Sudden unexpected death due to Graves' disease during physical altercation.

Science.gov (United States)

Wei, Dengming; Yuan, Xiaogang; Yang, Tiantong; Chang, Lin; Zhang, Xiang; Burke, Allen; Fowler, David; Li, Ling

2013-09-01

We report a case of a 30-year-old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed. © 2013 American Academy of Forensic Sciences.

Years of Life Lost Due to External Causes of Death in the Lodz Province, Poland

Science.gov (United States)

Pikala, Malgorzata; Bryla, Marek; Bryla, Pawel; Maniecka-Bryla, Irena

2014-01-01

Background The aim of the study is the analysis of years of life lost due to external causes of death, particularly due to traffic accidents and suicides. Materials and Methods The study material includes a database containing information gathered from 376,281 death certificates of inhabitants of the Lodz province who died between 1999 and 2010. The Lodz province is characterized by the highest mortality rates in Poland. The SEYLLp (Standard Expected Years of Life Lost per living person) and the SEYLLd (per death) indices were used to determine years of life lost. Joinpoint models were used to analyze time trends. Results In 2010, deaths due to external causes constituted 6.0% of the total number of deaths. The standardized death rate (SDR) due to external causes was 110.0 per 100,000 males and was five times higher than for females (22.0 per 100,000 females). In 2010, the SEYLLp due to external causes was 3746 per 100,000 males and 721 per 100,000 females. Among males, suicides and traffic accidents were the most common causes of death (the values of the SEYLLp were: 1098 years and 887 years per 100,000 people, respectively). Among females, the SEYLLp values were 183 years due to traffic accidents and 143 years due to suicides (per 100,000 people). Conclusions A decrease in the number of years of life lost due to external causes is much higher among females. The authors observe that a growing number of suicides contribute to an increase in the value of the SEYLLp index. This directly contributes to over-mortality of males due to external causes. The analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes. PMID:24810942

Aliocha Dostoevski’s death during an epileptic seizure

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Edson José Amâncio

Full Text Available ABSTRACT Mortality due to epilepsy is of great concern worldwide. Individuals with epilepsy have a two- or three-fold risk of death when compared to the general population. Based on biographical data and Anna Grigoriévna Dostoevskaia’s memories, the authors concluded that a prolonged episode of status epilepticus was the culprit in the death of young Aliocha, youngest son of Fyodor Mikhailovich and Anna Dostoevski. At the time of Aliocha’s death, very limited knowledge about epilepsy or therapeutic resources was available. Despite all the progress, epilepsies remain potentially fatal conditions. The suffering generated by Aliocha’s death and other similar cases remains as a challenge for epileptologists who assemble efforts to fight against such conditions.

Serial CT scans of cerebral hypoxia due to prolonged status epilepticus

Energy Technology Data Exchange (ETDEWEB)

Saiwai, Shigeo; Matsumura, Yasumasa; Tamaoka, Koichi; Fukuda, Teruo; Miyamoto, Takeshi [Kobe Central Municipal Hospital, Kobe (Japan)

1983-04-01

Serial computed tomography (CT) scans of 5 infants with status epilepticus were reviewed. Four out of the 5 infants fortunately had CT scans before status epilepticus because of a convulsion. There was a diffuse and mild low density in the hemisphere, with small ventricles and tight sulci (brain swelling) at 1 to 2 days after ictus. Thereafter, a diffuse low density became apparent except for the cerebellum, the brain stem, the thalamus, and the basal ganglia. Two to 4 weeks after ictus, a localized, mottled low density was demonstrated on the cerebral mantle and atrophic changes became progressively clear. In 3 cases, no abnormal enhancement was elicited on contrast CT scans performed between 5 to 16 days after status epilepticus. We discussed the possible pathophysiological aspects of the brain damage due to ''prolonged status epilepticus.''

Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources

Directory of Open Access Journals (Sweden)

Bagshaw Sean M

2009-02-01

Full Text Available Abstract Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.

Serial CT scans of cerebral hypoxia due to prolonged status epilepticus

Energy Technology Data Exchange (ETDEWEB)

Saiwai, Shigeo; Matsumura, Yasumasa; Tamaoka, Koichi; Fukuda, Teruo; Miyamoto, Takeshi (Kobe Central Municipal Hospital, Kobe (Japan))

1983-04-01

Serial computed tomography (CT) scans of 5 infants with status epilepticus were reviewed. Four out of the 5 infants fortunately had CT scans before status epilepticus because of a convulsion. There was a diffuse and mild low density in the hemisphere, with small ventricles and tight sulci (brain swelling) at 1 to 2 days after ictus. Thereafter, a diffuse low density became apparent except for the cerebellum, the brain stem, the thalamus, and the basal ganglia. Two to 4 weeks after ictus, a localized, mottled low density was demonstrated on the cerebral mantle and atrophic changes became progressively clear. In 3 cases, no abnormal enhancement was elicited on contrast CT scans performed between 5 to 16 days after status epilepticus. We discussed the possible pathophysiological aspects of the brain damage due to ''prolonged status epilepticus.''

Serial CT scans of cerebral hypoxia due to prolonged status epilepticus

International Nuclear Information System (INIS)

Saiwai, Shigeo; Matsumura, Yasumasa; Tamaoka, Koichi; Fukuda, Teruo; Miyamoto, Takeshi

1983-01-01

Serial computed tomography (CT) scans of 5 infants with status epilepticus were reviewed. Four out of the 5 infants fortunately had CT scans before status epilepticus because of a convulsion. There was a diffuse and mild low density in the hemisphere, with small ventricles and tight sulci (brain swelling) at 1 to 2 days after ictus. Thereafter, a diffuse low density became apparent except for the cerebellum, the brain stem, the thalamus, and the basal ganglia. Two to 4 weeks after ictus, a localized, mottled low density was demonstrated on the cerebral mantle and atrophic changes became progressively clear. In 3 cases, no abnormal enhancement was elicited on contrast CT scans performed between 5 to 16 days after status epilepticus. We discussed the possible pathophysiological aspects of the brain damage due to ''prolonged status epilepticus.'' (author)

Sudden Cardiac Death of a Body Packer Due to Cocaine Cardiotoxicity

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Parthasarathi Pramanik

2016-01-01

Full Text Available This article presents a case of sudden cardiac death due to the effects of cocaine concealed in the body of a male drug smuggler in his 40s, a so-called body packer. A total of 57 body packets filled with cocaine powder were discovered in his body cavities. The detailed autopsy examination, including histopathology and toxicology findings, is discussed with the aim of describing the mechanism of cocaine intoxication in the body packer and an analysis of cocaine-induced cardiotoxicity and sudden death.

Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair

DEFF Research Database (Denmark)

Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik

2011-01-01

Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death <30 days after elective ventral hernia repair.......Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death

[Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)].

Science.gov (United States)

López, Cristina; Masiá, Mar; Padilla, Sergio; Aquilino, Ana; Bas, Cristina; Gutiérrez, Félix

2016-04-01

The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%; Pcauses of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Sudden fetal death due to dualism of the sino-atrial node.

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Pusiol, Teresa; Roncati, Luca; Lavezzi, Anna Maria; Taddei, Fabrizio; Piscioli, Francesco; Ottaviani, Giulia

2016-01-01

First, we report a sudden fetal death at 33(+3)weeks due to sino-atrial node dualism. The female stillborn was delivered by induced labor. The postmortem examination of the cardiac conduction system revealed a dualism of the sino-atrial node, associated with fragmentation of the atrio-ventricular node and His bundle. These abnormalities of the cardiac conduction system represent the morphological substrate for the development of malignant arrhythmias. In particular, the dualism of the sino-atrial node can cause the dissociation of the longitudinal nodal impulse into two distinct ways of different pulse generation, resulting in supraventricular tachyarrhythmias. This observation suggests new avenues of research on the pathogenesis of the sudden unexpected fetal death. Moreover, our findings confirm the need for an accurate postmortem examination, including serial sectioning of the cardiac conduction system, in every case of unexplained fetal death, following standardized autoptic protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

Death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer and their progeny: a result of nationwide survey in Japan.

Science.gov (United States)

Watanabe, Shinya; Nagai, Takashi

2009-06-01

To obtain the data concerning death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer (SCNT) and their progeny produced by Japanese institutions, a nationwide survey was carried out in July-August, 2006. As a result, lifetime data concerning 482 SCNT cattle (97.5% of cattle produced in the country at that time) and 202 progeny of SCNT cattle were accumulated and the death loss of these cattle was analyzed. Although 1/3 of delivered SCNT calves died during the perinatal period due to stillbirth and neonatal death, incidence of death loss due to diseases in SCNT cattle surviving more than 200 days after birth seems to be the same as these in conventionally bred cattle. In contrast, progeny of SCNT cattle showed the same level in death loss as observed in conventionally bred cattle throughout their lifetime. These results suggest that robust health would be expected in SCNT cattle surviving to adulthood and their progeny.

Are shame and self-esteem risk factors in prolonged grief after death of a spouse?

