov (United States)

    Rahman, Shaminah; De Souza, Joanna

    2014-07-01

    This case study explores a scenario that was observed by a final year nursing student on placement in a paediatric emergency department, in a busy London teaching hospital. A mother appeared distressed following the news that her son who had survived a road traffic incident with minimal impact to his cognitive and physical abilities, was stable enough to be transferred to the children's medical ward. Whilst this appeared to be positive for supporting figures in her life and the emergency practitioners involved, observation and discussion with the mother revealed that her distress was related to her experience of losses that were undetected by those around her. This included losses related to her son's future and the loss of her previous world. Amongst the plethora of theories about how we as humans react to loss and change, one theory which could explain the mother's grief suggests that it was disenfranchised, i.e. it was not acknowledged or validated by society. There are consequences of disenfranchised grief, such as a lack of social support leading to a higher risk of adverse psychological outcomes. Nurses in the emergency department can help resolve negative outcomes for patients and families experiencing disenfranchised grief. The key steps are to have knowledge of disenfranchised grief to be able to detect it, and then to validate it as a form of grief.

  7. EMOTIONAL AND COGNITIVE CHANGES DURING AND POST A NEAR FATAL HEART ATTACK AND ONE-YEAR AFTER: A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Andrew M. Lane

    2010-09-01

    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

  8. Primary angiitis of the central nervous system presenting with subacute and fatal course of disease: a case report

    Directory of Open Access Journals (Sweden)

    Börnke Christian

    2005-09-01

    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.

  9. A nationwide, retrospective analysis of symptoms, comorbidities, medical care and autopsy findings in cases of fatal pulmonary embolism in younger patients

    DEFF Research Database (Denmark)

    Haunsø, S; Theilade, J; Winkel, B G

    2010-01-01

    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....

  10. The turning point in the number of traffic fatalities

    DEFF Research Database (Denmark)

    Brüde, Ulf; Elvik, Rune

    2015-01-01

    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...

  11. Fatal and non-fatal burn injuries with electrical weapons and explosive fumes.

    Science.gov (United States)

    Kroll, Mark W; Ritter, Mollie B; Williams, Howard E

    2017-08-01

    While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including eye injuries and falls. With the presence of explosive fumes or fuels there also exists the possibility of burn injury. We searched for cases of fatal and non-fatal major burns with TASER(®) electrical weapon usage where there was a possibility that the weapon ignited the explosion. We confirmed 6 cases of fatal burn injury and 4 cases of major non-fatal burns out of 3.17 million field uses. The mean age was 35.5 ± 9.7 years which is consistent with the typical arrest-related death. Moderate, minor, and noninjurious fires - typically due to a cigarette lighters in a pocket, petrol, recreational inhalants, or body spray were also noted. The use of electrical weapons presents a small but real risk of death from fatal burn injury. It also presents a small risk of major non-fatal burn injury. The ignition of petrol fumes dominates these cases of major fatal and nonfatal burns. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  12. Fatal pneumoni med Panton-Valentine-leukocidinproducerende Staphylococcus aureus

    DEFF Research Database (Denmark)

    Rabøl, Peter Hedelund; Dessau, Ram Benny; Warnecke, Mads

    2010-01-01

    We describe a case of fatal pneumonia in a previously healthy 14-year-old boy. The patient was severely affected at the time of admission with high fever, tachypnea, tachycardia and peripheral cyanosis. The condition worsened despite treatment with antibiotics as well as respiratory and pressure ...... support. Acidosis and critical leucopenia supervened and the patient died just short of 24 hours after admission. Subsequent bacterial cultivation showed Panton-Valentine Leucocidin-producing Staphylococcus aureus....

  13. The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918-1919 influenza pandemic in the United States.

    Science.gov (United States)

    Grant, William B; Giovannucci, Edward

    2009-07-01

    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 vitamin D status. Substantial correlations were found for associations of July UVB dose with case fatality rates (r = -0.72, p = 0.009) and rates of pneumonia as a complication of influenza (r = -0.77, p = 0.005). Similar results were found for wintertime UVB. Vitamin D upregulates production of human cathelicidin, LL-37, which has both antimicrobial and antiendotoxin activities. Vitamin D also reduces the production of proinflammatory cytokines, which could also explain some of the benefit of vitamin D since H1N1 infection gives rise to a cytokine storm. The potential role of vitamin D status in reducing secondary bacterial infections and loss of life in pandemic influence requires further evaluation.

  14. Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Cheng Hsien; Huang, Chen Chin; Wang, Li Jen; Wong, Yon Cheng; Wang, Chao Jan; Lo, Wang Chak; Lin, Being Chuan; Wan, Yung Liang; Haueh, Chuen [Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (China)

    2012-06-15

    Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CT appears to be valuable in discriminating fatal from non-fatal SC.

  15. Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma

    Directory of Open Access Journals (Sweden)

    Beauchamp Kathryn M

    2011-07-01

    Full Text Available Abstract Background Vertebral artery injury (VAI after blunt cervical trauma occurs more frequently than historically believed. The symptoms due to vertebral artery (VA occlusion usually manifest within the first 24 hours after trauma. Misdiagnosed VAI or delay in diagnosis has been reported to cause acute deterioration of previously conscious and neurologically intact patients. Case presentation A 67 year-old male was involved in a motor vehicle crash (MVC sustaining multiple injuries. Initial evaluation by the emergency medical response team revealed that he was alert, oriented, and neurologically intact. He was transferred to the local hospital where cervical spine computed tomography (CT revealed several abnormalities. Distraction and subluxation was present at C5-C6 and a comminuted fracture of the left lateral mass of C6 with violation of the transverse foramen was noted. Unavailability of a spine specialist prompted the patient's transfer to an area medical center equipped with spine care capabilities. After arrival, the patient became unresponsive and neurological deficits were noted. His continued deterioration prompted yet another transfer to our Level 1 regional trauma center. A repeat cervical spine CT at our institution revealed significantly worsened subluxation at C5-C6. CT angiogram also revealed complete occlusion of bilateral VA. The following day, a repeat CT of the head revealed brain stem infarction due to bilateral VA occlusion. Shortly following, the patient was diagnosed with brain death and care was withdrawn. Conclusion Brain stem infarction secondary to bilateral VA occlusion following cervical spine trauma resulted in fatal outcome. Prompt imaging evaluation is necessary to assess for VAI in cervical trauma cases with facet joint subluxation/dislocation or transverse foramen fracture so that treatment is not delayed. Additionally, multiple transportation events are risk factors for worsening when unstable cervical

  16. High frequency welded (ERW) casing

    Energy Technology Data Exchange (ETDEWEB)

    Duisberg, J. (Hoesch Roehrenwerke A.G., Hamm (Germany, F.R.))

    1980-09-01

    Due to the up-to-date standard in welding and testing techniques, the significance of ERW-casing is growing rapidly. The basic items of ERW-pipe are explained in detail. The forming mechanism, the high frequency welding by induction and contact welding processes is explained in detail as well as destructive and non-destructive testing methods. Finishing the ends as threading, thread control (gauging), power tight connection, pressure test and final quality control are rounding up the picture of the production of ERW-casing. Last but not least the test results from the joint strength- and collapse tests which are of outstanding interest for casings, are compared with API requirements in order to demonstrate compliance with API requirements.

  17. [Fatal outcome of an hydrogen sulfide poisoning].

    Science.gov (United States)

    Querellou, E; Jaffrelot, M; Savary, D; Savry, C; Perfus, J-P

    2005-10-01

    We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team.

  18. Substance use among Iranian drivers involved in fatal road accidents

    Directory of Open Access Journals (Sweden)

    Shervin eAssari

    2014-08-01

    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.

  19. Fatal Clostridial necrotizing enterocolitis in a term infant with gastroschisis

    Directory of Open Access Journals (Sweden)

    Kevin M. Riggle

    2016-11-01

    Full Text Available Necrotizing enterocolitis (NEC is most often a disease of preterm infants, but can develop in full term infants with gastroschisis. The latter cases typically present later and have a milder clinical course; we present the first case of fatal Clostridium perfringes-associated NEC in a full term infant with gastroschisis. Our case highlights the need for a high index of clinical suspicion for Clostridial NEC when there is rapid progression of disease and/or evidence of hemolysis. When Clostridial NEC is suspected, we recommend treatment with penicillin G and clindamycin, as well as prompt, aggressive surgical intervention.

  20. Fatal case of dichloromethane poisoning.

    Science.gov (United States)

    Goullé, J P; Lacroix, C; Vaz, E; Rouvier, P; Proust, B

    1999-09-01

    A 47-year-old man was found dead in a factory where dichloromethane (DCM) tanks were stocked. He was making an inventory of the annual stock of DCM contained in several tanks (5- to 8000-L capacity) by transferring the solvent into an additional tank with the help of compressed air. During this operation, one of the tanks overflowed and the man, who was not wearing any protection, was intoxicated. Autopsy showed digestive, suprarenal, and liver bleeding. Blood was also found in the trachea. DCM was identified by headspace gas chromatography-mass spectrometry (GC-MS). A headspace gas chromatography-flame ionization detection technique (GC-HS-FID) optimized for quantitation in biological fluids, organs and viscera was established at autopsy. The following concentrations of DCM were found: blood (150 mg/L), urine (2.0 mg/L), gastric content (5.6 mg/L), brain (122 mg/kg), fat (99 mg/kg), liver (44 mg/kg), lung (20 mg/kg), and kidney (15 mg/kg). A study of the storage stability of DCM was carried out on these samples. Ethanol production was measured in some organs. The results are discussed in light of the rarity of existing literature.

  1. [Fatal exposure to Aconitum napellus].

    Science.gov (United States)

    German Jørgensen, Jørgen Rahr; Andersen, Anne Elsborg

    2013-06-10

    Fatal exposure to poisonous plants in northern Europe is a rare condition. In this case report we describe an intended poisoning with Aconitum napellus (monkshood), which contains the toxin aconitine. The lethal dose in adults is 3-6 mg. The toxin affects excitable cells such as neurons and myocytes causing degrees of unconsciousness, hypotension and cardiac arrhythmias. There is no antidote and treatment is symptomatic. We describe a patient who had eaten monkshood. She was treated with infusion of lidocaine and survived. After 24 hours of treatment and monitoring she was discharged from the intensive care unit.

  2. [Fatal poisoning due to Indigofera].

    Science.gov (United States)

    Labib, S; Berdai, M-A; Bendadi, A; Achour, S; Harandou, M

    2012-01-01

    Indigo, also known in Morocco as Nila, is a dye widely used in the coloring of Moroccan handicrafts. It is obtained from fermentation reactions on the leaves and branches of true indigo, Indigofera tinctoria, which is a widespread plant in tropical Africa and Asia. We report a case of fatal poisoning in a 3-year-old child after administration of indigo for therapeutic purposes. Death resulted from multiple organ failure. The toxicity of this compound is little known in the literature and deserves to be explored through toxicokinetic and toxicodynamic studies, in order to better determine the toxic constituents of the dye.

  3. Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade: estudo de caso e controle Prognostic factors for hospital case-fatality due to diarrhea or pneumonia: a case-control study

    Directory of Open Access Journals (Sweden)

    Cora Luiza Araújo Post

    1992-12-01

    and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold associated with nutritional deficit. The duration of breastfeeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.

  4. Assessment of blood–brain barrier penetration of miltefosine used to treat a fatal case of granulomatous amebic encephalitis possibly caused by an unusual Balamuthia mandrillaris strain

    NARCIS (Netherlands)

    Roy, Sharon L.; Atkins, Jane T.; Gennuso, Rosemaria; Kofos, Danny; Sriram, Rama R.; Dorlo, Thomas P. C.; Hayes, Teresa; Qvarnstrom, Yvonne; Kucerova, Zuzana; Guglielmo, B. Joseph; Visvesvara, Govinda S.

    2015-01-01

    Balamuthia mandrillaris, a free-living ameba, causes rare but frequently fatal granulomatous amebic encephalitis (GAE). Few patients have survived after receiving experimental drug combinations, with or without brain lesion excisions. Some GAE survivors have been treated with a multi-drug regimen in

  5. Presentations of patients of poisoning and predictors of poisoning-related fatality: Findings from a hospital-based prospective study

    Directory of Open Access Journals (Sweden)

    Lin Hung-Jung

    2008-01-01

    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.

  6. Proton Pump Inhibitors in the Management of Tachypnoea following Panproctocolectomy: A Case of High Output Ileostomy

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    Neville Azzopardi

    2011-04-01

    Full Text Available High output ileostomies are important complications of stoma formation following bowel surgery. Adequate management of such stomas might prevent severe morbidity and mortality when this potentially fatal complication develops. In this case report, we describe a female patient with a recent ileostomy formation following panproctocolectomy for ulcerative colitis who presented with progressively increasing shortness of breath. The patient was found to have a hypochloraemic metabolic acidosis on arterial blood gases. She rapidly improved with adequate sodium and fluid replacement and with the use of a course of proton pump inhibitors. This case highlights the importance of recognising high output ileostomies early and important management issues in their regard.

  7. Fatal Primary Capillary Leak Syndrome in a Late Preterm Newborn.

    Science.gov (United States)

    Kulihova, Katarina; Prochazkova, Martina; Semberova, Jana; Janota, Jan

    2016-10-01

    Primary capillary leak syndrome is a rare disease of unknown etiology, characterized by episodes of vascular collapse and plasma extravasation, which may lead to multiple organ failure. Primary capillary leak is extremely rare in children. The authors report a case of a late preterm newborn with fatal capillary leak syndrome of unknown etiology, manifesting as hypotension unresponsive to treatment, extravasation leading to generalised edema, disseminated intravascular coagulation and finally, multiple organ dysfunction syndrome. Aggressive volumotherapy and a combination of inotropes and high doses of terlipressin did not influence systemic vascular collapse and plasma extravasation. The newborn developed multiple organ failure and died on day 27 of life. Investigations performed failed to reveal any specific cause of capillary leak. This is the first report of a fatal primary capillary leak syndrome in a newborn.

  8. Fatal disease: misplaced amebae

    Energy Technology Data Exchange (ETDEWEB)

    Carter, S.A.