Science.gov (United States)

Dellmann, Thomas

2018-07-01

Although many single factors of prolonged grief have been identified in the literature, a comprehensive understanding of predictors is still lacking. This article argues that shame and low self-esteem, present risk factors in prolonged grief after spousal loss, based on a review of correlational studies. Using a practitioner-scientist approach, a developmental model of shame as a core factor in prolonged grief is proposed, outlining the progression from childhood relational trauma, to insecure attachment, shame, self-esteem contingent on spousal approval to eventual prolonged grief.

Reporting a sudden death due to accidental gasoline inhalation.

Science.gov (United States)

Martínez, María Antonia; Ballesteros, Salomé; Alcaraz, Rafael

2012-02-10

The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes. Copyright © 2011 Elsevier Ireland Ltd. All rights

Death due to fracture of thin calvarial bones after a fall: A forensic approach

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Georgios Sioutas

2017-06-01

Full Text Available A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.

Nationwide (Denmark) study of symptoms preceding sudden death due to arrhythmogenic right ventricular cardiomyopathy.

Science.gov (United States)

Sadjadieh, Golnaz; Jabbari, Reza; Risgaard, Bjarke; Olesen, Morten S; Haunsø, Stig; Tfelt-Hansen, Jacob; Winkel, Bo G

2014-04-01

In this study, we investigated medical history and symptoms before death in all subjects aged 1 to 35 years who died a sudden cardiac death (SCD) from arrhythmogenic right ventricular cardiomyopathy (ARVC) in Denmark in the years 2000 to 2006. All deaths (n=6,629) in subjects aged 1 to 35 years in Denmark in the period 2000 to 2006 were included. A total of 16 cases of SCD due to ARVC were identified based on histopathologic examination. Information on medical history was retrieved from The National Patient Registry, general practitioners, and hospitals. Symptoms before death were compared with 2 control groups in the same age group and time interval: one consisting of subjects who died in traffic accidents (n=74) and the other consisting of patients who died a SCD due to coronary artery disease (CAD; n=34). In the case group, 8 of the 16 patients with ARVC experienced antecedent cardiac symptoms and 7 of them sought medical attention. None were diagnosed with ARVC before death. Only 1 patient in the healthy control group and 31 of the 39 patients with CAD experienced cardiac symptoms before death. A total of 6 patients of the 16 with ARVC died during strenuous physical activity and 4 of the deaths were sports-related SCDs. In conclusion, antecedent cardiac symptoms before SCD in the young were seen in 1/2 of the patients who died because of ARVC, and this is significantly higher than in the healthy control group. When considering the ARVC and CAD groups collectively, antecedent cardiac symptoms are seen in the majority. Copyright © 2014 Elsevier Inc. All rights reserved.

Prolonged Pregnancy: Methods, Causal Determinants and Outcome

DEFF Research Database (Denmark)

Olesen, Annette Wind

) to study the incidence of prolonged pregnancy as a function of methods for determining gestational age; 2) to determine the risk of obstetrical and fetal complications in prolonged pregnancy; 3) to validate the self-reported gestational age in the National Birth Cohort; 4) to determine whether...... an ultrasound scan in the first or second trimester, or menstrual history was best at predicting the day of delivery; 5) to study the risk of recurrence of prolonged pregnancy as a function of change in male partner, social status and municipality; and 6) to detect prenatal risk indicators of prolonged...... of perinatal and obstetrical complications was high in post-term delivery compared to term delivery (OR between 1.2 and 3.1). The risk of perinatal death (OR=1.36 (1.08-1.72)) was also higher in the post-term group (I). The self-reported gestational ages in the National Birth Cohort correlated well with data...

Nationwide (Denmark) Study of Symptoms Preceding Sudden Death due to Arrhythmogenic Right Ventricular Cardiomyopathy

DEFF Research Database (Denmark)

Sadjadieh, Golnaz; Jabbari, Reza; Risgaard, Bjarke

2014-01-01

In this study, we investigated medical history and symptoms before death in all subjects aged 1 to 35 years who died a sudden cardiac death (SCD) from arrhythmogenic right ventricular cardiomyopathy (ARVC) in Denmark in the years 2000 to 2006. All deaths (n=6,629) in subjects aged 1 to 35 years...... control groups in the same age group and time interval: one consisting of subjects who died in traffic accidents (n=74) and the other consisting of patients who died a SCD due to coronary artery disease (CAD; n=34). In the case group, 8 of the 16 patients with ARVC experienced antecedent cardiac symptoms...

Death due to fracture of thin calvarial bones after a fall: A forensic approach.

Science.gov (United States)

Sioutas, Georgios; Karakasi, Maria-Valeria; Kapetanakis, Stylianos; Pavlidis, Pavlos

2017-06-01

A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001-2010.

Science.gov (United States)

Forrester, Joseph D; Kugeler, Kiersten J; Perea, Anna E; Pastula, Daniel M; Mead, Paul S

2015-11-01

Associations between Lyme disease and certain neurodegenerative diseases have been proposed, but supportive evidence for an association is lacking. Similar geographic distributions would be expected if 2 conditions were etiologically linked. Thus, we compared the distribution of Lyme disease cases in the United States with the distributions of deaths due to Alzheimer disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson disease; no geographic correlations were identified. Lyme disease incidence per US state was not correlated with rates of death due to ALS, MS, or Parkinson disease; however, an inverse correlation was detected between Lyme disease and Alzheimer disease. The absence of a positive correlation between the geographic distribution of Lyme disease and the distribution of deaths due to Alzheimer disease, ALS, MS, and Parkinson disease provides further evidence that Lyme disease is not associated with the development of these neurodegenerative conditions.

A CLINICAL STUDY OF MATERNAL DEATHS DUE TO PPH

Directory of Open Access Journals (Sweden)

Basavana Gowda

2015-03-01

Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal mortality is a global problem, facing every country in the world. Target specific interventions are needed for specific population. Fifth millennium development goal (MDG is to reduce maternal mortality by 75% by the year 2015, worthwhile investment for every case provider, results that investing on mothers

Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique

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Divya Srivastava

2013-01-01

Full Text Available Appropriate airway management is an essential part of anesthesiologist′s role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed.

Number of deaths due to lung diseases: How large is the problem?

International Nuclear Information System (INIS)

Wagener, D.K.

1990-01-01

The importance of lung disease as an indicator of environmentally induced adverse health effects has been recognized by inclusion among the Health Objectives for the Nation. The 1990 Health Objectives for the Nation (US Department of Health and Human Services, 1986) includes an objective that there should be virtually no new cases among newly exposed workers for four preventable occupational lung diseases-asbestosis, byssinosis, silicosis, and coal workers' pneumoconiosis. This brief communication describes two types of cause-of-death statistics- underlying and multiple cause-and demonstrates the differences between the two statistics using lung disease deaths among adult men. The choice of statistic has a large impact on estimated lung disease mortality rates. The choice of statistics also may have large effect on the estimated mortality rates due to other chromic diseases thought to be environmentally mediated. Issues of comorbidity and the way causes of death are reported become important in the interpretation of these statistics. The choice of which statistic to use when comparing data from a study population with national statistics may greatly affect the interpretations of the study findings

Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis.

Directory of Open Access Journals (Sweden)

Antoine Poncet

Full Text Available Sudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT is common in this population and predisposes to Torsades-de-Pointes (TdP and subsequent mortality.To estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients.We built a decision analytic model based on a decision tree to evaluate the cost-effectiveness and utility of LQT screening from a health care perspective. LQT proportion parameters were derived from an in-hospital cross-sectional study. We performed experts' elicitation to estimate the risk of TdP, given extent of QT prolongation. A TdP reduction of 65% after LQT detection was based on positive drug dechallenge rate and through adequate treatment and electrolyte adjustments. The base-case model uncertainty was assessed with one-way and probabilistic sensitivity analyses. Finally, the TdP related mortality and TdP avoidance parameters were varied in a two-way sensitivity analysis to assess their effect on the Incremental Cost-Effectiveness Ratio (ICER.Costs, Quality Ajusted Life Year (QALY, ICER, and probability of cost effectiveness thresholds ($ 10,000, $25,000, and $50,000 per QALY.In the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498 per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50,000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT.In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion.

Effect of Poultry Litter Treatment (PLT) on death due to ascites in broilers.

Science.gov (United States)

Terzich, M; Quarles, C; Goodwin, M A; Brown, J

1998-01-01

The purposes of this study were to determine the effect of Poultry Litter Treatment (PLT) on levels of litter moisture, litter nitrogen, atmospheric ammonia, and death due to ascites. Data were collected from chicks raised in containment conditions that resembled commercial settings. The ascites death rate (5.9%) in broiler chicks on PLT-treated litter was significantly (chi 2 = 15.5, df = 1, P = 0.0001) lower than that (31.5%) in broiler chicks raised on untreated litter. Likewise, atmospheric ammonia levels in pens that had been treated with PLT were significantly (P litter moisture and litter nitrogen levels were not different (P > 0.05) among treatments at any sample interval.

Asian-American deaths near the Harvest Moon Festival.

Science.gov (United States)

Smith, Gary

2004-01-01

Reexamine the claim that elderly Chinese-American women are able to prolong their lives until after the celebration of the Harvest Moon Festival. See if independent 1985 to 2000 data for Chinese-, Korean-, and Vietnamese-Americans replicate results that were reported using 1960 to 1984 data for Chinese-Americans. The original 1960 to 1984 data do not support the death-postponement theory unless deaths that occur on the festival day are classified as having occurred after the festival. The new data do not support the theory, no matter how deaths on the festival day are classified. These data do not support the hypothesis that elderly Chinese-, Korean-, or Vietnamese-American women are able to prolong their lives until after the celebration of the Harvest Moon Festival.