    1977-04-01

    More than 75 cases of primary amebic meningoencephalitis (PAME) have been reported within the past twenty years. By 1970, it was obvious to most investigators that there was an association of the majority of cases of PAME with a recent history of swimming or diving in warm water of high organic content. Lakes, rivers, ponds, swimming pools, drainage ditches, hot springs, domestic waste water, septic-tank effluent, and bathtubs--all have been linked to PAME. Because of the widespread distribution and survival of the organisms and the projected growth of new power plants and new industries, it can be expected that the number of cases of PAME will increase. (CAJ)

  9. Fatal Fulminant Hepatic Failure from Adenovirus in Allogeneic Bone Marrow Transplant Patients

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    Jatin M. Vyas

    2012-01-01

    Full Text Available We report two cases of fatal hepatic failure in patients who received matched unrelated bone marrow transplantation. Both patients presented with high fevers, abnormal liver functions tests, and hypodense lesions in the liver by CT scan. Histologic examination of postmortem liver samples demonstrated extensive necrosis, and immunohistochemistry was positive for adenovirus.

  10. Fatalities and catastrophic injuries in high school and college sports, 1982-1997 lessons for improving safety.

    Science.gov (United States)

    Cantu, R C; Mueller, F O

    1999-08-01

    The prohibition of 'spearing' in football and the rules regarding water depth and the racing dive in swimming are examples of how data on deaths and catastrophic injuries can be used to help promote the safety of young athletes. Other preventive measures supported by research include anchoring movable soccer goals to prevent tipping, improved training for high school wrestling coaches, increased awareness of pathogenic weight control in wrestling and gymnastics, rules against pushing or checking from behind in ice hockey, protective helmets for batting-practice pitchers in baseball, and barriers around the discus circle in track and field.

  11. Anticipating early fatality: friends', schoolmates' and individual perceptions of fatality on adolescent risk behaviors.

    Science.gov (United States)

    Haynie, Dana L; Soller, Brian; Williams, Kristi

    2014-02-01

    Past research indicates that anticipating adverse outcomes, such as early death (fatalism), is associated positively with adolescents' likelihood of engaging in risky behaviors. Health researchers and criminologists have argued that fatalism influences present risk taking in part by informing individuals' motivation for delaying gratification for the promise of future benefits. While past findings highlight the association between the anticipation of early death and a number of developmental outcomes, no known research has assessed the impact of location in a context characterized by high perceptions of fatality. Using data from Add Health and a sample of 9,584 adolescents (51% female and 71% white) nested in 113 schools, our study builds upon prior research by examining the association between friends', school mates', and individual perceptions of early fatality and adolescent risk behaviors. We test whether friends' anticipation of being killed prior to age 21 or location in a school where a high proportion of the student body subscribes to attitudes of high fatality, is associated with risky behaviors. Results indicate that friends' fatalism is positively associated with engaging in violent delinquency, non-violent delinquency, and drug use after controlling for individual covariates and prior individual risk-taking. Although friends' delinquency accounts for much of the effect of friends' fatalism on violence, none of the potential intervening variables fully explain the effect of friends' fatalism on youth involvement in non-violent delinquency and drug use. Our results underscore the importance of friendship contextual effects in shaping adolescent risk-taking behavior and the very serious consequences perceptions of fatality have for adolescents' involvement in delinquency and drug use.

  12. 2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究%In-hospital case-fatality rate and its distribution among patients with acute myocardial infarction in Beijing during 2007 -2009

    Institute of Scientific and Technical Information of China (English)

    张秀英; 郭默宁; 万浩; 刘静; 赵冬; 王薇; 谢学勤; 韦再华; 王淼; 孙佳艺; 齐玥; 刘军

    2012-01-01

    rate for AMI is still high in Beijing. However, a decline was noticed during 2007 - 2009, indicating the improvement in the in-hospital treatments of AMI in Beijing. Differences in in-hospital case-fatality rates exist among AMI patients with different characteristics. Results from the present study may guide future health care planning and help to determine priorities for clinical treatment.%目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征.方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统.AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例.结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2%.3年中AMI患者平均住院病死率为10.0%,女性为14.3%,高于男性的7.9% (P <0.001).在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4%比9.0%,P<0.001),中医医院高于西医医院者(17.5%比9.5%,P<0.001).ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4%比8.4%,P<0.001).住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4%比1.9%,P<0.001).2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7%、9.8%和9.4%,3年间下降了12.1%,男女两性分别下降了11.1%和10.7%.结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高.不同特征AMI患者的住院病死率存在差异.研究结果为进一步改善北京市AMI的住院治疗水平提供了依据.

  13. Evaluation of poly-drug use in methadone-related fatalities using segmental hair analysis.

    Science.gov (United States)

    Nielsen, Marie Katrine Klose; Johansen, Sys Stybe; Linnet, Kristian

    2015-03-01

    In Denmark, fatal poisoning among drug addicts is often related to methadone. The primary mechanism contributing to fatal methadone overdose is respiratory depression. Concurrent use of other central nervous system (CNS) depressants is suggested to heighten the potential for fatal methadone toxicity. Reduced tolerance due to a short-time abstinence period is also proposed to determine a risk for fatal overdose. The primary aims of this study were to investigate if concurrent use of CNS depressants or reduced tolerance were significant risk factors in methadone-related fatalities using segmental hair analysis. The study included 99 methadone-related fatalities collected in Denmark from 2008 to 2011, where both blood and hair were available. The cases were divided into three subgroups based on the cause of death; methadone poisoning (N=64), poly-drug poisoning (N=28) or methadone poisoning combined with fatal diseases (N=7). No significant differences between methadone concentrations in the subgroups were obtained in both blood and hair. The methadone blood concentrations were highly variable (0.015-5.3, median: 0.52mg/kg) and mainly within the concentration range detected in living methadone users. In hair, methadone was detected in 97 fatalities with concentrations ranging from 0.061 to 211ng/mg (median: 11ng/mg). In the remaining two cases, methadone was detected in blood but absent in hair specimens, suggesting that these two subjects were methadone-naive users. Extensive poly-drug use was observed in all three subgroups, both recently and within the last months prior to death. Especially, concurrent use of multiple benzodiazepines was prevalent among the deceased followed by the abuse of morphine, codeine, amphetamine, cannabis, cocaine and ethanol. By including quantitative segmental hair analysis, additional information on poly-drug use was obtained. Especially, 6-acetylmorphine was detected more frequently in hair specimens, indicating that regular abuse of

  14. Fatal Disseminated Aspergillus penicillioides Infection in a 3-Month-Old Infant with Suspected Cystic Fibrosis: Autopsy Case Report with Review of Literature.

    Science.gov (United States)

    Gupta, Kirti; Gupta, Parikshaa; Mathew, Joseph L; Bansal, Arun; Singh, Gangandeep; Singh, Meenu; Chakrabarti, Arunaloke

    Patients with cystic fibrosis (CF) often are colonized by Aspergillus species in their respiratory tract, but invasive aspergillosis is a rare complication. We describe the autopsy findings of an infant with cystic fibrosis who had fatal disseminated aspergillosis. The causative agent was identified as A. penicillioides by molecular technique. To our knowledge, this is the first report of disseminated aspergillosis caused by A. penicillioides in any type of patient. The literature on invasive aspergillosis in patients with cystic fibrosis also is reviewed.

  15. The Characteristics of Road Traffic Fatalities in Kazakhstan's Semey Region, 2006-2010: A Descriptive Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Ayan Myssayev

    2014-06-01

    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.

  16. Investigation of a fatal airplane crash: autopsy, computed tomography, and injury pattern analysis used to determine who was steering the plane at time of accident. A case report

    DEFF Research Database (Denmark)

    Høyer, Christian Bjerre; Nielsen, Trine Skov; Nagel, Lise Loft

    2012-01-01

    A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior to the au......A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior...... to the autopsy. The autopsies showed massive destruction to the bodies of the two victims but did not identify any signs of acute or chronic medical conditions that could explain loss of control of the airplane. PMCT, histological examination, and forensic chemical analysis also failed to identify an explanation...... of fatal airplane crashes should be subject to forensic autopsy, including PMCT and forensic chemical analysis. The continuous accumulation of knowledge about injury patterns from “simple” accidents is the foundation for the correct analysis of “difficult” accidents....

  17. A fatal poisoning involving Bromo-Dragonfly

    DEFF Research Database (Denmark)

    Andreasen, Mette Findal

    This poster reports a fatal overdose case involving Bromo-Dragonfly. Bromo-Dragonfly is a common name for 1-(8-bromobenzo[1,2-b; 4,5-b´]difuran-4-yl)-2-aminopropane. Structurally, it is closely related to phenylethylamines like 2C-B and DOB. Bromo-Dragonfly is considered an extremely potent hallu...

  18. Fatal lawn mower related projectile injury

    DEFF Research Database (Denmark)

    Colville-Ebeling, Bonnie; Lynnerup, Niels; Banner, Jytte

    2014-01-01

    the 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...

  19. Fatal Monocytic Ehrlichiosis in Woman, Mexico, 2013

    Science.gov (United States)

    Sosa-Gutierrez, Carolina G.; Solorzano-Santos, Fortino; Walker, David H.; Torres, Javier; Serrano, Carlos A.

    2016-01-01

    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

  20. Fatal cerebral oedema in adult diabetic ketoacidosis.

    NARCIS (Netherlands)

    Haringhuizen, A.; Tjan, D.H.; Grool, A.; Vugt, R. van; Zante, A.R. van

    2010-01-01

    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

  1. A fatal poisoning involving Bromo-Dragonfly

    DEFF Research Database (Denmark)

    Andreasen, Mette Findal

    This poster reports a fatal overdose case involving Bromo-Dragonfly. Bromo-Dragonfly is a common name for 1-(8-bromobenzo[1,2-b; 4,5-b´]difuran-4-yl)-2-aminopropane. Structurally, it is closely related to phenylethylamines like 2C-B and DOB. Bromo-Dragonfly is considered an extremely potent...

  2. Bordetella bronchiseptica and fatal pneumonia of dogs and cats

    Science.gov (United States)

    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...

  3. Fatal overdose from Bendectin.

    Science.gov (United States)

    Bayley, M; Walsh, F M; Valaske, M J

    1975-05-01

    A three-year old male ingested approximately 100 tablets of Bendectin. He developed tonic-clonic seizures followed by cardiac arrest. Toxicologic analysis yielded high levels of doxylamine, dicyclomine, and pyridoxine in blood, peritoneal fluid, and tissue homogenates. The antihistamine, doxylamine succinate appears to be the toxic constituent. Analytical methods used to document the case are herein described.

  4. Fatal poisonings in Oslo: a one-year observational study

    Directory of Open Access Journals (Sweden)

    Heyerdahl Fridtjof

    2010-06-01

    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

  5. Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report Tromboembolismo pulmonar fatal no intra-operatório de gastrectomia por adenocarcinoma gástrico: relato de caso

    Directory of Open Access Journals (Sweden)

    Cláudio Bresciani

    1999-08-01

    Full Text Available The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm, arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST, and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE. If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.Relata-se um caso de paciente com adenocarcinoma gástrico com indicação de gastrectomia. O ato operatório transcorreu sem anormalidades. Foi realizada gastrectomia subtotal paliativa, pois encontrou-se linfonodos para-aórticos comprometidos pela neoplasia, confirmado por exame anátomo-patológico de congelação realizado no decorrer da intervenção. Ao fim da confecção da gastroêntero-anastomose o paciente passou a apresentar bradicardia intensa: 38 batimentos por minuto (bpm, hipotensão arterial, altera

  6. Brazilian spotted fever: description of a fatal clinical case in the State of Rio de Janeiro Febre maculosa brasileira: descrição de um caso fatal no estado do Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Elba Regina Sampaio de Lemos

    2002-10-01

    Full Text Available We describe a case of Brazilian spotted fever in a previously healthy young woman who died with petechial rash associated to acute renal and respiratory insufficiency 12 days following fever, headache, myalgia, and diarrhea. Serologic test in a serum sample, using an immunofluorescence assay, revealed reactive IgM/IgG.Descreve-se um caso de febre maculosa brasileira numa paciente adulta, previamente saudável, que evoluiu para o óbito apresentando um quadro de exantema petequial associado à insuficiência respiratória e renal após 12 dias de doença caracterizada por febre, cefaléia, mialgia e diarréia. Teste de imunofluorescência indireta realizado em amostra de sangue foi reativo para IgM e IgG anti-Rickettsia rickettsii.

  7. Trends and factors associated with dengue mortality and fatality in Brazil

    Directory of Open Access Journals (Sweden)

    Enny Santos Paixão

    2015-08-01

    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.

  8. Fatal rhabdomyolysis after acute sodium monensin (Rumensin® toxicity: case report Rabdomiólise fatal aguda pós-intoxicação por monensina sódica (Rumensin®: relato de caso

    Directory of Open Access Journals (Sweden)

    João Aris Kouyoumdjian

    2001-09-01

    Full Text Available Myoglobinuria or rhabdomyolysis occurs when myoglobin escapes into the blood and then into the urine after acute muscle necrosis. It can be a serious medical condition leading to renal failure and death. There are many causes including exertion, crush syndromes, ischaemia, metabolic disorders, exogenous toxins and drugs, heat stroke and hereditary disorders such as malignant hyperthermia. We report the case of a 17 year-old boy who developed myoglobinuria, renal failure and death 11 days after ingesting sodium monensin, possibly with the intention of developing muscles. Sodium monensin, the active principle of Rumensin®, is a dietary additive used as a growth promoter for confined cattle. There are no previous reports of human intoxication. Accidental or experimental sodium monensin intoxication in animals produces similar findings to those seen in this case.Mioglobinúria ou rabdomiólise refere-se a necrose muscular aguda com liberação de mioglobina na circulação e na urina podendo causar, na sua forma mais grave, insuficiência renal e óbito. A etiologia é ampla, incluindo exercício intenso, síndrome do esmagamento, isquemia, toxinas exógenas, anormalidades metabólicas, medicações, altas temperaturas, além de algumas condições herdadas como hipertermia maligna. Neste relato descreve-se o caso de um paciente jovem, do sexo masculino, que desenvolveu mioglobinúria, insuficiência renal e óbito, 11 dias após ingestão de monensina sódica, princípio ativo de Rumensin®, usado como aditivo alimentar para gado confinado; a ingestão possivelmente foi feita para desenvolvimento muscular. Não há relato na literatura de intoxicação humana e o quadro clínico nos animais com intoxicação experimental ou acidental pelo Rumensin® se assemelha àquele observado no presente caso.

  9. [Autoerotic fatalities in Greater Dusseldorf].

    Science.gov (United States)

    Hartung, Benno; Hellen, Florence; Borchard, Nora; Huckenbeck, Wolfgang

    2011-01-01

    Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide.

  10. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review

    NARCIS (Netherlands)

    Tiemersma, E.W.; van der Werf, M.J.; Borgdorff, M.W.; Williams, B.G.; Nagelkerke, N.J.D.

    2011-01-01

    Background The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting

  11. Investigation of a fatal airplane crash: autopsy, computed tomography, and injury pattern analysis used to determine who was steering the plane at time of accident. A case report

    DEFF Research Database (Denmark)

    Høyer, Christian Bjerre; Nielsen, Trine Skov; Nagel, Lise Loft

    2012-01-01

    A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior to the au......A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior...... to the autopsy. The autopsies showed massive destruction to the bodies of the two victims but did not identify any signs of acute or chronic medical conditions that could explain loss of control of the airplane. PMCT, histological examination, and forensic chemical analysis also failed to identify an explanation...... for the crash. A detailed review of an airplane identical to the crashed airplane was performed in collaboration with the Danish Accident Investigation Board and the Danish National Police, National Centre of Forensic Services. The injuries were described using the abbreviated injury scale, the injury severity...

  12. Muertes por homicidio, consecuencia fatal de la violencia: el caso de Mexico, 1979-1992 Mortality by homicide, the fatal consequences of violence: the case of Mexico, 1979-1992

    Directory of Open Access Journals (Sweden)

    María Victoria López

    1996-02-01

    Full Text Available Se analizaron las muertes registradas como homicidio en México de 1979-1992. El estudio se basó en fuente secundaria, siendo las variables analizadas: año, edad, sexo y causa externa de traumatismos y envenenamientos según CIE IX Rev.(E960-E969. Se utilizó un modelo de regresión Poisson para las causas más frecuentes, obteniendo riesgos relativos según edad y sexo. El grupo de referencia fue el de 10-14 años y el sexo femenino. Se registraron 198,485 muertes por Homicidio, con un promedio anual de 14,177 y diario de 39. La principal causa fue ataque con arma de fuego y explosivos(56%. El riesgo relativo más alto fue para el grupo de 35-39 años, con RR 15,4 IC(95% 14,9-16,0, en comparación al de referencia. El sexo masculino presentó un riesgo relativo 10,1 veces mayor que el femenino, ajustado por edad IC10.0-10.3. Los resultados llaman la atención sobre la necesidad de profundizar y analizar el problema de los homicidios bajo una perspectiva multidisciplinaria.A study of homicide in the population of Mexico, was undertaken for the purpose of discovering the mortality panorama by this cause during 1979-1992. Homicide mortality trends were analized, as well as the main causes by age and sex. Rate by cause and sex were also analized using a Poisson Regression model. The variables were: age, sex, year, external cause of intentional injuries ICD 9th. E960-E969. Results: The total number of deaths due to homicide was 198,485. Each day 35 persons die in Mexico as a result of homicide. Men were more affected than women with a RR of 10.1 and CI (95%14.9-16.0, adjusted for age. The main cause 56% was homicide by firearms and explosives.The high relative risk was for those aged from 35 to 39 with an RR of 15.4 CI 14.9-16.0. To the cause assault by other and unspecified means, the elderly population has a RR of 21.2 IC 19.7-22.9. Further research in the area and prevention should make use of a multidisciplinary approach in considering the

  13. Fatal aluminium phosphide poisoning

    Directory of Open Access Journals (Sweden)

    Meena Mahesh Chand

    2015-06-01

    Full Text Available Aluminium phosphide (AlP is a cheap solid fumigant and a highly toxic pesticide which is commonly used for grain preservation. AlP has currently aroused interest with a rising number of cases in the past four decades due to increased use for agricultural and non-agricultural purposes. Its easy availability in the markets has increased also its misuse for committing suicide. Phosphine inhibits cellular oxygen utilization and can induce lipid peroxidation. Poisoning with AlP has often occurred in attempts to commit suicide, and that more often in adults than in teenagers. This is a case of suicidal consumption of aluminium phosphide by a 32-year-old young medical anesthetist. Toxicological analyses detected aluminium phosphide. We believe that free access of celphos tablets in grain markets should be prohibited by law.

  14. [Fatal poisoning caused by aconite monk's hood (Aconitum napellus)].

    Science.gov (United States)

    Feldkamp, A; Köster, B; Weber, H P

    1991-06-01

    Severe intoxications after ingestion of monk's hood are rare in childhood. We report a case of fatal intoxication in a 20 months old child. There is no specific therapy available. A review of the literature is added.

  15. Fatal Bacillus cereus bacteremia in a patient with diabetes.

    Science.gov (United States)

    Orrett, F A

    2000-04-01

    This report describes a fatal case of Bacillus cereus septicemia in a patient with uncontrolled diabetes and re-emphasizes the potential seriousness of Bacillus infections in patients with compromised immune function.

  16. [Application of hair analysis of selected psychoactive substances for medico-legal purposes. Part II. Cases of complex fatal poisonings: interactions of heroine - cocaine - amphetamines].

    Science.gov (United States)

    Rojek, Sebastian; Kłys, Małgorzata; Rzepecka-Woźniak, Ewa; Konopka, Tomasz

    2010-01-01

    The study represents an attempt at employing segmental hair analysis in complex poisonings with xenobiotic mixtures of heroine - cocaine - amphetamines in the context of the cause of death as a consequence of complex interaction mechanisms which occurred prior to death. Two cases of complex poisonings: heroine - cocaine and heroine - cocaine - amphetamines were analyzed and documented with macro- and microscopic examinations and complex toxicological examinations, including the analysis of classic biological material, i.e. samples of selective blood, and alternative material, i.e. hair samples. Determinations of opioids, cocaine and its metabolite and amphetamines in the hair biological matrix were performed using high performance liquid chromatography--atmospheric pressure chemical ionization--tandem mass spectrometry (HPLC-APCI-MS-MS). Segmental hair analysis of the investigated cases indicated a prolonged intake of similar psychoactive substances and a developed adaptation of the addicted to interaction mechanisms, which, however, led gradually to multiorgan anatomopathological changes, and in consequence to death.

  17. Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003 Hospital case fatality associated with coronary angioplasty in Rio de Janeiro State, Brazil, 1999-2003

    Directory of Open Access Journals (Sweden)

    Paulo Henrique Godoy

    2007-04-01

    Full Text Available O estudo analisa a letalidade hospitalar nas angioplastias coronárias, pagas pelo Sistema Único de Saúde (SUS, realizadas nos hospitais do Estado do Rio de Janeiro, Brasil, de 1999 até 2003. As informações sobre as angioplastias coronárias provieram do banco de Autorizações de Internações Hospitalares da Secretaria de Estado de Saúde do Estado do Rio de Janeiro. As taxas de letalidade foram estimadas segundo faixas etárias, sexo, diagnósticos e hospitais. A letalidade geral foi de 1,9% em 8.735 angioplastias coronárias. A taxa mais baixa ocorreu nas anginas (0,8%, as mais elevadas nos infartos agudos do miocárdio (6% e em outros diagnósticos (7%. A letalidade foi menor nas mulheres na faixa etária entre 50 e 69 anos, e a partir dos setenta anos foi quase três vezes maior que a dos mais jovens (de 1,4 a 4%, em ambos os sexos. Ocorreu grande variabilidade entre as taxas de letalidade nas angioplastias coronárias nos diferentes hospitais (entre 0 e 6,5%. Portanto, é necessário acompanhar de modo contínuo a adequação da utilização da angioplastia coronária. Em conclusão, a performance deste procedimento no âmbito da modalidade de atenção pelo SUS nos hospitais, dentro do período estudado, não foi satisfatória.This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA covered by the Brazilian Unified National Health System (SUS and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8% and the highest rates with acute myocardial infarction (6% and other diagnoses (7%. In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was

  18. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study.

    Science.gov (United States)

    Bazazi, Alexander R; Zelenev, Alexei; Fu, Jeannia J; Yee, Ilias; Kamarulzaman, Adeeba; Altice, Frederick L

    2015-07-01

    Overdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. In 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. All 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9-16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI: 0.5-0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI: 1.9-3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI: 1.1-4.2), as was methamphetamine use (AOR 2.3, CI: 1.3-4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI: 1.5-5.9). This study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment. Copyright © 2014 Elsevier B

  19. Active Surveillance of Child Abuse Fatalities.

    Science.gov (United States)

    Schloesser, Patricia; And Others

    1992-01-01

    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)

  20. Road traffic fatalities among pedestrians, bicyclists and mo-tor vehicle occupants in Sirjan, Kerman, Iran

    Institute of Scientific and Technical Information of China (English)

    Ghorbanali Mohammadi

    2009-01-01

    Objective: To analyze the crash and injury data in forensic medicine for years of 2004-2007. Methods: A sample of over 567 accident cases (9 pedestrians, 116 bicyclists, and 442 motor vehicle occupants) was considered from the Department of Foren-sic Medicine, Shahid Bahonar University of Kerman, in-volving drivers of all ages and covering a four-year period.Results: The male fatality rates were significantly higher than female ones. The groups at 15-30 years old and at 30-55 years old had the first and second highest numbers of deaths (40% and 34%, respectively). There were sub-stantial differences in distribution of injuries in motor ve-hicle occupants and pedestrians and bicyclists. Among motor vehicle occupants, there were more head injuries, such as skull fracture, brain contusion, subdural haemorrhage, and epidural haemorrhage. Nearly 77% of fatalities occurred during 08:00-22:00 in Sirjan. Internal bleeding was also higher in motor vehicle occupants. Pedestrians and bicyclists also had head injuries frequently.Conclusions: In spite of reduction of road traffic fatali-ties in Sirjan in 2007, it is still one of the cities with high road traffic fatality in the world. These results underline the im-portance of preventive strategies in transportation, sug-gesting that different methods are necessary to reduce fa-talities of various traffic participants.

  1. [Fatal methadone poisoning: observations at the CHU of Liege].

    Science.gov (United States)

    Denooz, R; Charlier, C

    2006-01-01

    All methadone-associated deaths from October 2002 to April 2005 are analysed. A regular increase in these fatal intoxications has been recorded, in Belgium as in other countries, due, in particular, to an intensified prescription of this product, of which illicit use as street dope becomes problematic. Over the 30 months period covered by the study, 26 deaths related to methadone were listed, of which 3 occurred in accidental circumstances. In the other 23 cases, methadone can be found, yet always associated with psychotropic substances, mainly benzodiazepines (18 cases), narcotics (15 cases) and finally alcohol (5 cases). Based upon the nature of the products combined with methadone, records have been divided in two groups: In the first group (17 observations), xenobiotics at (infra)therapeutic levels are detected. In the other group (6 observations), xenobiotics at high and toxic levels are detected. Blood methadone concentrations are not so different between the 2 groups of individuals since the median values and the extreme values are worth respectively 308, and 110-11300 microg/L, for the first group and 776 and 93-2080 microg/L for the second group. There is thus an important overlap between the therapeutic blood methadone concentrations (150-400 microg/L) and blood concentrations observed in fatalities.Thus, it is necessary that all information and post-mortem results must be examined in a critical way to identify and justify cause of the death.

  2. Pedestrian fatalities resulting from train-person collisions.

    Science.gov (United States)

    Sousa, Sérgio; Santos, Liliana; Dinis-Oliveira, Ricardo Jorge; Magalhães, Teresa; Santos, Agostinho

    2015-01-01

    Train-person collisions have a significant impact in our society, due to their negative economic and psychological effects. This work aims to study fatalities resulting from train-person collisions in Portugal. A retrospective study was conducted based on the analysis of autopsy reports related to train-person fatalities performed in the North Branch of the National Institute of Legal Medicine and Forensic Sciences. Suicide was responsible for most of the cases, and males were more often involved in train-person collisions than females. Victims, between 40 and 59 years old, were found to be involved in a high percentage (39%) of the cases, and people older than 65 accounted for a significant percentage (40%) of the accidents. No seasonality was observed in suicide cases, but a decrease in accident numbers was registered in summer. Regarding weekday and time of day, afternoon and non-rush hour were the times when most suicides were observed, whereas accidents did not showed a specific weekday or time of day, except for rush hour, during which they were more frequent. Alcohol-positive blood analysis accounting for 25% of the cases. Differences from other European studies were found, which may be related to the different cultures of the countries/regions, as well as to the differences in the railway systems. More extensive studies must be performed in order to develop strategies to prevent train-person collisions.

  3. Fatal Acute Diclofenac-Induced Rhabdomyolysis in A Pediatric Patient

    Directory of Open Access Journals (Sweden)

    Ahmet Güzel

    2011-03-01

    Full Text Available Diclofenac, a widely used nonsteroidal anti-inflammatory drug, has been reported to cause fatal drug-induced rhabdomyolysis very rarely . We report a case of a 13-month-old girl who developed fatal rhabdomyolysis after administration of intramuscular diclofenac for relief of pain caused by a scalding burn injury. Rhabdomyolysis due to diclofenac has not been reported in children. Here, we present the first case report to demonstrate rhabdomylysis secondary to diclofenac administration.

  4. Decision Tree Model for Non-Fatal Road Accident Injury

    Directory of Open Access Journals (Sweden)

    Fatin Ellisya Sapri

    2017-02-01

    Full Text Available Non-fatal road accident injury has become a great concern as it is associated with injury and sometimes leads to the disability of the victims. Hence, this study aims to develop a model that explains the factors that contribute to non-fatal road accident injury severity. A sample data of 350 non-fatal road accident cases of the year 2016 were obtained from Kota Bharu District Police Headquarters, Kelantan. The explanatory variables include road geometry, collision type, accident time, accident causes, vehicle type, age, airbag, and gender. The predictive data mining techniques of decision tree model and multinomial logistic regression were used to model non-fatal road accident injury severity. Based on accuracy rate, decision tree with CART algorithm was found to be more accurate as compared to the logistic regression model. The factors that significantly contribute to non-fatal traffic crashes injury severity are accident cause, road geometry, vehicle type, age and collision type.

  5. Long-term trends in flood fatalities in the United State

    Science.gov (United States)

    Sharif, Hatim; Chaturvedi, Smita

    2015-04-01

    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.

  6. Injury patterns and features of cycling fatalities in South Australia.

    Science.gov (United States)

    Olds, Kelly; Byard, Roger W; Langlois, Neil E I

    2015-08-01

    There has been an increase in cycling in Australia. This means that more cyclists are at risk of injuries, which account for a proportion of transport-related fatalities. In this study, all cyclist fatalities from 2002 to 2013 in South Australia where post-mortem examinations were performed were investigated. There were 42 deaths representing 3% of the total road fatalities over the same time. Of this total number of cases, 13 deaths (31%) involved collapse (mostly natural causes from an underlying medical condition) and 29 (69%) resulted from trauma. There were no cases of hyperthermia. Of the decedents 95% were male, and the mean age at death was 47 years. Fatal incidents were more likely to occur during April and November, and on a Monday. However, statistical analysis was not possible due to the small number of cases. Fatalities (traumatic and collapse) predominantly occurred whilst the cyclist was riding (86%). The majority of riding fatalities were as a result of collision with vehicles (81%). Drugs (including alcohol) were detected in two (15%) of the 13 cases of the collapses, and in seven (26%) of the 27 trauma cases tested. In trauma cases, death was most often due to multiple injuries. The most frequent area for injury was the head (found in 90% of traumatic deaths). Despite the increasing numbers of cyclists on South Australian roads over the last decade, death rates have trended downwards suggesting that road safety campaigns and the provision of more dedicated bicycle lanes have had a positive outcome.