Prognostic Significance Of QT Interval Prolongation In Adult ...

African Journals Online (AJOL)

Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. Ninety-six ...

PR interval prolongation in coronary patients or risk equivalent: excess risk of ischemic stroke and vascular pathophysiological insights.

Science.gov (United States)

Chan, Yap-Hang; Hai, Jo Jo; Lau, Kui-Kai; Li, Sheung-Wai; Lau, Chu-Pak; Siu, Chung-Wah; Yiu, Kai-Hang; Tse, Hung-Fat

2017-08-24

Whether PR prolongation independently predicts new-onset ischemic events of myocardial infarction and stroke was unclear. Underlying pathophysiological mechanisms of PR prolongation leading to adverse cardiovascular events were poorly understood. We investigated the role of PR prolongation in pathophysiologically-related adverse cardiovascular events and underlying mechanisms. We prospectively investigated 597 high-risk cardiovascular outpatients (mean age 66 ± 11 yrs.; male 67%; coronary disease 55%, stroke 22%, diabetes 52%) for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and cardiovascular death. Vascular phenotype was determined by carotid intima-media thickness (IMT). PR prolongation >200 ms was present in 79 patients (13%) at baseline. PR prolongation >200 ms was associated with significantly higher mean carotid IMT (1.05 ± 0.37 mm vs 0.94 ± 0.28 mm, P = 0.010). After mean study period of 63 ± 11 months, increased PR interval significantly predicted new-onset ischemic stroke (P = 0.006), CHF (P = 0.040), cardiovascular death (P 200 ms. Using multivariable Cox regression, PR prolongation >200 ms independently predicted new-onset ischemic stroke (HR 8.6, 95% CI: 1.9-37.8, P = 0.005), cardiovascular death (HR 14.1, 95% CI: 3.8-51.4, P PR interval predicts new-onset MI at the exploratory cut-off >162 ms (C-statistic 0.70, P = 0.001; HR: 8.0, 95% CI: 1.65-38.85, P = 0.010). PR prolongation strongly predicts new-onset ischemic stroke, MI, cardiovascular death, and combined cardiovascular endpoint including CHF in coronary patients or risk equivalent. Adverse vascular function may implicate an intermediate pathophysiological phenotype or mediating mechanism.

Cancer Deaths due to Lack of Universal Access to Radiotherapy in the Brazilian Public Health System.

Science.gov (United States)

Mendez, L C; Moraes, F Y; Fernandes, G Dos S; Weltman, E

2018-01-01

Radiotherapy plays a fundamental role in the treatment of cancer. Currently, the Brazilian public health system cannot match the national radiotherapy demand and many patients requiring radiotherapy are never exposed to this treatment. This study estimated the number of preventable deaths in the public health system if access to radiotherapy was universal. Incidence rates for the year 2016 provided by Instituto Nacional de Cancer were used in this analysis. The number of untreated patients requiring radiotherapy was obtained through the difference between the total number of patients requiring radiotherapy and the total amount of delivered radiotherapy treatments in the public health system. The number of deaths for the three most common cancers in each gender due to radiotherapy shortage was calculated. Initially, the total number of patients per cancer type was divided in stages using Brazilian epidemiological data. Subsequently, previously published tree arm diagrams were used to define the rate of patients requiring radiotherapy in each specific clinical setting. Finally, the clinical benefit of radiotherapy in overall survival was extracted from studies with level 1 evidence. Over 596 000 cancer cases were expected in Brazil in 2016. The public health system covers more than 75% of the Brazilian population and an estimated 111 432 patients who required radiotherapy in 2016 did not receive this treatment. Breast, colorectal and cervix cancers are the most frequent malignant tumours in women and prostate, lung and colorectal in men. The number of deaths due to a radiotherapy shortage in the year 2016 for these types of cancer were: (i) breast: 1011 deaths in 10 years; (ii) cervix: 2006 deaths in 2 years; (iii) lung: 1206 deaths in 2 years; (iv) prostate, intermediate risk: 562 deaths in 13 years; high risk: 298 deaths in 10 years; (v) colorectal: 0 deaths, as radiotherapy has no proven benefit in overall survival. Thousands of cancer patients requiring

Maternal Deaths in 1990 at Kamuzu Central Hospital

African Journals Online (AJOL)

obstetric complication of pregnancy, labour or the puerperium. .... A) Deaths from puerperal sepsis, excluding abortion -. There were 24 ... an intrauterine death, complicated by prolonged rupture of .... and vaginal tears are inevitable unless a generous incision in the lower ... health institutions if they can see that the outcome.

Years of life lost because of premature death due to intentional and unintentional accidents in Ghazvin province from 2004 till 2008

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Nahid Jafari

2015-01-01

Full Text Available Background: Accidents are the second cause of death in Iran and one of the significant challenges in public health. They can affect people in all ages. In this study, we try to calculate years of life lost due to intentional and unintentional injuries, which is considered as one of the main indicators for prioritizing public health problems.  Methods: This study is a practical cross sectional survey research HSR (health system research that uses secondary analysis on the death data of Ghazvin province. The calculations also take into account the WHO standards in age group, sex and years of life lost (YLL due to death.  Results: This study showed that the unintentional accidents were the leading cause of death based on YLL from 2004 until 2008 in Ghazvin province. The number of deaths due to intentional and unintentional accidents was 3796 deaths as of which 2954 (77.8% was male and 842 (22.2% female. In general three quarter of the YLL due to early death relates to accidents for males and less than a quarter relates to accidents for females. Between 2004 until 2008, the maximum number of years of life lost (YLL in both sexes is for the age group of 15 to 49.  Conclusion: Considering the high level of years of life lost (YLL due to accident in this province, especially in men, more appropriate interventions for the more risk prone age groups and male in general need to be taken into account.

Death Education and Attitudes toward Euthanasia and Terminal Illness.

Science.gov (United States)

Nagi, Mostafa H.; Lazerine, Neil G.

1982-01-01

Analyzed attitudes of 614 Protestant and Catholic Cleveland clergy toward terminal illness and euthanasia. Clergy responses revealed that, although eager to prolong life, terminally ill patients feared prolonged illness more than death. The controversial nature of euthanasia became more apparent with clergy who had more training in death…

An inducer of VGF protects cells against ER stress-induced cell death and prolongs survival in the mutant SOD1 animal models of familial ALS.

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Masamitsu Shimazawa

2010-12-01

Full Text Available Amyotrophic lateral sclerosis (ALS is the most frequent adult-onset motor neuron disease, and recent evidence has suggested that endoplasmic reticulum (ER stress signaling is involved in the pathogenesis of ALS. Here we identified a small molecule, SUN N8075, which has a marked protective effect on ER stress-induced cell death, in an in vitro cell-based screening, and its protective mechanism was mediated by an induction of VGF nerve growth factor inducible (VGF: VGF knockdown with siRNA completely abolished the protective effect of SUN N8075 against ER-induced cell death, and overexpression of VGF inhibited ER-stress-induced cell death. VGF level was lower in the spinal cords of sporadic ALS patients than in the control patients. Furthermore, SUN N8075 slowed disease progression and prolonged survival in mutant SOD1 transgenic mouse and rat models of ALS, preventing the decrease of VGF expression in the spinal cords of ALS mice. These data suggest that VGF plays a critical role in motor neuron survival and may be a potential new therapeutic target for ALS, and SUN N8075 may become a potential therapeutic candidate for treatment of ALS.

Potentiation of ghrelin signaling attenuates cancer anorexia–cachexia and prolongs survival

Science.gov (United States)

Fujitsuka, N; Asakawa, A; Uezono, Y; Minami, K; Yamaguchi, T; Niijima, A; Yada, T; Maejima, Y; Sedbazar, U; Sakai, T; Hattori, T; Kase, Y; Inui, A

2011-01-01

Cancer anorexia–cachexia syndrome is characterized by decreased food intake, weight loss, muscle tissue wasting and psychological distress, and this syndrome is a major source of increased morbidity and mortality in cancer patients. This study aimed to clarify the gut–brain peptides involved in the pathogenesis of the syndrome and determine effective treatment for cancer anorexia–cachexia. We show that both ghrelin insufficiency and resistance were observed in tumor-bearing rats. Corticotropin-releasing factor (CRF) decreased the plasma level of acyl ghrelin, and its receptor antagonist, α-helical CRF, increased food intake of these rats. The serotonin 2c receptor (5-HT2cR) antagonist SB242084 decreased hypothalamic CRF level and improved anorexia, gastrointestinal (GI) dysmotility and body weight loss. The ghrelin receptor antagonist (D-Lys3)-GHRP-6 worsened anorexia and hastened death in tumor-bearing rats. Ghrelin attenuated anorexia–cachexia in the short term, but failed to prolong survival, as did SB242084 administration. In addition, the herbal medicine rikkunshito improved anorexia, GI dysmotility, muscle wasting, and anxiety-related behavior and prolonged survival in animals and patients with cancer. The appetite-stimulating effect of rikkunshito was blocked by (D-Lys3)-GHRP-6. Active components of rikkunshito, hesperidin and atractylodin, potentiated ghrelin secretion and receptor signaling, respectively, and atractylodin prolonged survival in tumor-bearing rats. Our study demonstrates that the integrated mechanism underlying cancer anorexia–cachexia involves lowered ghrelin signaling due to excessive hypothalamic interactions of 5-HT with CRF through the 5-HT2cR. Potentiation of ghrelin receptor signaling may be an attractive treatment for anorexia, muscle wasting and prolong survival in patients with cancer anorexia–cachexia. PMID:22832525