  7. Has the great recession and its aftermath reduced traffic fatalities?

    Science.gov (United States)

    Noland, Robert B; Zhou, Yuhan

    2017-01-01

    An analysis of state-level data from 1984 to 2014 provides evidence on the relationship between economic recessions and US traffic fatalities. While there are large reductions associated with decreases in household median income, other policy variables tend to have additional and in some cases, larger effects. An increase in the inequality of the income distribution, measured by the Gini index, has reduced traffic fatalities. Graduated licensing policies, cell phone laws, and motorcycle helmet requirements are all associated with reductions in fatalities. Other factors include a proxy for medical technology, and access to emergency medical services (based on the percent of vehicle miles traveled in rural areas); reductions in the latter accounted for a substantial reduction in fatalities and is likely another indicator of reduced economic activity. Changes in the road network, mainly increases in the percent of collector roads has increased fatalities. Population growth is associated with increased traffic fatalities and changes in age cohorts has a small negative effect. Overall, results suggest that there has been a beneficial impact on traffic fatalities from reduced economic activity, but various policies adopted by the states have also reduced traffic fatalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Fatal motorcycle accidents and alcohol

    DEFF Research Database (Denmark)

    Larsen, C F; Hardt-Madsen, M

    1987-01-01

    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...

  9. Fifteen years of child drowning--a 1967-1981 analysis of all fatal cases from the Brisbane Drowning Study and an 11 year study of consecutive near-drowning cases.

    Science.gov (United States)

    Nixon, J; Pearn, J; Wilkey, I; Corcoran, A

    1986-06-01

    A total population study of childhood fresh water drowning accidents (fatalities) for the 15 year period, 1967-1981, is reported. These data are from the ongoing Brisbane Drowning Study which has now also analysed 255 fresh water child immersions (both fatalities and near-fatalities) over the eleven year period, 1978-1981, and as such forms a consecutive unselected series for over one decade. The annual fatality (drowning) rate is 3.53 per 100,000. Details of immersion accidents by site, sex and by outcome (survivors versus fatalities) are presented. An analysis of secular trends revealed that one epidemic peak of child drownings in swimming pools and domestic baths (noted in the mid 1970s in Australia and other countries) is now passed. Evidence is presented to suggest that a vigorous education, and public awareness campaign can reduce the incidence of serious child immersion accidents by one-third. Such a campaign may have influence on all types of childhood household drownings (pools, baths, garden ponds), irrespective of site. Survival rates for unsupervised children who lose consciousness in fresh water are site-dependent, only 21% of such potential victims surviving after losing consciousness in rivers and creeks, compared with the survival rate of 65% for those in potential drowning incidents in their own backyard. Violent death continues to account for more than half of all deaths in childhood up to the age of 14 years [Gratz, 1979; Mayer, Walker and Johnson et al., 1981].(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Fatal fulminant hepatic failure related to the use of disulfiram.

    Science.gov (United States)

    Watts, Thomas E; Pandey, Richa A; Vancil, Tobias J

    2014-06-01

    We report a case of fatal fulminant hepatic failure related to the use of disulfiram. This is a commonly used medication; however there are few reported cases in the medical literature of fatal liver failure related to its use. Patients using disulfiram for alcohol cessation typically have multiple risk factors for liver disease and are not acutely candidates for orthotopic liver transplant due to recent alcohol dependence. This case demonstrates a rare adverse reaction to a commonly used medication with a fatal outcome. Our patient was a sixty-six year old man who had recently started using disulfiram for the purpose of alcohol cessation. He developed hepatotoxicity that progressed to fulminant hepatic failure. Despite cessation of the medication and supportive care, the outcome was fatal.

  11. Alcoholic beverages as determinants of traffic fatalities

    OpenAIRE

    José Mª Arranz; Gil, Ana I.

    2008-01-01

    The most important contribution of this research lies in considering the impact of wine, beer and liquors on the ratio of traffic fatalities because each kind of alcoholic beverage is characterized by different ethanol content. The data, drawn for case of Spain, validate our theoretical hypothesis. Our findings support the strategy of incrementing alcohol taxes in order to reduce the negative externalities of alcohol abuse. However, it is necessary to implement non-economic policies because o...

  12. Primary cutaneous amebiasis with a fatal outcome.

    Science.gov (United States)

    Al-Daraji, Wael Ismail; Husain, Ehab A; Ilyas, Mohammed; Robson, Alistair

    2008-08-01

    We report a fatal case of disseminated amebiasis in a young African woman, which initially presented with an ulcerated cutaneous lesion on the left flank. The causative organism was confirmed by examination of a wet drop preparation from the ulcer discharge and by skin biopsy. The patient was not immunosuppressed and was treated unsuccessfully with metronidazole. Postmortem examination revealed the presence of intestinal amebiasis complicated by a liver abscess.

  13. Cunninghamella echinulata causing fatally invasive fungal sinusitis.

    Science.gov (United States)

    LeBlanc, Robert E; Meriden, Zina; Sutton, Deanna A; Thompson, Elizabeth H; Neofytos, Dionissios; Zhang, Sean X

    2013-08-01

    We report a fatal case of invasive fungal sinusitis caused by Cunninghamella echinulata in a febrile, neutropenic 15-year-old male with relapsing acute leukemia. The isolate was recovered from a nasal biopsy from the right middle meatus, and microscopic examination of the tissue revealed angioinvasion and necrosis. Human infection caused by this organism has not been well documented; however, this report alerts us to its life-threatening potential.

  14. Fatal Necrotizing Fasciitis following Episiotomy

    Directory of Open Access Journals (Sweden)

    Faris Almarzouqi

    2015-01-01

    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  15. Analysis of fatal road traffic crashes in Ghana.

    Science.gov (United States)

    Ackaah, Williams; Adonteng, David O

    2011-03-01

    The major objective of this study was to identify the risk factors associated with fatal road traffic crashes (RTCs) and to propose remedial measures to address them. Fatal RTC data for the period 2005-2007 in Ghana were analysed using the Micro-computer Accident Analysis Package (MAAP) software. Other transport-related research works were reviewed and incorporated in the article. The study showed that pedestrians accounted for 42% of all road traffic fatalities and nearly one-third (33%) of these crashes occurred during the early night-time hours. Children alone constituted almost one-third of all pedestrian fatalities. The occupants of goods vehicles accounted for 12% of all road traffic fatalities although goods vehicles constitute just about 9% of the total motor vehicle population in Ghana. Pedestrians, especially children bear a disproportionately high share of road traffic fatalities in Ghana. The risk of being killed as a pedestrian in traffic is exacerbated during night time. Excessive vehicular speeds, inappropriate use of goods vehicles for passenger transport, excessive loading and inadequate trauma care are the key contributory risk factors to the high number of road traffic fatalities. Concerted efforts spanning education, engineering, enforcement and trauma care are needed to stem the rise in fatal crashes in Ghana.

  16. Immunohistochemical, in situ hybridization, and ultrastructural localization of SARS-associated coronavirus in lung of a fatal case of severe acute respiratory syndrome in Taiwan.

    Science.gov (United States)

    Shieh, Wun-Ju; Hsiao, Cheng-Hsiang; Paddock, Christopher D; Guarner, Jeannette; Goldsmith, Cynthia S; Tatti, Kathleen; Packard, Michelle; Mueller, Laurie; Wu, Mu-Zong; Rollin, Pierre; Su, Ih-Jen; Zaki, Sherif R

    2005-03-01

    This article describes the pathological studies of fatal severe acute respiratory syndrome (SARS) in a 73-year-old man during an outbreak of SARS in Taiwan, 2003. Eight days before onset of symptoms, he visited a municipal hospital that was later identified as the epicenter of a large outbreak of SARS. On admission to National Taiwan University Hospital in Taipei, the patient experienced chest tightness, progressive dyspnea, and low-grade fever. His condition rapidly deteriorated with increasing respiratory difficulty, and he died 7 days after admission. The most prominent histopathologic finding was diffuse alveolar damage of the lung. Immunohistochemical and in situ hybridization assays demonstrated evidence of SARS-associated coronavirus (SARS-CoV) infection in various respiratory epithelial cells, predominantly type II pneumocytes, and in alveolar macrophages in the lung. Electron microscopic examination also revealed coronavirus particles in the pneumocytes, and their identity was confirmed as SARS-CoV by immunogold labeling electron microscopy. This report is the first to describe the cellular localization of SARS-CoV in human lung tissue by using a combination of immunohistochemistry, double-stain immunohistochemistry, in situ hybridization, electron microscopy, and immunogold labeling electron microscopy. These techniques represent valuable laboratory diagnostic modalities and provide insights into the pathogenesis of this emerging infection.

  17. A case-control study of community-acquired Acinetobacter baumannii pneumonia and melioidosis pneumonia in northeast Thailand: an emerging fatal disease with unique clinical features.

    Science.gov (United States)

    Patamatamkul, Samadhi; Klungboonkrong, Voravan; Praisarnti, Pakawas; Jirakiat, Kittitouch

    2017-01-01

    Acinetobacter baumannii is the emerging cause of severe and often fatal gram-negative, community-acquired pneumonia (CAP-AB) in Thailand. Due to its rarity, its specific clinical features are ill defined. In this retrospective study, we compared the demographic data, risk factors, clinical characteristics, radiographic pattern, and microbiological data between CAP-AB and Burkholderia pseudomallei CAP (CAP-BP) to identify the clinical features and risk factors of CAP-AB. CAP-AB was associated with a more productive cough and a shorter duration of symptoms, while CAP-BP was associated with more musculoskeletal symptoms. The white blood cell and neutrophil counts were significantly lower in the CAP-AB group. Gram staining of the sputum revealed a significantly higher amount of bacteria in the CAP-AB group. Lobar infiltration and unilateral right lung involvement were the most common radiographic patterns in the CAP-AB group. CAP-AB is associated with severe pneumonia and has unique clinical features that distinguish it from CAP-BP.

  18. Fatal accidents among Danes with multiple sclerosis

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Hansen, Thomas; Koch-Henriksen, Nils

    2006-01-01

    We compared the rate of fatal accidents among Danes with multiple sclerosis (MS) with that of the general population. The study was based on linkage of the Danish Multiple Sclerosis Registry to the Cause of Death Registry and covered all 10174 persons in whom MS was diagnosed during the period 1953......-1996. The end of follow-up was 1 January 1999. We calculated standardized mortality ratios (SMRs) for various types of fatal accidents. A total of 76 persons (48 men and 28 women) died from accidents, whereas the expected number of fatalities from such causes was 55.7 (31.4 men and 24.3 women). Thus, the risk...... for death from accidents among persons with MS was 37% higher than that of the general population (SMR = 1.37). We found no significant excess risk for fatal road accidents (SMR = 0.80). The risk for falls was elevated (SMR = 1.29) but not statistically significantly so. The risks were particularly high...

  19. Fatal poisoning among patients with drug addiction.

    Science.gov (United States)

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte; Linnet, Kristian; Andersen, Ljubica V

    2015-10-01

    Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. All fatal poisonings examined at the three institutes of forensic medicine in Denmark in 2012 were included in the study. A total of 188 fatal intoxications were recorded. The median age increased from 37.5 in 2007 to 41.5 in 2012. The majority were men (77%). Methadone (59%) was the main intoxicant. The decrease in the frequency of heroin/morphine deaths since 1997 (71%) continued, declining to 44% in 2002, 33% in 2007 and finally to 27% in 2012. Few deaths from central stimulants (amphetamine and cocaine) occurred. Multiple drug use was common and consisted mainly of opioids, cocaine, amphetamine, cannabis, benzodiazepines and alcohol. Heroin/morphine use was most frequent on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone was the main intoxicant. The increase in methadone deaths seems to be associated with use of methadone in substitution treatment. Nevertheless, methadone treatment also seems to save lives, as indicated by the increasing median age. Use of antidepressants and antipsychotics increased to a high level compared with 2007, indicating that a considerable number of drug addicts also have psychiatric illness. none. not relevant.

  20. Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System.

    Science.gov (United States)

    Byler, Christen; Kesy, Laura; Richardson, Scott; Pratt, Stephanie G; Rodríguez-Acosta, Rosa L

    2016-07-01

    Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to

  1. 云南地区旋毛虫病致死9例的分布及病理学特点分析%Analysis of Distribution and Pathological Characteristics of 9 Fatal Trichinosis Cases in Yunnan

    Institute of Scientific and Technical Information of China (English)

    刘翔; 杨利萍; 白桦; 赵以诚

    2013-01-01

    Objective To explore forensic pathology features of the fatal trichinosis cases and to summarize the population distribution characteristics of trichinosis in Yunnan. Methods Nine recent fatal trichinosis cases were collected from the Forensic Science Identification Center of Kunming Forensic Hospital. Pathological and epidemiological characteristics of trichinosis were analyzed. Results The nine cases were all died in heart failure due to myocarditis. Among them,1 case was complicated by encephalitis and 3 cases were complicated by pneumonia. The population mainly involved Bai and Dai nationalities. The geographic distribution was concentrated in Dali,Dehong,Lincang,Xishuangbanna,etc. The cases commonly appeared in winter and spring. Conclusion The cause of trichinosis is closely due to the habit of eating raw pork. It can be diagnosis through the pathological changes of the muscle system in the death cases.%目的 分析云南地区旋毛虫病致死案例的法医病理学特点,并总结和分析旋毛虫病在云南地区的人群分布特点. 方法 收集近年来昆明法医院司法鉴定中心受理的旋毛虫病致死法医病理学案件9例,对旋毛虫病病理学及流行病学特点进行分析.结果 9例旋毛虫病致死案例均系心肌炎并发心力衰竭死亡,其中1例合并脑炎,3例合并肺炎.人群分布主要为白族、傣族人群.地域分布多集中在大理、德宏、临沧、西双版纳等地.流行时间多集中在冬春季. 结论 旋毛虫病的发病原因与生食猪肉的习惯密切相关,其死亡案例中肌肉系统的病理改变可作为诊断的主要依据.

  2. Correlation Research of Fever and Case Fatality Rate in Patients with Craniocerebral Injury in ICU%ICU颅脑损伤患者发热与病死率相关性的研究

    Institute of Scientific and Technical Information of China (English)

    徐建民; 叶媛; 孟新科; 甑云

    2014-01-01

    Objective To evaluate the predictors of fever with in patients,and to study the ef ect of fever on in-hospital case fatality.Methods Retrospective data col ection of consecutive patients admit ed to the intensive care unit(ICU).Neurological patients were matched by sex,age,and Acute Physiology and Chronic Health Evaluation II(APACHE-II) to a cohort of nonneurological patients.Fever was defined as any temperature>37.5℃within the first 24 hours upon admission to the ICU.The primary outcome measure was in-hospital case fatality.Results Mean age among neurological patients was 65.5±14 years,47%were men,and median APACHE-II was 15 (interquartile range 11-20).More neurological patients experienced fever than nonneurological patients.The mean hospital length of stay was higher for nonneurological patients,and more neurological patients were dead at hospital discharge (30%vs 20%, <0.05).The fol owing variables were associated with higher in-hospital case fatality:APACHE-II,neurological diagnosis,mean arterial pressure,cardiovascular and respiratory dysfunction in ICU,and fever.Conclusion These data suggest that fever is a frequent occurrence after brain injury,and that it is associated with in-hospital case fatality.%目的探讨ICU颅脑损伤患者发热发生的危险因素以及发热与病死率相关性。方法对入选的72例患者临床资料进行分析,脑损伤患者患者分别按性别、年龄(±2年)、以及疾病的严重程度(APACHE-域评分±5分)与非脑损伤患者进行匹配。入住ICU第一个24h内的最高温度高于37.5℃者确定为发热。主要转归指标为病死率。结果36例脑损伤患者年龄为65.5±14年,47豫为男性,平均APACHE-域评分为15(IQR11-20)。平均住院时间脑损伤患者明显低于非脑损伤患者。相较于非神经系统患者来说,脑损伤患者的平均最高温度更高,入住ICU后脑损伤患者发热更易出现。两组相比较脑损伤患者病死率

  3. Fatal poisoning in drug addicts in the Nordic countries

    DEFF Research Database (Denmark)

    Steentoft, Anni; Teige, Brita; Ceder, Gunnel

    2001-01-01

    . For all countries the distribution of deaths according to geographical regions showed a decreasing number of drug deaths in the metropolitan area and an increasing number in other cities. Heroin/ morphine dominated as the cause of death and was responsible for about 90% of the cases in Norway. In Sweden...... and Denmark, however, heroin/morphine caused only about 70% of the fatal poisonings. About 30% of the fatal poisonings in Denmark and Sweden were caused by other group I drugs, in Denmark mainly methadone and in Sweden mainly propoxyphene. Apart from two cases in Sweden methadone deaths were not seen...... in the other Nordic countries. In Finland heroin/morphine deaths have increased from about 10% in 1991 to about 40% in 1997. Forty-four percent of the fatal poisonings in Finland were caused by other group I drugs, mainly codeine and propoxyphene. The two fatal poisonings in Iceland were caused by carbon...

  4. Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia.

    Science.gov (United States)

    Duong, Veasna; Mey, Channa; Eloit, Marc; Zhu, Huachen; Danet, Lucie; Huang, Zhong; Zou, Gang; Tarantola, Arnaud; Cheval, Justine; Perot, Philippe; Laurent, Denis; Richner, Beat; Ky, Santy; Heng, Sothy; Touch, Sok; Sovann, Ly; van Doorn, Rogier; Tan Tran, Thanh; Farrar, Jeremy J; Wentworth, David E; Das, Suman R; Stockwell, Timothy B; Manuguerra, Jean-Claude; Delpeyroux, Francis; Guan, Yi; Altmeyer, Ralf; Buchy, Philippe

    2016-09-21

    Human enterovirus 71 (EV-A71) causes hand, foot and mouth disease (HFMD). EV-A71 circulates in many countries and has caused large epidemics, especially in the Asia-Pacific region, since 1997. In April 2012, an undiagnosed fatal disease with neurological involvement and respiratory distress occurred in young children admitted to the Kantha Bopha Children's Hospital in Phnom Penh, Cambodia. Most died within a day of hospital admission, causing public panic and international concern. In this study, we describe the enterovirus (EV) genotypes that were isolated during the outbreak in 2012 and the following year. From June 2012 to November 2013, 312 specimens were collected from hospitalized and ambulatory patients and tested by generic EV and specific EV-A71 reverse transcription PCR. EV-A71 was detected in 208 clinical specimens while other EVs were found in 32 patients. The VP1 gene and/or the complete genome were generated. Our phylogenetic sequencing analysis demonstrated that 80 EV-A71 strains belonged to the C4a subgenotype and 3 EV-A71 strains belonged to the B5 genotype. Furthermore, some lineages of EV-A71 were found to have appeared in Cambodia following separate introductions from neighboring countries. Nineteen EV A (CV-A6 and CV-A16), 9 EV B (EV-B83, CV-B3, CV-B2, CV-A9, E-31, E-2 and EV-B80) and 4 EV C (EV-C116, EV-C96, CV-A20 and Vaccine-related PV-3) strains were also detected. We found no molecular markers of disease severity. We report here that EV-A71 genotype C4 was the main etiological agent of a large outbreak of HFMD and particularly of severe forms associated with central nervous system infections. The role played by other EVs in the epidemic could not be clearly established.

  5. Car Crash Fatalities Associated With Fire in Sweden

    OpenAIRE

    Viklund, Åsa; Björnstig, Johanna; Larsson, Magnus; Björnstig, Ulf

    2013-01-01

    Objective: To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods: The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998-2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results: In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and mi...

  6. Risk Factors for Fatal Recurrence of Liver Transplant Recipients with Hepatocellular Carcinoma in the First Year

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To investigate the clinicopathological risk factors for fatal recurrence of hepatocellular carcinoma (HCC) in orthotopic liver transplant recipients in the first year. Methods: From April 2002 to October 2005, 303 recipients who received orthotopic liver transplantation for HCC were reviewed. Of These patients, those who demonstrated diffuse intra-hepatic or multiple systemic recurrent lesions and died within 1 y after surgery were investigated (fatal recurrence group, 48 cases). The remaining patients were designated as the control group, and the two groups were compared for clinicopathologic risk factors by logistic regression analysis. Results: Among the 303 patients reviewed, 48 patients were enrolled in the fatal recurrence group (15.84%). Multivariate analysis between the fatal recurrence group and control group showed that the presence of vascular invasion, tumor size greater than 6.5 cm, and pre-operative serum alpha-fetoprotein (AFP) level greater than 1000 μg/L were the risk factors in the fatal recurrence group. 85.71% of the patients who had all the three risk factors, 37.84% of those who had two risk factors, 13.64% of those who had one risk factors, and 6.71% of those who had none risk factors died because of recurrence within 1 y after transplantation. Conclusion: Three distinct risk factors attributed to fatal recurrence of liver transplant recipients for HCC are vascular invasion, tumor size ≥6.5 cm, and pre-operative serum AFP level ≥1000 μg/L. The high risk HCC patients with two or more risk factors should not to be the candidates for liver transplantation.

  7. Intoxications with the monoamine oxidase inhibitor tranylcypromine: an analysis of fatal and non-fatal events.

    Science.gov (United States)

    Gahr, Maximilian; Schönfeldt-Lecuona, Carlos; Kölle, Markus A; Freudenmann, Roland W

    2013-11-01

    Tranylcypromine (TCP) is a non-selective and irreversible monoamine oxidase inhibitor and an effective agent in the treatment of major depression. It features a complex pharmacologic profile and overdoses might induce severe intoxications. To identify typical clinical presentations of TCP-intoxications, range of associated TCP-dosages and possible differences between fatal and non-fatal intoxications a systematic review of all previously published cases of TCP-intoxications was conducted. We detected n=20 reports of TCP-intoxications in the literature (fatalities n=10). Mean age was 36.7 years (median 37); the majority of patients were female (60%). Frequent findings in patients with TCP-intoxications were disturbance of consciousness/cognitive dysfunction (90%), cardio-vascular symptoms (55%), hyperthermia (50%), respiratory distress (45%), delirium (45%), muscular rigidity (30%) and renal failure (20%). Suicidal intent was present in n=18 (90%) patients. First clinical symptoms related to TCP-intoxication developed on average in less than 1 day. The average dosage related to TCP-intoxication was 677 mg. The highest survived TCP-dosage was 4000 mg and the lowest fatal dosage was 170 mg. Patients with fatal intoxications were on average older (40.5 vs. 32.8 years) and developed a more rapid onset of symptoms (0.2 vs. 0.8 days). Death occurred after a mean time of 0.6 days; symptom relief in patients with non-fatal intoxications developed on average after 3.2 days. Considering the large dose spectrum between survived and lethal TCP-dosages individual susceptibility factors might play a role regarding the severity of clinical symptoms independently of the ingested dosage.

  8. Allegheny County Fatal Accidental Overdoses

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Fatal accidental overdose incidents in Allegheny County, denoting age, gender, race, drugs present, zip code of incident and zip code of residence. Zip code of...

  9. Lessons from the past: familial aggregation analysis of fatal pandemic influenza (Spanish flu) in Iceland in 1918.

    Science.gov (United States)

    Gottfredsson, Magnús; Halldórsson, Bjarni V; Jónsson, Stefán; Kristjánsson, Már; Kristjánsson, Kristleifur; Kristinsson, Karl G; Löve, Arthur; Blöndal, Thorsteinn; Viboud, Cécile; Thorvaldsson, Sverrir; Helgason, Agnar; Gulcher, Jeffrey R; Stefánsson, Kári; Jónsdóttir, Ingileif

    2008-01-29

    The pandemic influenza of 1918 (Spanish flu) killed 21-50 million people globally, including in Iceland, where the characteristics and spread of the epidemic were well documented. It has been postulated that genetic host factors may have contributed to this high mortality. We identified 455 individuals who died of the Spanish flu in Iceland during a 6-week period during the winter of 1918, representing >92% of all fatal domestic cases mentioned by historical accounts. The highest case fatality proportion was 2.8%, and peak excess mortality was 162/100,000/week. Fatality proportions were highest among infants, young adults, and the elderly. A genealogical database was used to study relatedness and relative risk (RR) of the fatal influenza victims and relatives of their unaffected mates. The significance of these RR computations was assessed by drawing samples randomly from the genealogical database matched for age, sex, and geographical distribution. Familial aggregation of fatalities was seen, with RRs for death ranging from 3.75 for first-degree relatives (P Spanish flu was similar within families of patients who succumbed to the illness and within families of their mates who survived. Our data do not provide conclusive evidence for the role of genetic factors in susceptibility to the Spanish flu.

  10. Fatal interstitial lung disease associated with high erlotinib and metabolite levels. A case report and a review of the literature.

    NARCIS (Netherlands)

    Heine, R. ter; Bosch, R.T. van den; Schaefer-Prokop, C.M.; Lankheet, N.A.; Beijnen, J.H.; Staaks, G.H.; Westerlaken, M.M. van der; Malingre, M.M.; Brand, J.J. van den

    2012-01-01

    INTRODUCTION: Erlotinib is an agent in the class of oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. Although this class of agents is considered to be relatively safe, the most serious, but rare, adverse reaction is drug-associated interstitial lung disease (ILD). This potent

  11. Fatal respiratory distress syndrome due to coronavirus infection in a child with severe combined immunodeficiency.

    Science.gov (United States)

    Szczawinska-Poplonyk, Aleksandra; Jonczyk-Potoczna, Katarzyna; Breborowicz, Anna; Bartkowska-Sniatkowska, Alicja; Figlerowicz, Magdalena

    2013-09-01

    Coronaviruses have been demonstrated to contribute substantially to respiratory tract infections among the child population. Though infected children commonly present mild upper airway symptoms, in high-risk patients with underlying conditions, particularly in immunocompromised children these pathogens may lead to severe lung infection and extrapulmonary disorders. In this paper, we provide the first report of the case of a 15-month-old child with severe combined immunodeficiency and coronavirus HKU1-related pneumonia with fatal respiratory distress syndrome.

  12. Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers.

    Science.gov (United States)

    Meissner, Christoph; Recker, Sabine; Reiter, Arthur; Friedrich, Hans Juergen; Oehmichen, Manfred

    2002-11-05

    The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.

  13. Highly Concentrated Acetic Acid Poisoning: 400 Cases Reviewed

    Directory of Open Access Journals (Sweden)

    Konstantin Brusin

    2012-12-01

    Full Text Available Background: Caustic substance ingestion is known for causing a wide array of gastrointestinal and systemic complications. In Russia, ingestion of acetic acid is a major problem which annually affects 11.2 per 100,000 individuals. The objective of this study was to report and analyze main complications and outcomes of patients with 70% concentrated acetic acid poisoning. Methods: This was a retrospective study of patients with acetic acid ingestion who were treated at Sverdlovsk Regional Poisoning Treatment Center during 2006 to 2012. GI mucosal injury of each patient was assessed with endoscopy according to Zargar’s scale. Data analysis was performed to analyze the predictors of stricture formation and mortality. Results: A total of 400 patients with median age of 47 yr were included. GI injury grade I was found in 66 cases (16.5%, IIa in 117 (29.3%, IIb in 120 (30%, IIIa in 27 (16.7% and IIIb in 70 (17.5%. 11% of patients developed strictures and overall mortality rate was 21%. Main complications were hemolysis (55%, renal injury (35%, pneumonia (27% and bleeding during the first 3 days (27%. Predictors of mortality were age 60 to 79 years, grade IIIa and IIIb of GI injury, pneumonia, stages “I”, “F” and “L” of kidney damage according to the RIFLE scale and administration of prednisolone. Predictors of stricture formation were ingestion of over 100 mL of acetic acid and grade IIb and IIIa of GI injury. Conclusion: Highly concentrated acetic acid is still frequently ingested in Russia with a high mortality rate. Patients with higher grades of GI injury, pneumonia, renal injury and higher amount of acid ingested should be more carefully monitored as they are more susceptible to develop fatal consequences.          