BRAIN DEATH DIAGNOSIS

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Calixto Machado

2009-10-01

Full Text Available Brain death (BD diagnosis should be established based on the following set of principles, i.e. excluding major confusing factors, identifying the cause of coma, determining irreversibility, and precisely testing brainstem reflexes at all levels of the brainstem. Nonetheless, most criteria for BD diagnosis do not mention that this is not the only way of diagnosing death. The Cuban Commission for the Determination of Death has emphasized the aforesaid three possible situations for diagnosing death: a outside intensive care environment (without life support physicians apply the cardio-circulatory and respiratory criteria; b in forensic medicine circumstances, physicians utilize cadaveric signs (they do not even need a stethoscope; c in the intensive care environment (with life support when cardiorespiratory arrest occurs physicians utilize the cardio-circulatory and respiratory criteria. This methodology of diagnosing death, based on finding any of the death signs, is not related to the concept that there are different types of death. The irreversible loss of cardio-circulatory and respiratory functions can only cause death when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of irreversible loss of brain functions, that is to say BD diagnosis, is fully reviewed.

Sudden death of a child due to respiratory diphtheria.

Science.gov (United States)

Swain, Rajanikanta; Behera, Chittaranjan; Arava, Sudheer Kumar; Kundu, Naveen

2016-06-01

A four-year-old girl presented to the emergency department with respiratory distress. Death occurred despite attempted resuscitation. The illness was not clinically diagnosed. Her father revealed that she had a fever and sore throat for the last four days and was not immunised for diphtheria. Characteristic gross and microscopic pathology of respiratory diphtheria and microbiological findings were observed. The cause of death was acute respiratory failure consequent upon upper airway obstruction from diphtheria. Forensic pathologists should remember that the diphtheria cases can cause sudden death especially in developing countries. © The Author(s) 2016.

Deaths due to abuse of dextromethorphan sold over-the-counter in Pakistan

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Humera Shafi

2016-09-01

Full Text Available Dextromethorphan is the most commonly used over-the-counter anti-tussive and expectorant medicine at therapeutic doses. Due to easy availability, euphoric high and hallucinogenic effects at larger doses, dextromethorphan popularity amongst the drug abusers is growing day by day. It is often mixed with alcohol, opiates, cannabinoids or other drugs of abuse for recreational purposes despite their lethal synergistic effects. More than 50 deaths were reported the first time in Pakistan after consuming cough syrups containing dextromethorphan, manufactured by two local pharmaceutical industries. All deceased had the history of drug abuse. We report the deaths of nineteen males, ages ranged from 17 to 45 years, in two major cities of Pakistan who purposefully ingested large doses of dextromethorphan for recreational purposes and died as a result of direct toxic effects of the drug. Toxicological analysis revealed high levels of dextromethorphan ranging from 7.3 to 41.7 mg/L in the peripheral blood, 4.2–92.6 mg/kg in the liver and 9.9–349.6 mg/L in the gastric content by high performance liquid chromatography. The dextromethorphan concentrations in all subjects significantly exceeded the therapeutic range and were consistent with concentrations reported in other cases of dextromethorphan abuse and toxicity. Besides dextromethorphan other drugs of abuse like cannabinoids, opiates, benzodiazepines, ethanol and chlorpheniramine were also detected. The cause of death was determined to be acute dextromethorphan intoxication with lethal synergistic effect of other co-ingested drugs of abuse. The deaths resulted in the prosecution of all individuals involved in manufacturing, distribution or sale of the cough syrup.

Deaths Due to Accidental Air Conditioner Compressor Explosion: A Case Series.

Science.gov (United States)

Behera, Chittaranjan; Bodwal, Jatin; Sikary, Asit K; Chauhan, Mohit Singh; Bijarnia, Manjul

2017-01-01

In an air-conditioning system, the compressor is a large electric pump that pressurizes the refrigerant gas as part of the process of turning it back into a liquid. The explosion of an air conditioner (AC) compressor is an uncommon event, and immediate death resulted from the blast effect is not reported in forensic literature. We report three such cases in which young AC mechanics were killed on the spot due to compressor blast, while repairing the domestic split AC unit. The autopsy findings, the circumstances leading to the explosion of the compressor, are discussed in this study. © 2016 American Academy of Forensic Sciences.

Prolonged delirium misdiagnosed as a mood disorder.

Science.gov (United States)

Cao, Fei; Salem, Haitham; Nagpal, Caesa; Teixeira, Antonio L

2017-01-01

Delirium can be conceptualized as an acute decline in cognitive function that typically lasts from hours to a few days. Prolonged delirium can also affect patients with multiple predisposing and/or precipitating factors. In clinical practice, prolonged delirium is often unrecognized, and can be misdiagnosed as other psychiatric disorders. We describe a case of a 59-year-old male presenting with behavioral and cognitive symptoms that was first misdiagnosed as a mood disorder in a general hospital setting. After prolonged delirium due to multiple factors was confirmed, the patient was treated accordingly with symptomatic management. He evolved with progressive improvement of his clinical status. Early diagnosis and management of prolonged delirium are important to improve patient prognosis and avoid iatrogenic measures.

Prolonged Delayed Graft Function Is Associated with Inferior Patient and Kidney Allograft Survivals.

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Tainá Veras de Sandes-Freitas

Full Text Available It is unclear if there is an association between the duration of delayed graft function (DGF and kidney transplant (KT outcomes. This study investigated the impact of prolonged DGF on patient and graft survivals, and renal function one year after KT. This single center retrospective analysis included all deceased donor KT performed between Jan/1998 and Dec/2008 (n = 1412. Patients were grouped in quartiles according to duration of DGF (1-5, 6-10, 11-15, and >15 days, designated as prolonged DGF. The overall incidence of DGF was 54.2%. Prolonged DGF was associated with retransplantation (OR 2.110, CI95% 1.064-4.184,p = 0.033 and more than 3 HLA mismatches (OR 1.819, CI95% 1.117-2.962,p = 0.016. The incidence of acute rejection was higher in patients with DGF compared with those without DGF (36.2% vs. 12.2%, p<0.001. Compared to patients without DGF, DGF(1-5, DGF(6-10, and DGF(11-15, patients with prolonged DGF showed inferior one year patient survival (95.2% vs. 95.4% vs. 95.5% vs. 93.4% vs. 88.86%, p = 0.003, graft survival (91% vs. 91.4% vs. 92% vs. 88.7% vs. 70.5%, p<0.001, death-censored graft survival (95.7% vs. 95.4% vs. 96.4% vs. 94% vs. 79.3%, p<0.001, and creatinine clearance (58.0±24.6 vs. 55.8±22.2 vs. 53.8±24.1 vs. 53.0±27.2 vs. 36.8±27.0 mL/min, p<0.001, respectively. Multivariable analysis showed that prolonged DGF was an independent risk factor for graft loss (OR 3.876, CI95% 2.270-6.618, p<0.001, death censored graft loss (OR 4.103, CI95% 2.055-8.193, p<0.001, and death (OR 3.065, CI95% 1.536-6.117, p = 0.001. Prolonged DGF, determined by retransplantation and higher HLA mismatches, was associated with inferior renal function, and patient and graft survivals at one year.

[Labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012].

Science.gov (United States)

Cubí-Mollá, Patricia; Peña-Longobardo, Luz María; Casal, Bruno; Rivera, Berta; Oliva-Moreno, Juan

2015-09-01

To estimate the years of potential life lost, years of potential productive life lost and the labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012 in Spain. Several statistical sources were combined (Spanish Registry of Deaths, Labor Force Survey and Wage Structure Survey) to develop a simulation model based on the human capital approach. This model allowed us to estimate the loss of labor productivity caused by premature deaths following traffic injuries from 2002 to 2012. In addition, mortality tables with life expectancy estimates were used to compute years of potential life lost and years of potential productive life lost. The estimated loss of labour productivity caused by fatal traffic injuries between 2002 and 2012 in Spain amounted to 9,521 million euros (baseline year 2012). The aggregate number of years of potential life lost in the period amounted to 1,433,103, whereas the years of potential productive life lost amounted to 875,729. Throughout the period analyzed, labor productivity losses and years of life lost diminished substantially. Labor productivity losses due to fatal traffic injuries decreased throughout the period analyzed. Nevertheless, the cumulative loss was alarmingly high. Estimation of the economic impact of health problems can complement conventional indicators of distinct dimensions and be used to support public policy making. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Population-based studies of antithyroid drugs and sudden cardiac death

NARCIS (Netherlands)

C. van Noord (Charlotte); M.C.J.M. Sturkenboom (Miriam); S.M.J.M. Straus (Sabine); A. Hofman (Albert); J.C.M. Witteman (Jacqueline); B.H.Ch. Stricker (Bruno)

2009-01-01

textabstractWHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Thyroid hormone free T4 is associated with QTc-interval prolongation, which is a risk factor for sudden cardiac death. • The association between hyperthyroidism and ventricular arrhythmias or sudden cardiac death has been reported in several

Early maternal death due to acute encephalitis

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M Vidanapathirana

2014-03-01

Full Text Available Maternal death in an unmarried woman poses a medico-legal challenge. A 24-year-old unmarried schoolteacher, residing at a boarding place, had been admitted to hospital in a state of cardiac arrest. At the autopsy, mild to moderate congestion of subarachnoid vessels and oedema of the brain was noted. An un-interfered foetus of 15 weeks with an intact sac and placental tissues were seen. Genital tract injuries were not present. Histopathological examination showed diffuse perivascular cuffing by mononuclear cells suggestive of viral encephalitis, considering the circumstances of death and the social stigma of pregnancy in this unmarried teacher, the possibility of attempted suicide by ingestion of a poison was considered. Abrus precatorius (olinda seeds commonly found in the area is known to produce acute encephalitis as well as haemorrhagic gastroenteritis and pulmonary congestion was also considered as a possible cause for this unusual presentation

Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

Science.gov (United States)

Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

2016-03-01

"Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

Increased albumin excretion in industrial workers due to shift work rather than to prolonged exposure to low concentrations of chlorinated hydrocarbons.

OpenAIRE

Boogaard, P J; Caubo, M E

1994-01-01

OBJECTIVES--It has been reported that groups of workers in petrochemical industries who have been exposed to low concentrations of chemicals for prolonged periods have an increased urinary albumin excretion compared with unexposed controls. This increase, however, seemed to be unrelated to the extent, duration, and type of exposure. The aim of the present study was to investigate the suggestion that the small increase in albumin excretion might be due to differences in physical workload betwe...

Four deaths due to carbon monoxide poisoning in car washes.

Science.gov (United States)

Carson, H J; Stephens, P J

1999-09-01

In a period of 13 months, three separate incidents of lethal carbon monoxide (CO) poisoning in closed car wash bays resulted in the deaths of 4 white men aged 20 to 36 years. Each man appears to have been intoxicated with mind-altering substances, which may impair judgment, perception of outside conditions, and self-awareness. All four died in winter months. For three men, the deaths were ruled accidental, and for the remaining man, the previous deaths appear to have provided a model for suicide. Warning signs may not be effective to prevent future CO deaths in car washes because of the possible role of intoxication. Mechanical or electronic methods to prevent a bay door from closing completely may be preferable.

A case of death due to rescue action by a power shovel after being buried alive.

Science.gov (United States)

Watanabe-Suzuki, K; Nozawa, H; Ishii, A; Seno, H; Suzuki, O

2001-12-01

We report a rare case of death due to rescue using a power shovel. A 41-year-old female was accidentally buried alive by a landslide of the earth and sand upon working at a construction site. One of her colleagues started to save her using a power shovel. However, she was dug out dead at the spot about 10 min after the accident with marked head and face injuries. The autopsy disclosed that there was extensive laceration across the face and head with marked skull bone fractures. Around these injuries, extensive hemorrhage could be observed as a vital reaction. Asphyxial death had to be taken into consideration, because she was buried under the earth and sand for about 10 min; but we finally judged that the cause of her death was head injury by the power shovel inflicted during the attempted rescue.

Sudden unexpected infant death (SUDI in a newborn due to medium chain acyl CoA dehydrogenase (MCAD deficiency with an unusual severe genotype

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Lovera Cristina

2012-10-01

Full Text Available Abstract Medium chain acyl CoA dehydrogenase deficiency (MCAD is the most common inborn error of fatty acid oxidation. This condition may lead to cellular energy shortage and cause severe clinical events such as hypoketotic hypoglycemia, Reye syndrome and sudden death. MCAD deficiency usually presents around three to six months of life, following catabolic stress as intercurrent infections or prolonged fasting, whilst neonatal-onset of the disease is quite rare. We report the case of an apparently healthy newborn who suddenly died at the third day of life, in which the diagnosis of MCAD deficiency was possible through peri-mortem blood-spot acylcarnitine analysis that showed very high concentrations of octanoylcarnitine. Genetic analysis at the ACADM locus confirmed the biochemical findings by demonstrating the presence in homozygosity of the frame-shift c.244dup1 (p.Trp82LeufsX23 mutation, a severe genotype that may explain the unusual and very early fatal outcome in this newborn. This report confirms that inborn errors of fatty acid oxidation represent one of the genetic causes of sudden unexpected deaths in infancy (SUDI and underlines the importance to include systematically specific metabolic screening in any neonatal unexpected death.

How do we reduce maternal deaths due to puerperal sepsis in ...

African Journals Online (AJOL)

Puerperal sepsis remains one of the leading causes of maternal deaths in South Africa and a large number of these deaths are avoidable. The National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) identified these avoidable factors which included missed diagnoses, lack of appreciation of the ...

Pediatric Death Due to Myocarditis After Exposure to Cannabis

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Thomas M. Nappe

2017-03-01

Full Text Available Since marijuana legalization, pediatric exposures to cannabis have increased. 1 To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

Psychotropic Pharmacotherapy Associated With QT Prolongation Among Veterans With Posttraumatic Stress Disorder.

Science.gov (United States)

Stock, Eileen M; Zeber, John E; McNeal, Catherine J; Banchs, Javier E; Copeland, Laurel A

2018-04-01

In 2012, the Food and Drug Administration issued Drug Safety Communications on several drugs associated with QT prolongation and fatal ventricular arrhythmias. Among these was citalopram, a selective serotonin reuptake inhibitor (SSRI) approved for depression and commonly used for posttraumatic stress disorder (PTSD). Evaluation of the risk for QT prolongation among other psychotropic drugs for individuals with PTSD remains limited. Explore psychotropic drugs associated with QT prolongation among veterans with PTSD. Patients in the Veterans Health Administration in 2006-2009 with PTSD and QT prolongation (176 cases) were matched 1:4 on age, gender, visit date and setting, and physical comorbidity. Classification trees assessed QT prolongation risk among prescribed medications (n=880). Receipt of any drug with known risk of QT prolongation varied by group (23% QT cases vs 15% control, prisks included ziprasidone (3% vs 1%, p=0.02) and buspirone (6% vs 2%, p=0.01). Increased risk was not observed for the SSRIs, citalopram and fluoxetine. Classification trees found that sotalol and amitriptyline carried greater risk among cardiac patients and methadone, especially if prescribed with quetiapine, among noncardiac patients. Per adjusted survival model, patients with QT prolongation were at increased risk for death (hazard ratio=1.60; 95% CI=1.04-2.44). Decision models are particularly advantageous when exploring nonlinear relationships or nonadditive interactions. These findings may potentially affect clinical decision-making concerning treatment for PTSD. For patients at higher risk of QT prolongation, antidepressants other than amitriptyline should be considered. Medications for comorbid conditions should also be closely monitored for heightened QT prolongation risk.

[Maternal death from severe malaria due to Plasmodium vivax].

Science.gov (United States)

Arróspide, Nancy; Espinoza, Máximo Manuel; Miranda-Choque, Edwin; Mayta-Tristán, Percy; Legua, Pedro; Cabezas, César

2016-06-01

Here we describe the case of a 19-year-old woman, in her 29th week of gestation, who was from Llumpe (Ancash, Peru) and had a history of traveling to Chanchamayo (Junín, Peru) and Rinconada (Ancash, Peru). The patient presented at Chacas Hospital (Chacas, Ancash, Peru) with general malaise, dehydration, respiratory distress, jaundice, the sensation of thermal rise, and abdominal pain. Analysis of blood smears revealed 60% hemoparasites. She was transferred to Ramos Guardia Hospital (Huaraz, Peru) where she presented increasing respiratory distress, choluria, hematuria, and decreased urine output, moreover she was positive for Plasmodium. From there she was transferred to Cayetano Heredia Hospital (Lima, Peru), where she was admitted to the intensive care unit (ICU) with multiple organ failure, stillbirth, and leading to death. She underwent mechanical ventilation, was administered clindamycin, and was prescribed quinine, which she did not received due a lack by availability. The evolution of the illness was torpid, and she ultimately developed multiple organ failure and died. Plasmodium vivax infection was confirmed. Accordingly, we emphasize the importance of improving our diagnostic capabilities and management techniques to enable clinicians to provide adequate and timely treatment.