  14. Clinical diagnosis versus autopsy findings in polytrauma fatalities

    Directory of Open Access Journals (Sweden)

    Fakler Johannes K

    2010-10-01

    Full Text Available Abstract Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008 from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%, the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16% patients while obvious differences in interpreting the cause of death were found in another three (16% cases. Five fatalities (three with obvious differences and two with marginal differences were remarked as early death (1-4 h after trauma and one fatality with marginal differences as late death (>1 week after trauma. Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

  15. Community Poverty and Child Abuse Fatalities in the United States.

    Science.gov (United States)

    Farrell, Caitlin A; Fleegler, Eric W; Monuteaux, Michael C; Wilson, Celeste R; Christian, Cindy W; Lee, Lois K

    2017-05-01

    Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources. Copyright © 2017 by the American Academy of Pediatrics.

  16. [Co-infection by Chikungunya virus (CHIK-V) and dengue virus (DEN-V) during a recent outbreak in Cali, Colombia: Report of a fatal case].

    Science.gov (United States)

    Rosso, Fernando; Pacheco, Robinson; Rodríguez, Sarita; Bautista, Diego

    2016-08-01

    The recent outbreaks of Chikungunya (CHIK-V) virus in endemic areas of dengue (DEN-V) could increase the risk of co-infection. CHIK infection has been considered not severe and with very unusual mortality, however DEN is associated with severe manifestations and increased mortality. Little is known about coinfection. It is possible that co-infection could generate severe cases. We present a case report of co-infection DEN-V -3 and CHIK-V in an elderly patient who developed acute renal failure, dengue shock syndrome (DSS), progresses to multiple organ failure and died. With the recent emergence of CHIK-V in Colombia, the possibility of co-infection with DEN-V should be suspected, especially in severe cases.

  17. FATAL QUARTET OR QUINTET?

    Directory of Open Access Journals (Sweden)

    Y. V. Sviryaev

    2011-01-01

    Full Text Available Correction of potential risk factors is essential for effective therapy for cardiovascular diseases. This clinical case demonstrates negative impact of non-corrected risk factors — obstructive sleep apnea — in occurrence and further progression of cardiovascular disease.

  18. FATAL TRACHEO-INNOMINATE ARTERY FISTULA ASSOCIATED WITH A TRACHEOSTOMY TUBE AT A TEACHING UNIVERSITY HOSPITAL IN ADDIS ABABA: CASE REPORT AND REVIEW OF LITERATURE.

    Science.gov (United States)

    Bekele, Abebe; Tesfaye, Samuel

    2015-07-01

    Tracheo-innominate artery fistula (TIAF) is a potentially lethal but rare complication associated with tracheostomy. As tracheostomies are one of the common life saving procedures that are performed routinely in the country, bring this complication to the attention of all health care professionals is of paramount importance. Hence, this case report is prepared.

  19. Pediatric epidemiological aspects of scorpionism and report on fatal cases from Tityus stigmurus stings (Scorpiones: Buthidae in State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Cleide Maria Ribeiro de Albuquerque

    2013-08-01

    Full Text Available Introduction Envenomation by scorpion stings is a major public health problem in numerous tropical countries because of its frequent incidence and potential severity. Approximately 1,900 species of scorpions are known in the world, and at least 130 of these have been described in Brazil. Methods This work reports on 3 child deaths caused by Tityus stigmurus stings and characterizes epidemiological and clinical surveys on pediatric cases of scorpionism recorded in the Centro de Assistência Toxicológica de Pernambuco (Ceatox-PE. Results Scorpion stings accounted for more than 60% of all cases recorded for venomous animals. The children were from 37 cities of the Pernambuco state and accounted for 28.8% of the victims treated for scorpion stings, with the highest incidence in the metropolitan area of Recife. Stings occurred throughout the year and slightly increased during the rainy season. Independent of the elapsed time for a prognosis, most cases showed mild symptoms. Three moderate cases that resulted in death featured cardiogenic shock and/or pulmonary edema or severe neurological symptoms. For the first time, death attributed to T. stigmurus was confirmed by the presence of the scorpion. Conclusions These results suggest that scorpionism in Pernambuco is a public health problem that needs to be monitored carefully throughout the year by the government.

  20. Letalidade na epidemiologia da doença meningocócica: estudo na região de Campinas, SP, 1993 a 1998 Case fatality rate for meningococcal disease: study in the region of Campinas, SP, Brazil 1993 to 1998

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    Maria Rita C Donalisio

    2000-12-01

    surveillance system was carried out. A logistic regression analysis allowed identifying the risk factors related to fatal outcomes of meningococcal disease. RESULTS: The highest fatality rates (23.8% were seen in the period of 1996 and 1997, coinciding with the incidence peaks of serogroup B Neisseria and a high percentage of septicemia cases. Also at the same period there was registered a poor etiological investigation of the cases. A seasonal pattern and the predomination of strains B:4:P1.15 and C:2b:P1.3 were observed. In the logistic regression analysis, the risk factors related to fatality were: septicemia with or without meningitis (adjusted odds ratio [ORa] = 13.88 and 95% confidence interval [CI] = 4.68--42.13; age over 30 years (ORa = 6.42; CI = 2.32--17.80; age under 1 year (ORa = 2.95; CI = 1.55--5.63; and serogroup B (ORa = 2.33; CI = 1.14--4.79. CONCLUSIONS: Septicemia, age and serogroup were predictive variables related to a fatal outcome. In 1996 and 1997, case-fatality rates were high, indicating the need to further assessment of the quality of the services delivered and their readiness to take preventive action. The lack of etiological identification in many cases precluded more accurate inferences about the epidemiological behavior of Neisseria meningitidis in the region.

  1. A social gradient in fatal opioids and cocaine related overdoses?

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    Alain Origer

    Full Text Available To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011.Overdose cases were individually matched with four controls in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. The study sample, composed of 272 cases and 1,056 controls, was stratified according to a Social Inequality Accumulation Score (SIAS, based on educational attainment, employment, income, financial situation of subjects and the professional status of their father or legal guardian. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII of the study sample.A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group. In terms of the Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.88 times as high as that of their peers from the highest socioeconomic group (95% CI 6.49-13.26.Our findings suggest the existence of a marked social gradient in opioids and cocaine related overdose fatalities. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social (reintegration but crucially in order to meet their most important objective, that is to reduce drug-related mortality.

  2. A social gradient in fatal opioids and cocaine related overdoses?

    Science.gov (United States)

    Origer, Alain; Le Bihan, Etienne; Baumann, Michèle

    2015-01-01

    To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011. Overdose cases were individually matched with four controls in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. The study sample, composed of 272 cases and 1,056 controls, was stratified according to a Social Inequality Accumulation Score (SIAS), based on educational attainment, employment, income, financial situation of subjects and the professional status of their father or legal guardian. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII) of the study sample. A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group. In terms of the Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.88 times as high as that of their peers from the highest socioeconomic group (95% CI 6.49-13.26). Our findings suggest the existence of a marked social gradient in opioids and cocaine related overdose fatalities. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social (re)integration but crucially in order to meet their most important objective, that is to reduce drug-related mortality.

  3. FATAL EFFECTS OF HYPERKALEMIA

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    Mohammed

    2015-09-01

    Full Text Available Hyperkalemia is one of the few potentially lethal electrolyte disturbances. Prompt recognition and treatment of severe hyperkalemia are expected to save lives. Electrocardiographic manifestations of hyperkalemia vary from the classic sine - wave rhythm, whic h occurs in severe hyperkalemia, to nonspecific repolarization abnormalities seen with mild elevations of serum potassium. We present a case of hyperkalemia and review of causes of hyperkalemia is presented, examining the electrophysiological and electroca rdiographic changes that occur as serum potassium levels increase.

  4. Diving fatality investigations: recent changes.

    Science.gov (United States)

    Edmonds, Carl; Caruso, James

    2014-06-01

    Modifications to the investigation procedures in diving fatalities have been incorporated into the data acquisition by diving accident investigators. The most germane proposal for investigators assessing diving fatalities is to delay the drawing of conclusions until all relevant diving information is known. This includes: the accumulation and integration of the pathological data; the access to dive computer information; re-enactments of diving incidents; post-mortem CT scans and the interpretation of intravascular and tissue gas detected. These are all discussed, with reference to the established literature and recent publications.

  5. Histopathological findings in fatal novel H1N1: an autopsy case series from September-November 2009 in New Orleans, Louisiana.

    Science.gov (United States)

    Springer, Jeffrey; Safley, Matthew; Huber, Samantha; Troxclair, Dana; Craver, Randall; Newman, William P; McGoey, Robin R

    2010-01-01

    Autopsy findings are presented on six patients in the greater New Orleans area with confirmed novel H1N1 in New Orleans, Louisiana, between the months of September to November 2009. Each case was reviewed for antemortem clinical data as well as pre-existing comorbidities. Results from postmortem gross, histological and bacteriologic analyses are detailed and support the assertion that pathologic findings associated with novel H1N1 are similar to those attributed to previous pandemics, though the rate of bacterial super-infection is variable and may depend on the analytical method of microbiologic testing. The current case series is also remarkable for the associated rate of pulmonary thromboemboli and acute renal failure as potential clinical associations with the current pandemic.

  6. Fatal measles pneumonitis during Hodgkin's lymphoma.

    Science.gov (United States)

    Wyplosz, Benjamin; Lafarge, Marion; Escaut, Lélia; Stern, Jean-Baptiste

    2013-10-08

    The treatment of measles pneumonitis in immunocompromised adults is not established. We describe a patient with Hodgkin's lymphoma who developed acute pneumonia during a measles infection. On day 13, intravenous ribavirin and immunoglobulins were administrated. On day 18, the patient developed acute respiratory failure. An examination of transbronchial pulmonary biopsies showed Warthin-Finkeldey giant cells that are pathognomonic of measles pneumonitis. The patient died despite aggressive supportive care. Our case and a review of literature show that measles pneumonitis is routinely fatal in patients with cancer. We suggest that antiviral drugs should be considered as soon as the diagnosis has been established.

  7. Fatal outbreak of botulism in Greenland

    DEFF Research Database (Denmark)

    Hammer, Tóra Hedinsdottir; Jespersen, Sanne; Kanstrup, Jakob

    2015-01-01

    Botulism commonly occurs when the anaerobic, gram-positive bacterium Clostridium botulinum, under suitable conditions, produces botulinum neurotoxins. Named A-F, these toxins are the immediate causative agent of the clinical symptoms of symmetrical, descending neurological deficits, including...... recovery was complete. Microbiological assays, including toxin neutralization bioassay, demonstrated the presence of neurotoxin E in two survivors. The third survivor was shown by PCR to have the BoNT type E gene in faeces. This is the first report of cases of fatal botulism in Greenland. It underscores...

  8. Clash of Desires: Detective vs. Femme Fatale

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    Veronika Pituková

    2013-06-01

    Full Text Available This article discusses the theme of desire presented in American hard-boiled detective fiction and its subsequent transformation on the screen in form of films noir of the 1940’s. The works in focus are novels The Maltese Falcon by Dashiell Hammett, Farewell, My Lovely by Raymond Chandler and Build My Gallows High by Daniel Mainwaring and their film noir adaptations – The Maltese Falcon (1941, Murder, My Sweet (1944 and Out of the Past (1947. The proposed paper seeks to offer a contrastive analysis of the novels and the films and situate them in their respective social and cultural contexts. The central conflict of this article is presented by the clash between the femme fatale’s and detective’s desires. Hard-boiled novels present femme fatale as a dame with a past, a spider woman, and the detective as a hero with no future, caught in her web of intrigues. The only way out for the detective is to suppress the sexual desire for the woman and hold strong to his professional code. The femme fatale’s desire for more and for better is deadly and dangerous for those who succumb to her lure, but the detective’s desire for truth can be fatal for the dark lady too.  This clash presented in the novels is confronted with the 1940’s Hollywood production. When the detective frees himself from the sexual lure of the fatal woman he has a chance to live and even bring her to justice, but she can still escape or decide herself what to do with her destiny. Both, the dame and the hero are victims of their desires. The 1940’s films noir’s femme fatales have to pay for their crimes, no matter how crafty, seductive or manipulative they are.  Thus these films present the masculine dominance as strong and undefeated.

  9. Is 2 weeks of antibiotic therapy enough to treat elderly patients with nontyphoid Salmonella bacteremia? A case report of fatal endovascular infection.

    Science.gov (United States)

    Chen, Po-Lin; Tsai, Liang-Miin; Kan, Chung-Dann; Ko, Wen-Chien

    2014-08-01

    Nontyphoid Salmonella (NTS) can cause invasive diseases in the elderly. Notably, the most feared complication of NTS bacteremia is endovascular infection. The risk factors for infected aortic aneurysm include old age and atherosclerosis. Extended use of antimicrobial therapy (> 2 weeks) for NTS bacteremia should be considered for those who demonstrate the risk factors for endovascular infection, even when a metastatic focus is clinically elusive. Herein, we report the case of a 75-year-old patient with diabetes mellitus, hypertension, chronic kidney disease, and myocardial infarction who died of an infected aortic aneurysm despite 3 weeks of antibiotic therapy that was administered to treat the initial NTS bacteremia.

  10. Tissue microscopic changes and artifacts in multi-phase post-mortem computed tomography angiography in a hospital setting: a fatal case of systemic vasculitis.

    Science.gov (United States)

    Capuani, Caroline; Guilbeau-Frugier, Céline; Mokrane, Fatima-Zohra; Delisle, Marie-Bernadette; Marcheix, Bertrand; Rousseau, Hervé; Telmon, Norbert; Rougé, Daniel; Dedouit, Fabrice

    2014-09-01

    A 27-year-old man suddenly died in hospital of acute respiratory distress syndrome secondary to severe systemic vasculitis. Multi-phase post-mortem computed tomography angiography followed by scientific autopsy of the thoracic and abdominal cavity and histology was performed, illustrating the advantages and drawbacks of such techniques. Imaging enabled us to examine the cranium, as the family refused cerebral dissection. MPMCTA revealed absence of opacification of the left middle cerebral artery. But parenchymal findings of thoracic and abdominal organs were still difficult to interpret after both imaging and macroscopic examination during the autopsy. Microscopic examination provided the definitive diagnosis of cause of death. Analysis revealed systemic vasculitis of the lung complicated by diffuse alveolar, mediastinal, splenic and retroperitoneal lesions. We were unable to determine the type of vasculitis, whether polyarteritis nodosa or microscopic polyangiitis, because of artifactual glomerular collapse. We observed some structural changes in tissue secondary to contrast agent injection, affecting the vascular system and renal parenchyma in particular. Such artifacts must be known in order to avoid misinterpreting them as pathological findings. MPMCTA and conventional autopsy are two complementary techniques showing both their specific advantages and limits which have to be known in order to choose the appropriate technique. One limit of both techniques is the detection of microscopic findings which can only be obtained by additional histological examination. This case report underlines this fact and demonstrates that caution is required in some cases if microscopic analyses are carried out after contrast agent injection.