Antipsychotics and the risk of sudden cardiac death

NARCIS (Netherlands)

Straus, S.M.J.M.; Bleumink, G.S.; Dieleman, J.P.; van der Lei, J.; 't Jong, G.W.; Kingma, J. Herre; Sturkenboom, M.C J M; Stricker, B.H C

2004-01-01

Background Antipsychotics have been associated with prolongation of the corrected QT interval and sudden cardiac death. Only a few epidemiological studies have investigated this association. We performed a case-control study to investigate the association between use of antipsychotics and sudden

Prolonged continuous exposure to high fine particulate matter associated with cardiovascular and respiratory disease mortality in Beijing, China

Science.gov (United States)

Wang, Jinfeng; Yin, Qian; Tong, Shilu; Ren, Zhoupeng; Hu, Maogui; Zhang, Hongrui

2017-11-01

Although many studies examined the effects of fine particulate matter (PM2.5) on the deaths of cardiovascular disease (CVD) and respiratory disease (RD), few research has paid attention to the effects of prolonged continuous exposure to high PM2.5 pollution. This study estimated the excess risks (ER) of CVD and RD mortalities associated with prolonged continuous exposure to high PM2.5 pollution for the whole population and specific subsociodemographic groups in Beijing, which is the capital city of China with over 20 million residents and having severe PM2.5 pollution problems. Our results suggested that when high PM2.5 pollution occurred continuously, at various thresholds and durations, the adverse effects on CVD and RD mortalities varied significantly. The CVD mortality risks in association with prolonged continuous high PM2.5 pollution exposure were more serious for single individuals (including unmarried, divorced, and widowed), illiterate and outdoor workers than for other specific subsociodemographic groups. When the daily PM2.5 concentration higher than 105 μg/m3 consecutively occurs, at the ninth day, the ERs of CVD death for single individuals, illiterate and outdoor workers groups reached to 45% (95% CI: 22, 71), 51% (95% CI: 28, 79) and 53% (95% CI: 29, 82) respectively. On the other hand, prolonged continuous high PM2.5 pollution level appeared to contribute a higher proportion of RD deaths among illiterate and outdoor workers, but less significant for the other specific subsociodemographic groups. When the duration with daily PM2.5 pollution higher than 115 μg/m3 reached to six days, the ERs for outdoor workers and illiterate attributed to prolonged continuous PM2.5 pollution exposure increased 36% (95% CI: 5, 76) and 49% (95% CI: 16, 91) respectively.

[Diagnosis of congenital endocrinological disease in newborns with prolonged jaundice and hypoglycaemia].

Science.gov (United States)

Braslavsky, D; Keselman, A; Chiesa, A; Bergadá, I

2012-03-01

The association of prolonged neonatal jaundice and hypoglycaemia may be secondary to an endocrinological disease. Pituitary insufficiency and primary adrenal insufficiency are the most likely endocrine diseases that need to be ruled out. We retrospectively analysed the clinical and laboratory characteristics of thirteen patients referred to the Hospital de Niños Ricardo Gutiérrez between years 2003 and 2008 due to prolonged neonatal jaundice and hypoglycaemia secondary to pituitary insufficiency in twelve patients, and in one secondary to primary adrenal insufficiency. All patients had a history of neonatal hypoglycaemia. Ten patients had conjugated hyperbilirubinaemia and six also had elevated transaminases. Combined pituitary hormone deficiency was observed in the twelve hypopituitarism patients. Hormonal replacement normalised liver function and resolved the prolonged jaundice in all the patients. None of them underwent liver biopsy. Hypoglycaemia also remitted after hormonal therapy. Prolonged or cholestatic jaundice associated with neonatal hypoglycaemia is highly likely to be due to pituitary hormone deficiency or primary adrenal insufficiency. Early diagnosis and treatment of these children reverts the prolonged jaundice and prevents morbidity and mortality due to recurrent hypoglycaemia and hormone deficiencies. Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Qt interval prolongation and ventricular arrhythmias in patients with chronic heart failure

International Nuclear Information System (INIS)

Sarwar, M.; Majeed, S.M.I.; Khan, M.A.; Majeed, S.M.

2014-01-01

To determine the association of QTc interval prolongation with ventricular arrhythmias in patients with chronic heart failure. Study Design: Descriptive study. Place and Duration of Study: This study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan from April 2013 to August 2013. Patients and Methods: Fifty three heart failure patients were monitored for 48 hours using ambulatory holter electrocardiography recorders. Digital ECG data was analyzed for QTc interval along with frequency and severity of arrhythmias. Association of prolonged QTc interval with ventricular arrhythmias and severity of arrhythmias was analyzed. Results: Cardiac arrhythmias were observed in 79.2% patients. QT analysis revealed that 69.8% patients had prolonged QTc interval, 86.4% patients with prolonged QTc had ventricular arrhythmias. Of these 66% patients were found to have severe ventricular arrhythmias. Comparison of mean QTc interval of our study population with a reference value showed significantly higher QTc interval of our study group than the test value. Conclusion: Arrhythmia frequency and severity significantly increases with an increase in QTc interval in heart failure demonstrating association of prolonged QTc interval with high risk of severe ventricular arrhythmias and sudden cardiac death in chronic heart failure. (author)

Toxicokinetics of ibogaine and noribogaine in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine.

Science.gov (United States)

Henstra, Marieke; Wong, Liza; Chahbouni, Abdel; Swart, Noortje; Allaart, Cor; Sombogaard, Ferdi

2017-07-01

Ibogaine is an agent that has been evaluated as an unapproved anti-addictive agent for the management of drug dependence. Sudden cardiac death has been described to occur secondary to its use. We describe the clinical effects and toxicokinetics of ibogaine and noribogaine in a single patient. For this purpose, we developed a LC-MS/MS-method to measure ibogaine and noribogaine plasma-concentrations. We used two compartments with first order absorption. The maximum concentration of ibogaine was 1.45 mg/L. Our patient developed markedly prolonged QTc interval of 647ms maximum, several multiple cardiac arrhythmias (i.e., atrial tachycardia and ventricular tachycardia and Torsades des Pointes). QTc-prolongation remained present until 12 days after ingestion, several days after ibogaine plasma-levels were low, implicating clinically relevant noribogaine concentrations long after ibogaine had been cleared from the plasma. The ratio k 12 /k 21 for noribogaine was 21.5 and 4.28 for ibogaine, implicating a lower distribution of noribogaine from the peripheral compartment into the central compartment compared to ibogaine. We demonstrated a linear relationship between the concentration of the metabolite and long duration of action, rather than with parent ibogaine. Therefore, after (prolonged) ibogaine ingestion, clinicians should beware of long-term effects due to its metabolite.

LATE POTENTIALS IN A BRADYCARDIA-DEPENDENT LONG QT-SYNDROME ASSOCIATED WITH SUDDEN-DEATH DURING SLEEP

NARCIS (Netherlands)

TOBE, TJM; DELANGEN, CDJ; BINKBOELKENS, MTE; MOOK, PH; VIERSMA, JW; LIE, KI; WESSELING, H

1992-01-01

The purpose of this study was to determine the incidence of late potentials and their relation to QT prolongation in a family with a high incidence of sudden death during sleep at a young age and bradycardia-dependent QT prolongation (n = 9) and to compare the findings with those in consanguineous

[Deaths due to motorcycle accidents and their association with variables related to social reproduction in a northeastern Brazilian state].

Science.gov (United States)

Silva, Paul Hindenburg Nobre de Vasconcelos; Lima, Maria Luiza Carvalho; Souza, Wayner Vieira; Moreira, Rafael da Silveira; Oliveira, Fernando José Moreira

2015-09-01

The objective of this article was to identify the association between motorcycle deaths and variables related to Samaja's theory of social reproduction in the period 2000-2005 in the state of Pernambuco. An ecological, case-control study was carried out, with municipalities as the unit of analysis. Cases were defined as the 20% of municipalities with the highest local empirical Bayesian coefficients for mortality due to motorcycle accidents, and controls as the 40% with the lowest coefficients. The municipalities with the greatest chances of high coefficients for mortality due to motorcycle accidents showed high population growth factors and increases in the total fleet of motorcycles, with low population densities, low GDP per capita, and more than 20 motorcycles per thousand inhabitants. We conclude that the variables related to macro-policies proved to have greater force in explaining higher chances of motorcycle death.

Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery.

Science.gov (United States)

Fernandez-Zamora, Maria Dolores; Gordillo-Brenes, Antonio; Banderas-Bravo, Esther; Arboleda-Sánchez, José Andrés; Hinojosa-Pérez, Rafael; Aguilar-Alonso, Eduardo; Herruzo-Aviles, Ángel; Curiel-Balsera, Emilio; Sánchez-Rodríguez, Ángel; Rivera-Fernández, Ricardo

2018-05-01

Mortality among the small percentage of cardiac surgery patients receiving prolonged mechanical ventilation is high, but this issue appears to be inadequately addressed in guidelines. This study is a retrospective analysis of prospective, multi-center, and observational study in Spain including all adults undergoing cardiac surgery in 3 Andalusian hospitals between June 2008 and December 2012. The study included 3,588 adults with mean ± SD age of 63.5 ± 12.8 y and with median (interquartile range) EuroSCORE of 5 (3-7) points. Prolonged mechanical ventilation (> 24 h) was required by 415 subjects (11.6%), with ICU mortality of 44.3% (184 subjects), and was not required by 3,173 subjects (88.4%), with ICU mortality of 3.1% (99 subjects, P mechanical ventilation was associated with more complications and was required by 4.5% of subjects with a EuroSCORE 10. In the multivariable analysis, ICU mortality was associated with illness severity, duration of bypass surgery, surgery type, and prolonged mechanical ventilation (odds ratio 15.19, 95% CI 11.56-22.09). The main cause of death was multiple organ failure and sepsis in subjects who required prolonged mechanical ventilation (50.3%) and cardiogenic shock in those who did not (59.2%). Prolonged postoperative mechanical ventilation was required by 10-20% of cardiac surgery subjects, who constitute a specific group that represents most of the postoperative mortality, which is associated with multiple organ failure and sepsis. Copyright © 2018 by Daedalus Enterprises.

Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1 disease.

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Oliver W Morgan

Full Text Available BACKGROUND: Severe illness due to 2009 pandemic A(H1N1 infection has been reported among persons who are obese or morbidly obese. We assessed whether obesity is a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1, independent of chronic medical conditions considered by the Advisory Committee on Immunization Practices (ACIP to increase the risk of influenza-related complications. METHODOLOGY/PRINCIPAL FINDINGS: We used a case-cohort design to compare cases of hospitalizations and deaths from 2009 pandemic A(H1N1 influenza occurring between April-July, 2009, with a cohort of the U.S. population estimated from the 2003-2006 National Health and Nutrition Examination Survey (NHANES; pregnant women and children or=20 year olds, hospitalization was associated with being morbidly obese (BMI>or=40 for individuals with ACIP-recognized chronic conditions (OR = 4.9, 95% CI 2.4-9.9 and without ACIP-recognized chronic conditions (OR = 4.7, 95%CI 1.3-17.2. Among 2-19 year olds, hospitalization was associated with being underweight (BMIor=20 years without ACIP-recognized chronic medical conditions death was associated with obesity (OR = 3.1, 95%CI: 1.5-6.6 and morbid obesity (OR = 7.6, 95%CI 2.1-27.9. CONCLUSIONS/SIGNIFICANCE: Our findings support observations that morbid obesity may be associated with hospitalization and possibly death due to 2009 pandemic H1N1 infection. These complications could be prevented by early antiviral therapy and vaccination.

Avoidance of Bereavement-Related Stimuli in Chinese Individuals Experiencing Prolonged Grief: Evidence from a Dot-Probe Task

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Meng Yu

2017-07-01

Full Text Available Background: Attentional bias refers to a preference for (e.g., vigilance or a shifting away (e.g., avoidance of one’s focus with respect to specific stimuli. Accumulating evidence suggests that an attentional bias toward death/threat-related stimuli exists in bereaved individuals experiencing prolonged grief (PG. Measuring for different processing may reflect different cognitive characteristics. Therefore, this study sought to compare information-processing biases in Chinese individuals with high versus low levels of PG symptomatology at supraliminal and subliminal levels, respectively.Method: A 2 (grief level × 2 (consciousness level × 2 (word type three-factor mixed design with supraliminal and subliminal tasks was utilized in the current study. Based on their Prolonged Grief Questionnaire-13 (PG-13 scores, 38 participants were included in the low-PG group, and 34 individuals were included in the high-PG group. All the participants completed a dot-probe task in which they were primed with death-related and life-related words paired with neutral stimuli.Results: High-PG individuals were slower in reacting to the death-related information in both supraliminal and subliminal tasks. After controlling for other symptoms in the backward deletion regression, PG-13 scores significantly predicted the avoidance tendency to death-related words in the supraliminal task, while anxiety was the best predictor of turning one’s vision away from death-related stimuli in the subliminal trials.Conclusion: The results suggested that high PG is associated with a tendency to avoid death-related words. Future research is needed to explore interventions that address the avoidance of death-related stimuli among individuals with elevated, or diagnosable, levels of PG.

Sudden Death by Pulmonary Thromboembolism due to a Large Uterine Leiomyoma with a Parasitic Vein to the Mesentery

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Varsha Podduturi

2014-01-01

Full Text Available The pathophysiology of venous thrombosis is classically attributed to alterations in one or more components of Virchow’s triad: hypercoagulability, stasis, and damage to the vascular endothelium. Deep vein thrombosis (DVT may lead to pulmonary thromboembolism (PE, and the latter is culpable for many deaths annually in the United States; however, DVT as a complication of uterine leiomyoma has rarely been reported. We report a case of a 57-year-old woman whose death was due to a large pedunculated subserosal leiomyoma externally compressing the pelvic veins resulting in stasis and venous thrombosis leading to fatal PE. The association of large pelvic masses with venous thrombosis has clinical implications, since prophylactic surgery could be life-saving.

Dynamic Regression Model for Evaluating the Association Between Atmospheric Conditions and Deaths due to Respiratory Diseases in São Paulo, Brazil

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Ana Carla dos Santos Gomes

Full Text Available Abstract The article reports the modeling of mortality due to respiratory diseases emanating from atmospheric conditions, capturing significant associations and verifying the ability of stochastic modeling to predict deaths arising from the relationship between weather conditions and air pollution. The statistical methods used in the analysis were cross-correlation and pre-whitening, in addition to dynamic regression modeling combining the dynamics of time series and the effect of explanatory variables. The results show there are significant associations between mortality and sulfur dioxide, air temperature, atmospheric pressure, relative humidity, and autoregressive structure. The cross-correlations captured significant lags between atmospheric variables and deaths, of two months for SO2 and relative humidity, eleven months for PM10, seven months for O3, and eight months for air temperature and the cross-correlation without lag with NO2. With CO variables, precipitation and atmospheric pressure, cross-correlations were not detected. Stochastic modeling showed that deaths due to respiratory diseases can be predicted from the combination of meteorological and air pollution variables, especially considering the existing trend and seasonality.

38 CFR 3.1000 - Entitlement under 38 U.S.C. 5121 to benefits due and unpaid upon death of a beneficiary.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Entitlement under 38 U.S.C. 5121 to benefits due and unpaid upon death of a beneficiary. 3.1000 Section 3.1000 Pensions... Dependency and Indemnity Compensation Accrued § 3.1000 Entitlement under 38 U.S.C. 5121 to benefits due and...

Management of children with prolonged diarrhea [version 1; referees: 3 approved

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Antonietta Giannattasio

2016-02-01

Full Text Available Prolonged diarrhea is usually defined as acute-onset diarrhea lasting 7 days or more, but less than 14 days. Its trend has been declining in recent years because of improvement in the management of acute diarrhea, which represents the ideal strategy to prevent prolonged diarrhea. The pathogenesis of prolonged diarrhea is multifactorial and essentially based on persistent mucosal damage due to specific infections or sequential infections with different pathogens, host-related factors including micronutrient and/or vitamin deficiency, undernutrition and immunodeficiency, high mucosal permeability due to previous infectious processes and nutrient deficiency with consequential malabsorption, and microbiota disruption. Infections seem to play a major role in causing prolonged diarrhea in both developing and developed areas. However, single etiologic pathogens have not been identified, and the pattern of agents varies according to settings, host risk factors, and previous use of antibiotics and other drugs. The management of prolonged diarrhea is complex. Because of the wide etiologic spectrum, diagnostic algorithms should take into consideration the age of the patient, clinical and epidemiological factors, and the nutritional status and should always include a search for enteric pathogens. Often, expensive laboratory evaluations are of little benefit in guiding therapy, and an empirical approach may be effective in the majority of cases. The presence or absence of weight loss is crucial for driving the initial management of prolonged diarrhea. If there is no weight loss, generally there is no need for further evaluation. If weight loss is present, empiric anti-infectious therapy or elimination diet may be considered once specific etiologies have been excluded.

Causes of Death, other than that due to Prostatic Cancer, in Males ...

African Journals Online (AJOL)

This consisted of hypertensive heart disease, coronary artery disease and cardiomyopathy. Next were the violent death/unnatural death group (24.1%) which included severe head injury following road traffic accident, gunshot injury, burns, electrocution, traumatic rupture of the spleen with associated liver rupture during ...

Dying To Be Thin: Attachment to Death in Anorexia Nervosa

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Yael Latzer

2005-01-01

Full Text Available Anorexia Nervosa (AN usually follows a prolonged course accompanied by significant morbidity and high mortality. AN patients have been found to have elevated and attempted suicide rates, with suicide being the second most common cause of death in AN after the complications of the disorder itself. The suicide risk in AN is similar to that in major depression or conduct disorder and linked mainly to longer duration of illness, lower weight, bingeing and purging, impulsivity-related manifestations, comorbid substance abuse, and affective disorder. This paper reviews suicidal tendency and disturbed body image, death and eating disorders, and attachment and death with clinical implications related to AN.

Modes of death in neonatal intensive care units.

LENUS (Irish Health Repository)

Finan, E

2006-04-01

With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).

Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

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Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

of death, being bedridden, and re-admission were 55, 40, and 22, respectively. The goal of treatment was only palliative care in 80 percent of this patient group. Respiratory failure among the hospitalized was the strongest predictive factors of death (Odds ratio = 7.5, p < 0.001). The average costs of admission per patient was 163,870 THB and the percentage of reimbursement was only 72%. For total costs of admission in these two months, Siriraj Hospital lost a large amount of money (about 26 million THB) for patients admitted for 7 days or more and almost 50% of this was spent on the patients admitted for 90 days or more. The average cost of admission per patient in the latter group was 1,073,004 THB. Prolonged hospitalization had adverse outcomes for the patients and the hospital, such as high complications, poor outcomes, high costs of treatment and low reimbursement ratio that created an enormous economic burden for the hospital. Therefore possible preventable causes of prolonged admission must be identified, prevented and managed by improving quality of multidisciplinary health care system and ancillary services.