  11. Fatal hepatitis B reactivation treated with entecavir in an isolated anti-HBs positive lymphoma patient: a case report and literature review.

    Science.gov (United States)

    Ferreira, Rosa; Carvalheiro, Joana; Torres, Joana; Fernandes, Alexandra; Giestas, Sílvia; Mendes, Sofia; Agostinho, Cláudia; Campos, Mário J

    2012-01-01

    Hepatitis B virus (HBV) reactivation is a well-recognized complication that occurs in lymphoma patients who undergo chemotherapy. Only very few cases of HBV reactivation in patients with isolated antibody against hepatitis B surface antigen (anti-HBs) have been reported. We present a case of a 78-year-old woman diagnosed with diffuse large B cell non-Hodgkin's lymphoma who only displayed a positive anti-HBs, as the single possible marker of occult HBV infection, before starting therapy. She was treated with several chemotherapeutic regimens (including rituximab) for disease relapses during 3 years. Forty days after the last cycle of chemotherapy, she presented with jaundice, markedly elevated serum aminotransferase levels, and coagulopathy. HBV serology showed positivity for HBsAg, anti-HBc and anti-HBs. HBV DNA was positive. Antiviral treatment with entecavir was promptly initiated, but the patient died from liver failure. A review of the literature of HBV reactivation in patients with detectable anti-HBs levels is discussed.

  12. Non-fatal gunshot wounds in the context of intimate partner violence. The importance of a multidisciplinary approach: a case report.

    Science.gov (United States)

    Puentes, Katerina; Ribeiro, Cristina; Jardim, Patrícia; Santos, Agostinho; Magalhães, Teresa

    2011-07-01

    According to Portuguese law, if a case of intimate partner violence is noticed or suspected by a professional working in public services, reporting it to the police, medico-legal services or directly to the public prosecutor is mandatory. However, in most cases, reporting does not take place, despite its vital importance in triggering the multidisciplinary intervention that will ensure the correct and timely diagnosis and protection of the victim. In the present case, the victim, a 37 year-old woman, was sexually and physically abused by her husband in their home, and was physically abused again at the victim's mother's house. The victim mentioned that her husband struck her in the head with a hammer and shot a handgun while in her mother's house. However, she denied having a gunshot wound. The couple's daughter was also slapped in the face by her father. The police took the victim to the emergency room of a central hospital to receive medical attention, while the medical examiner on duty was called to the same emergency room to perform a medico-legal evaluation in the context of the intimate partner violence reported to the police. Medico-legal assessment revealed scalp injuries that had not been detected during the first inspection by the emergency room attending physicians who had performed a neurological examination, which revealed no neurological dysfunction. A cranial computed tomography with three-dimensional reconstitution and virtual dissection, requested by the medical examiner, revealed two projectiles trapped in between the inner and the outer table of the cranium, with linear fractures only in the inner table and no brain injuries. Gynecological examination with the collection of biological evidence, also performed by the medical examiner, made it possible to identify a male DNA profile matching her husband's. The victim was subjected to neurosurgery and a follow-up, and was released one month after the traumatic event. A forensic psychological

  13. Fatal community-acquired ribotype 002 Clostridium difficile bacteremia.

    Science.gov (United States)

    Dauby, Nicolas; Libois, Agnès; Van Broeck, Johan; Delmée, Michel; Vandenberg, Olivier; Martiny, Delphine

    2017-04-01

    Extra-colonic infections, and especially bacteremia, are infrequent manifestations of Clostridium difficile infection. C. difficile bacteremia is generally health-care associated and polymicrobial. We report the case of a patient on hunger strike that presented a C. difficile colitis and mono-microbial bacteremia on its admission to the hospital. Multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality. The strain was characterized as a ribotype 002, an emerging ribotype previously associated with high fatality rate. The patient received treatment by intra-venous amoxicillin-clavulanate and oral vancomycin but eventually died on the seventh day of admission with concomitant pneumonia and pulmonary embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Fatal rhino-orbito-cerebral mucormycosis in a healthy individual

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    Rama Krishna Angali

    2014-01-01

    Full Text Available Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.

  15. Acute respiratory failure and active bleeding are the important fatality predictive factors for severe dengue viral infection.

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    Kamolwish Laoprasopwattana

    Full Text Available To determine the outcome of severe dengue viral infection (DVI and the main dengue fatality risk factors.The medical records of patients aged <15 years admitted to Songklanagarind Hospital in southern Thailand during 1989-2011 were reviewed. Patients who had dengue hemorrhagic fever (DHF grades III-IV, organ failure (cardiovascular, respiratory, liver, renal or hematologic, impaired consciousness, or aspartate aminotransferase more than 1,000 units/L, were classified as having severe DVI. To determine the fatality risk factors of severe DVI, the classification trees were constructed based on manual recursive partitioning.Of the 238 children with severe DVI, 30 (12.6% died. Compared to the non-fatal DVI cases, the fatal cases had higher rates of DHF grade IV (96.7% vs 24.5%, repeated shock (93.3% vs 27.9%, acute respiratory failure (ARF (100% vs 6.7%, acute liver failure (ALF (96.6% vs 6.3%, acute kidney injury (AKI (79.3% vs 4.5%, and active bleeding requiring blood transfusion (93.3% vs 5.4%, all p<0.01. The combined risk factors of ARF and active bleeding considered together predicted fatal outcome with sensitivity, specificity, and negative and positive predictive values of 0.93 (0.78-0.99, 0.97 (0.93-0.99, 0.99 (0.97-1.00, and 0.82 (0.65-0.93, respectively. The likelihood ratios for a fatal outcome in the patients who had and did not have this risk combination were 32.4 (14.6-71.7 and 0.07 (0.02-0.26, respectively.Severe DVI patients who have ARF and active bleeding are at a high risk of death, while patients without these things together should survive.

  16. Contact investigation after a fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an aircraft, Germany, July 2013.

    Science.gov (United States)

    An der Heiden, Maria; Hauer, Barbara; Fiebig, Lena; Glaser-Paschke, Gisela; Stemmler, Markus; Simon, Claudia; Rüsch-Gerdes, Sabine; Gilsdorf, Andreas; Haas, Walter

    2017-03-23

    In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for newly acquired TB infection. Two-stage testing within 8 weeks from exposure and at least 8 weeks after exposure was suggested, using either interferon gamma release assays (IGRAs) or tuberculin skin test (TST). The TST cut-off was defined at a diameter > 10 mm; for differentiation between conversion and boosting, conversion was defined as increase of skin induration > 5 mm. Overall, 155 passengers and seven crew members were included in the investigation: the questionnaire response rate was 83%; 112 (69%) persons were tested at least once for TB infection. In one passenger, who sat next to the area where the patient died, a test conversion was registered. As of March 2017, no secondary active TB cases have been reported. We describe an unusual situation in which we applied contact tracing beyond existing European guidelines; we found one latent tuberculosis infection in a passenger, which we consider probably newly acquired. This article is copyright of The Authors, 2017.

  17. Quantification of aconitine in post-mortem specimens by validated liquid chromatography-tandem mass spectrometry method: three case reports on fatal 'monkshood' poisoning.

    Science.gov (United States)

    Bicker, Wolfgang; Monticelli, Fabio; Bauer, Andreas; Roider, Gabriele; Keller, Thomas

    2013-01-01

    The diester-diterpene alkaloid aconitine was quantified by liquid chromatography-tandem mass spectrometry in post-mortem specimens of three cases where suicidal ingestion of Aconitum napellus L. ('monkshood') was supposed. In an attempt at rationalization, sample preparation and chromatographic conditions of plasma/serum drug analysis routine were utilized. Linearity was established from 0.5 to 20 µg L⁻¹ using newborn calf serum (NCS) as a surrogate calibration matrix for all sample types and mesaconitine as an internal standard. Validation (selectivity, sensitivity, precision, accuracy, recovery of the extraction procedure, matrix effect, processed sample stability) confirmed the applicability of the analytical method to various post-mortem matrices. Internal standard selection was based on multi-matrix process efficiency data. In human post-mortem peripheral blood a lower limit of quantification of 0.51 µg L⁻¹ and a limit of detection of 0.13 µg L⁻¹ were accomplished (0.1 ml sample aliquots). Aconitine was degraded to a large extent in different sample types when being stored at +20 °C for 30 days, while at -20 °C and for some matrices also at +4 °C no appreciable degradation occurred. Aconitine concentrations in real samples were 10.3-17.9 µg L⁻¹ (peripheral blood, n = 3), 14.9-87.9 µg L⁻¹ (heart blood, n = 3), 317-481 µg L⁻¹ (urine, n = 2), 609-4040 µg L⁻¹ (stomach content, n = 3), 139-240 µg L⁻¹ (bile, n = 2), 8.4 µg L⁻¹ (vitreous humor, n = 1), 54.7 µg L⁻¹ (pericardial fluid, n = 1), 492 µg kg⁻¹ (liver, n = 1), 15.2-19.7 mg L⁻¹ (unknown liquids secured onsite, n = 3). Together with concomitant circumstances the analytical data provided compelling evidence for acute Aconitum poisoning as being the cause of death.

  18. Fatal thyrocardiac event

    Directory of Open Access Journals (Sweden)

    Samit Kumar Khutia

    2010-01-01

    Full Text Available Atrial fibrillation occurs frequently (2-20% in chronic hyperthyroidism patients. Poorly treated thyrotoxic patients may present with a life-threatening cerebrovascular accident giving little scope to revert the situation. At times, it is difficult to make a patient euthyroid with conventional management. The definitive treatment of choice is 131 I, radioiodine. An adjusted dose of an oral anticoagulant is highly efficacious for the prevention of all types of strokes. Timely intervention by a skilled airway manager with right instruments is the key to success in airway management. A 50-year-old thyrotoxic, semiconscious male presented with a sudden onset of haemiplegia. He had chronic AF, a huge thyroid swelling with gross tracheal deviation and dilated cardiomyopathy. A CT scan showed infarction in the left middle cerebral artery territory. After initial improvement with conservative management, patient′s condition deteriorated in the next 48 h. Repeat CT scan showed increase in the infarct size with haemorrhage and midline shift. Finally, he died despite all resuscitative measures.

  19. Herd immunity and fatal cases of influenza among the population exposed to poultry and wild birds in Russian Asia in 2013-2014.

    Science.gov (United States)

    Ilyicheva, Tatyana; Abdurashitov, Murat; Durymanov, Alexander; Susloparov, Ivan; Goncharova, Natalya; Kolosova, Natalya; Mikheev, Valery; Ryzhikov, Alexander

    2016-01-01

    In total 1,525 blood serum samples were collected in October, 2013 in Russian Asia from people who reside in territories that are at high risk for emergence of influenza viruses with pandemic potential. Presence of antibodies to influenza viruses in the sera was tested in hemagglutination inhibition test. None of the samples produced positive results with the antigens A/H5 and A/H7. Twelve strains of influenza A(H1N1pdm09) virus were isolated from people who died presumably from influenza during 2013-2014 epidemic season. All strains were similar to vaccine strain A/California/07/09 according to their antigenic properties and sensitivity to anti-neuraminidase drugs (oseltamivir and zanamivir). Genetic analysis revealed that all strains belong to group 6, subgroup 6B of influenza A(H1N1)pdm09 virus. Substitutions in HA1: S164F add E235K as well as E47G, A86V, K331R, N386K, N397K in NA, and K131E, N29S in NS1, and N29S, R34Q in NEP separate investigated strains into two groups: 1st group-A/Chita/1114/2014, A/Chita/1115/2014, A/Chita/853/2014, A/Barnaul/269/2014 and 2nd group-A/Chita/655/2014, A/Chita/656/2014, A/Chita/709/2014, A/Chita/873/2014. Mutation D222G in HA1, which is often associated with high morbidity of the illness, was present in strain A/Novosibirsk/114/2014. Substitution N386K in NA removes a potential N-glycosylation site in neuraminidases of A/Chita/1114/2014, A/Chita/1115/2014, A/Chita/853/2014, A/Barnaul/269/2014, A/Novosibirsk/114/2014, and A/Blagoveshensk/252/2014.

  20. Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1 virus infection in China.

    Directory of Open Access Journals (Sweden)

    Hongjie Yu

    Full Text Available BACKGROUND: While human cases of highly pathogenic avian influenza A (H5N1 virus infection continue to increase globally, available clinical data on H5N1 cases are limited. We conducted a retrospective study of 26 confirmed human H5N1 cases identified through surveillance in China from October 2005 through April 2008. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected from hospital medical records of H5N1 cases and analyzed. The median age was 29 years (range 6-62 and 58% were female. Many H5N1 cases reported fever (92% and cough (58% at illness onset, and had lower respiratory findings of tachypnea and dyspnea at admission. All cases progressed rapidly to bilateral pneumonia. Clinical complications included acute respiratory distress syndrome (ARDS, 81%, cardiac failure (50%, elevated aminotransaminases (43%, and renal dysfunction (17%. Fatal cases had a lower median nadir platelet count (64.5 x 10(9 cells/L vs 93.0 x 10(9 cells/L, p = 0.02, higher median peak lactic dehydrogenase (LDH level (1982.5 U/L vs 1230.0 U/L, p = 0.001, higher percentage of ARDS (94% [n = 16] vs 56% [n = 5], p = 0.034 and more frequent cardiac failure (71% [n = 12] vs 11% [n = 1], p = 0.011 than nonfatal cases. A higher proportion of patients who received antiviral drugs survived compared to untreated (67% [8/12] vs 7% [1/14], p = 0.003. CONCLUSIONS/SIGNIFICANCE: The clinical course of Chinese H5N1 cases is characterized by fever and cough initially, with rapid progression to lower respiratory disease. Decreased platelet count, elevated LDH level, ARDS and cardiac failure were associated with fatal outcomes. Clinical management of H5N1 cases should be standardized in China to include early antiviral treatment for suspected H5N1 cases.

  1. Distribution and load of elephant endotheliotropic herpesviruses in tissues from associated fatalities of Asian elephants.

    Science.gov (United States)

    Seilern-Moy, Katharina; Darpel, Karin; Steinbach, Falko; Dastjerdi, Akbar

    2016-07-15

    Elephant Endotheliotropic Herpesviruses (EEHVs) are the cause of a highly fatal haemorrhagic disease in elephants primarily affecting young Asian elephants (Elephas maximus) in both captivity and in the wild. The viruses have emerged as a significant threat to Asian elephant conservation, critically affecting overall sustainability of their population. So far insight into the pathogenesis of EEHV infections has been restricted to examination of EEHV-infected tissues. However, little is known about distribution and burden of the viruses within the organs of fatal cases, crucial elements in the understanding of the virus pathogenesis. This study was therefore undertaken to assess the extent of organ and cell involvement in fatal cases of EEHV-1A, 1B and 5 using a quantitative real-time PCR. EEHV-1 and 5 DNA were detectable in all the tissues examined, albeit with substantial differences in the viral DNA load. The highest EEHV-1A DNA load was observed in the liver, followed by the heart, thymus and tongue. EEHV-1B and 5 showed the highest DNA load in the heart, followed by tongue and liver. This study provides new insights into EEHV pathogenicity and has implications in choice of sample type for disease investigation and virus isolation.

  2. Fatal hypertensive crisis as presentation of mitochondrial complex I deficiency.

    NARCIS (Netherlands)

    Lohmeier, K.; Distelmaier, F.; Heuvel, L.P.W.J. van den; Rodenburg, R.J.T.; Smeitink, J.A.M.; Mayatepek, E.; Hoehn, T.

    2007-01-01

    Complex I deficiency is a frequent defect of the mitochondrial electron transport chain. We report on a 3-year-old boy, who rapidly deteriorated after sudden flushing and collapse. This fatal and unusual case was characterized by widely uncontrollable arterial hypertension. It might indicate that hy

  3. Hormone replacement therapy and risk of non-fatal stroke

    DEFF Research Database (Denmark)

    Pedersen, A T; Lidegaard, O; Kreiner, S;

    1997-01-01

    BACKGROUND: The effect of postmenopausal hormone replacement therapy (HRT) on the risk of subtypes of stroke is as yet unclear. To investigate the effect of oestrogen and combined oestrogen-progestagen therapy on the risk of non-fatal haemorrhagic and thromboembolic stroke, we carried out a case-...

  4. Fatal Fulminant Hepatic Failure in a Diabetic with Primary Dengue

    Science.gov (United States)

    Viswanathan, Stalin; Iqbal, Nayyar; Anemon, P. Philip; Kumar, G. Shyam

    2010-01-01

    We report a 49-year-old diabetic with dengue hemorrhagic fever who developed fulminant hepatitis, severe coagulopathy, shock, and refractory metabolic acidosis and died on the eighth day of illness. This is the only second report of an adult with fatal fulminant hepatic failure due to dengue, and the first case arising from a primary dengue infection. PMID:21234316

  5. Identification of new molecular alterations in Fatal Familial Insomnia.

    Science.gov (United States)

    Fatal familial insomnia (FFI) is an autosomal dominant prion disease caused by a D178N mutation in PRNP in combination with methionine (Met) at codon 129 in the mutated allele of the same gene (D178N-129M haplotype). The present study analyzes pathological and molecular features in seven FFI cases c...

  6. First reported fatal Morganella morganii infections in chickens.

    Science.gov (United States)

    Zhao, Changguang; Tang, Na; Wu, Yanping; Zhang, Yuanyuan; Wu, Zhen; Li, Wanmeng; Qin, Xiuhui; Zhao, Jixun; Zhang, Guozhong

    2012-05-01

    Morganella morganii, a Gram-negative rod commonly found in the intestines of humans and other animals, is here confirmed to cause a fatal infection in chickens by isolation and identification of the bacteria, 16S rRNA gene sequencing, and experimental infection. This is the first case of M. morganii infection in chickens.

  7. Fatal haemoptysis from the pulmonary artery as a late complication of pulmonary irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Makker, H.K.; Barnes, P.C. (Manchester Univ. (United Kingdom). School of Medicine Salford Royal Hospital (United Kingdom))

    1991-08-01

    Fatal massive haemoptysis occured as a late complication of erosion of the pulmonary artery by a non-malignant ulcer of the left main bronchus. Symptoms attributed to radiation pulmonary fibrosis are uncommon. We report a case of fatal massive haemoptysis in a patient known to have postirradiation pulmonary fibrosis. (author).

  8. Learning from Tragedy: A Survey of Child and Adolescent Restraint Fatalities

    Science.gov (United States)

    Nunno, Michael A.; Holden, Martha J.; Tollar, Amanda

    2006-01-01

    Objective: This descriptive study examines 45 child and adolescent fatalities related to restraints in residential (institutional) placements in the United States from 1993 to 2003. Method: The study team used common Internet search engines as its primary case discovery strategy to determine the frequency and the nature of the fatalities, as well…

  9. Cilia-associated bacteria in fatal Bordetella bronchiseptica pneumonia of dogs and cats

    Science.gov (United States)

    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...

  10. Pharyngitis – fatal infectious disease or medical error?

    Directory of Open Access Journals (Sweden)

    Marta Rorat

    2015-08-01

    Full Text Available Reporting on adverse events is essential to create a culture of safety, which focuses on protecting doctors and patients from medical errors. We present a fatal case of Streptococcus C pharyngitis in a 56-year-old man. The clinical course and the results of additional diagnostics and autopsy showed that sepsis followed by multiple organ failure was the ultimate cause of death. The clinical course appeared fatal due to a chain of adverse events, including errors made by the physicians caring for the patient for 10 days.

  11. Rare and fatal complication of Gianturco tracheobronchial stent.

    Science.gov (United States)

    Asopa, Sanjay; Moorjani, Narain; Saad, Rasheed A; Turner, Jonathan T; Amer, Khalid M

    2007-11-01

    Tracheobronchial stents are increasingly being used for the management of compromised large airways. Traditionally they have been used to palliate malignant conditions; however, they are now being used more frequently for nonmalignant conditions. The use of Gianturco self-expanding metal stent (William Cook, Bjaeverskov, Denmark) has been challenged for treatment of tracheobroncheomalacia, as fracture of the metal work could prove fatal. In this report we describe a case of fracture in the metal framework of a Gianturco stent resulting in recurrent pneumothoraces; heralding fatal haemoptysis as a result of perforation of the left subclavian artery.

  12. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Truelsen, T; Prescott, E; Lange, P;

    2001-01-01

    adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment. RESULTS: We found an inverse association between FEV1 and risk of first-time stroke....... For each 10% decrease in FEV1 in percentage of expected, the relative risk (RR) increased 1.05 (95% CI : 1.00-1.09, P = 0.03). This represents an approximately 30% higher risk of stroke in the group of people with the lowest lung function as compared to the group with the highest lung function...... function groups. CONCLUSIONS: This study shows that reduced lung function measured in percentage of predicted FEV1 is a predictor of first-time stroke and fatal stroke independent of smoking and inhalation. The high risk of fatal first-ever stroke in the group of people with low lung function may...

  13. Postmortem computed tomography as an adjunct to autopsy for analyzing fatal motor vehicle crash injuries: results of a pilot study.

    Science.gov (United States)

    Sochor, Mark R; Trowbridge, Matthew J; Boscak, Alexis; Maino, John C; Maio, Ronald F

    2008-09-01

    Detailed fatal injury data after fatal motor vehicle crashes (MVC) are necessary to improve occupant safety and promote injury prevention. Autopsy remains the principle source of detailed fatal injury data. However, procedure rates are declining because of a range of technical, ethical, and religious concerns. Postmortem computed tomography (PMCT) is a potential alternative or adjunct to autopsy which is increasingly used by forensic researchers. However, there are only limited data regarding the utility of PMCT for analysis of fatal MVC injuries. We performed whole body PMCT and autopsy on six subjects fatally injured in MVC in a single county in Michigan. All injuries detected by either method were coded using the Abbreviated Injury Scale (AIS). Severe injuries, defined as AIS 3 or higher (AIS 3+), were tallied for each forensic procedure to allow a comparison of relative diagnostic performance. A total of 46 AIS 3+ injuries were identified by autopsy and PMCT for these cases. The addition of PMCT to autopsy increased overall detection of AIS 3+ injuries (all types) by 28%. PMCT detected 27% more AIS 3+ skeletal injuries than autopsy but 25% less soft tissue injuries. Use of PMCT improves the detection of AIS 3+ injuries after fatal MVC compared with isolated use of autopsy and also produces a highly detailed permanent objective record. PMCT appears to improve detection of skeletal injury compared with autopsy but is less sensitive than autopsy for the detection of AIS 3+ soft tissue injuries. Neither autopsy nor PMCT identified all AIS 3+ injuries revealed by the combination of the two methodologies. This suggests that PMCT should be used as an adjunct to autopsy rather than a replacement whenever feasible.

  14. [Fatal child abuse in Japan and Germany. Comparative retrospective study].

    Science.gov (United States)

    Ohtsuji, M; Ohshima, T; Kondo, T; Godoy, M R; Oehmichen, M

    1998-01-01

    In this study a record for comparative international epidemiological studies on autopsy cases of child abuse is introduced. The form was proved in a retrospective comparative survey of cases of fatal child abuse at the Department of Legal Medicine in Kanazawa (Japan) and Institute of Legal Medicine of Lübeck (Germany). A total of 33 cases were included. The following data were evaluated: age and gender of victims and assailants, relationship between victims and assailants, causes and methods of abuse, chief autopsy findings, and causes of death. The results were leading into two directions between Kanazawa and Lübeck: (1) In the years of 1981-1996 in Kanazawa 23 cases of fatal child abuse were autopsied while during the same period in Lübeck only 10 cases were registered. (2) While sexual abuse was not registered in Kanazawa, it was recorded twice in Lübeck.

  15. Ethylene Glycol and Metabolite Concentrations in Fatal Ethylene Glycol Poisonings.

    Science.gov (United States)

    Viinamäki, Jenni; Sajantila, Antti; Ojanperä, Ilkka

    2015-01-01

    Ethylene glycol (EG) is used in antifreeze and other industrial products. It metabolizes to glycolic acid (GA) and oxalic acid (OX) that cause metabolic acidosis and are mainly responsible for the toxicity of EG. During 2010-2014, EG or GA was found in 25 postmortem cases in Finland. Of these cases, 21 were classified as fatal EG poisonings and 3 were classified as methanol (MeOH) poisonings. In this study, we report the concentrations of EG and GA in postmortem blood and urine samples of fatal EG or mixed MeOH/EG poisonings. In the fatal EG poisonings, the median EG and GA concentrations were 0.87 and 1.6 g/L in blood and 4.3 and 5.3 g/L in urine. The median urine-blood ratios were 3.8 and 3.1 for EG and GA. These results warrant the use of urine as a primary matrix for screening. In EG positive cases, the quantification of both EG and GA in blood is crucial as GA concentration appears to best indicate a fatal poisoning with an approximate threshold of 1.5 g/L. The measurement of urinary OX does not offer much additional value to toxic alcohol screening as it may originate from varying dietary conditions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Insomnia symptoms and risk for unintentional fatal injuries--the HUNT Study.

    Science.gov (United States)

    Laugsand, Lars Erik; Strand, Linn B; Vatten, Lars J; Janszky, Imre; Bjørngaard, Johan Håkon

    2014-11-01

    To assess the association between insomnia symptoms and risk of fatal unintentional injuries. Population-based prospective cohort study with a mean follow-up of 14 y, linking health survey data with information on insomnia symptoms to the National Cause of Death Registry. Nord-Trøndelag County, Norway. A total of 54,399 men and women 20-89 y of age who participated in the Nord-Trøndelag Health Study between 1995 and 1997. N/A. There were 277 unintentional fatal injuries, including 57 fatal motor vehicle injuries during follow-up. There was a dose-dependent association between the number of insomnia symptoms and risk of unintentional fatal injuries (P for trend 0.001) and fatal motor vehicle injuries (P for trend 0.023), respectively. The proportion of unintentional fatal injuries cases that could have been prevented in the absence of difficulties initiating sleep, difficulties maintaining sleep, and having a feeling of nonrestorative sleep were 8%, 9%, and 8%, respectively. The corresponding estimates for motor vehicle injuries were 34%, 11%, and 10%. Insomnia is a major contributor to both unintentional fatal injuries in general as well as fatal motor vehicle injuries. Increasing public health awareness about insomnia and identifying persons with insomnia may be important in preventing unintentional fatal injuries.

  17. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E;

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic......, where 83%-92% of the myocardium showed ischemia as defined by a 99mTc-hexamibi uptake below an arbitrary limit on half maximum uptake. Myocardial hypoperfusion might thus aggravate the functional impairment at myocardial infarction and lead to cardiogenic shock....

  18. Head and neck injury patterns in fatal falls: epidemiologic and biomechanical considerations.

    Science.gov (United States)

    Freeman, Michael D; Eriksson, Anders; Leith, Wendy

    2014-01-01

    Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. In the present study, we accessed data regarding head and neck fractures resulting from fatal falls from a Swedish autopsy database for the years 1992-2010, for the purposes of examining the relationships between skull and cervical spine fracture distribution and the circumstances of the fatal fall. Out of 102,310 medico-legal autopsies performed there were 1008 cases of falls associated with skull or cervical spine fractures. The circumstances of the falls were grouped in 3 statistically homogenous categories; falls occurring at ground level, falls from a height of cervical injuries (C0-C1 dislocation, C1 and C2 fractures), and lower cervical fractures. Logistic regression modeling revealed increased odds of skull base and lower cervical fracture in the middle and upper fall severity groups, relative to ground level falls (lower cervical cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base cervical spine fracture in falls from a height are consistent with prior observations that the risk of such injuries is related to the degree of victim inversion at impact. The finding that C0-C1 dislocations are most common in falls from more than 3 m is unique, an indication that the injuries likely result from high energy shear forces rather than pure tension, as previously thought.

  19. Fatal primary meningoencephalitis caused by Naegleria fowleri.

    Science.gov (United States)

    Shariq, Ali; Afridi, Faisal Iqbal; Farooqi, Badar Jahan; Ahmed, Sumaira; Hussain, Arif

    2014-07-01

    Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection.

  20. When attempts at robbing prey turn fatal.

    Science.gov (United States)

    Dejean, Alain; Corbara, Bruno; Azémar, Frédéric; Carpenter, James M

    2012-07-01

    Because group-hunting arboreal ants spread-eagle insect prey for a long time before retrieving them, these prey can be coveted by predatory flying insects. Yet, attempting to rob these prey is risky if the ant species is also an effective predator. Here, we show that trying to rob prey from Azteca andreae workers is a fatal error as 268 out of 276 potential cleptobionts (97.1 %) were captured in turn. The ant workers hunt in a group and use the "Velcro®" principle to cling firmly to the leaves of their host tree, permitting them to capture very large prey. Exceptions were one social wasp, plus some Trigona spp. workers and flies that landed directly on the prey and were able to take off immediately when attacked. We conclude that in this situation, previously captured prey attract potential cleptobionts that are captured in turn in most of the cases.