Current health and preferences for life-prolonging treatments: an application of prospect theory to end-of-life decision making.

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Winter, Laraine; Parker, Barbara

2007-10-01

As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.

Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: a comparison of postmortem computed tomography and autopsy findings.

Science.gov (United States)

Suzuki, Hideto; Hasegawa, Iwao; Hoshino, Norio; Fukunaga, Tatsushige

2015-05-01

In this report, we describe two autopsy cases of death due to upper gastrointestinal hemorrhage (Case 1: gastric ulcer, Case 2: aortoduodenal fistula). Postmortem computed tomography (CT) images from both cases revealed pooling of gastric fluid, which contained high attenuation areas, although these images also mirrored the different sources of the gastrointestinal hemorrhage. Fluid collection was observed in the small intestine for both cases, although the high attenuation areas were only remarkable in Case 2. The autopsy in Case 1 revealed a peptic ulcer, with small vessels exposed on the surface of the ulcer. Melena was also observed throughout the intestine, although clotting was only observed inside the stomach. The autopsy in Case 2 revealed diffuse massive clotting from the stomach to the upper portion of the ileum, which was due to a primary aortoduodenal fistula. Given our autopsy findings, the extent of the high attenuation areas in the digestive tract during postmortem CT scanning may be correlated with the speed of the gastrointestinal hemorrhage before death. Carefully evaluating the radiodensity of the gastrointestinal contents during postmortem CT scanning may indicate the primary site of the hemorrhage before the autopsy, thereby facilitating the accurate identification of the cause of death during forensic autopsy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Optimism in prolonged grief and depression following loss: A three-wave longitudinal study.

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Boelen, Paul A

2015-06-30

There is considerable evidence that optimism, the predisposition to have generalized favorable expectancies for the future, is associated with numerous desirable outcomes. Few studies have examined the association of optimism with emotional distress following the death of a loved one. Doing so is important, because optimism may be an important target for interventions for post-loss psychopathology. In the current study, we examined the degree to which optimism, assessed in the first year post-loss (Time 1, T1), was associated with symptom levels of prolonged grief and depression six months (Time 2, T2) and fifteen months (Time 3, T3) later, controlling for baseline symptoms and also taking into account positive automatic cognitions at T1. Findings showed that higher optimism at T1 was associated with lower concurrent prolonged grief and depression severity. Higher optimism at T1 was also inversely related with depression symptom severity at T2 and T3, but not prolonged grief severity at T2 and T3. Implications of these findings are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Aplastic anemia as a cause of death in a patient with glioblastoma multiforme treated with temozolomide

International Nuclear Information System (INIS)

Kopecky, Jindrich; Priester, Peter; Slovacek, Ladislav; Petera, Jiri; Macingova, Zuzana; Kopecky, Otakar

2010-01-01

Background: Standard treatment of glioblastoma multiforme consists of postoperative radiochemotherapy with temozolomide, followed by a 6-month chemotherapy. Serious hematologic complications are rarely reported. Case Report and Results: The authors present the case of a 61-year-old female patient with glioblastoma multiforme treated with external-beam radiation therapy and concomitant temozolomide. After completion of treatment, the patient developed symptoms of serious aplastic anemia that eventually led to death due to prolonged neutro- and thrombocytopenia followed by infectious complications. Conclusion: Lethal complications following temozolomide are, per se, extremely rare, however, a total of four other cases of aplastic anemia have been reported in the literature so far. (orig.)

Aplastic anemia as a cause of death in a patient with glioblastoma multiforme treated with temozolomide

Energy Technology Data Exchange (ETDEWEB)

Kopecky, Jindrich; Priester, Peter; Slovacek, Ladislav; Petera, Jiri; Macingova, Zuzana [Dept. of Clinical Oncology and Radiotherapy, Charles Univ. Hospital and Faculty of Medicine in Hradec Kralove (Czech Republic); Kopecky, Otakar [Clinical Oncology, Regional Hospital Nachod (Czech Republic)

2010-08-15

Background: Standard treatment of glioblastoma multiforme consists of postoperative radiochemotherapy with temozolomide, followed by a 6-month chemotherapy. Serious hematologic complications are rarely reported. Case Report and Results: The authors present the case of a 61-year-old female patient with glioblastoma multiforme treated with external-beam radiation therapy and concomitant temozolomide. After completion of treatment, the patient developed symptoms of serious aplastic anemia that eventually led to death due to prolonged neutro- and thrombocytopenia followed by infectious complications. Conclusion: Lethal complications following temozolomide are, per se, extremely rare, however, a total of four other cases of aplastic anemia have been reported in the literature so far. (orig.)

Nearly 800,000 deaths prevented due to declines in smoking

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Twentieth-century tobacco control programs and policies were responsible for preventing more than 795,000 lung cancer deaths in the United States from 1975 through 2000. If all cigarette smoking in this country had ceased following the release of the firs

Preventing newborn deaths due to prematurity.

Science.gov (United States)

Azad, Kishwar; Mathews, Jiji

2016-10-01

Preterm births (PTBs), defined as births before 37 weeks of gestation account for the majority of deaths in the newborn period. Prediction and prevention of PTB is challenging. A history of preterm labour or second trimester losses and accurate measurement of cervical length help to identify women who would benefit from progesterone and cerclage. Fibronectin estimation in the cervicovaginal secretions of a symptomatic woman with an undilated cervix can predict PTB within 10 days of testing. Antibiotics should be given to women with preterm prelabour rupture of membranes but tocolysis has a limited role in the management of preterm labour. Antenatal corticosteroids to prevent complications in the neonate should be given only when gestational age assessment is accurate PTB is considered imminent, maternal infection and the preterm newborn can receive adequate care. Magnesium sulphate for fetal neuroprotection should be given when delivery is imminent. After birth, most babies respond to simple interventions essential newborn care, basic care for feeding support, infections and breathing difficulties. Newborns weighing 2000 g or less, benefit from KMC. Babies, who are clinically unstable or cannot be given KMC may be nursed in an incubator or under a radiant warmer. Treatment modalities include oxygen therapy, CPAP, surfactant and assisted ventilation. Copyright © 2016. Published by Elsevier Ltd.

Ex vivo lung perfusion with adenosine A2A receptor agonist allows prolonged cold preservation of lungs donated after cardiac death.

Science.gov (United States)

Wagner, Cynthia E; Pope, Nicolas H; Charles, Eric J; Huerter, Mary E; Sharma, Ashish K; Salmon, Morgan D; Carter, Benjamin T; Stoler, Mark H; Lau, Christine L; Laubach, Victor E; Kron, Irving L

2016-02-01

Ex vivo lung perfusion has been successful in the assessment of marginal donor lungs, including donation after cardiac death (DCD) donor lungs. Ex vivo lung perfusion also represents a unique platform for targeted drug delivery. We sought to determine whether ischemia-reperfusion injury would be decreased after transplantation of DCD donor lungs subjected to prolonged cold preservation and treated with an adenosine A2A receptor agonist during ex vivo lung perfusion. Porcine DCD donor lungs were preserved at 4°C for 12 hours and underwent ex vivo lung perfusion for 4 hours. Left lungs were then transplanted and reperfused for 4 hours. Three groups (n = 4/group) were randomized according to treatment with the adenosine A2A receptor agonist ATL-1223 or the dimethyl sulfoxide vehicle: Infusion of dimethyl sulfoxide during ex vivo lung perfusion and reperfusion (DMSO), infusion of ATL-1223 during ex vivo lung perfusion and dimethyl sulfoxide during reperfusion (ATL-E), and infusion of ATL-1223 during ex vivo lung perfusion and reperfusion (ATL-E/R). Final Pao2/Fio2 ratios (arterial oxygen partial pressure/fraction of inspired oxygen) were determined from samples obtained from the left superior and inferior pulmonary veins. Final Pao2/Fio2 ratios in the ATL-E/R group (430.1 ± 26.4 mm Hg) were similar to final Pao2/Fio2 ratios in the ATL-E group (413.6 ± 18.8 mm Hg), but both treated groups had significantly higher final Pao2/Fio2 ratios compared with the dimethyl sulfoxide group (84.8 ± 17.7 mm Hg). Low oxygenation gradients during ex vivo lung perfusion did not preclude superior oxygenation capacity during reperfusion. After prolonged cold preservation, treatment of DCD donor lungs with an adenosine A2A receptor agonist during ex vivo lung perfusion enabled Pao2/Fio2 ratios greater than 400 mm Hg after transplantation in a preclinical porcine model. Pulmonary function during ex vivo lung perfusion was not predictive of outcomes after transplantation. Copyright �

Lost life years due to premature deaths caused by diseases of the digestive system in Poland in 2013

Science.gov (United States)

Paciej, Paulina; Ciabiada, Beata; Maniecka-Bryła, Irena

In order to evaluate the health status of a population, besides indicators measuring the incidence of diseases and deaths, potential measures are becoming more frequently used, ie. measures that take into account life-time potential of the individuals in the population. They can particularly by applied to analyse the problem of premature mortality, which is measured by lost life years. The aim of the study was to evaluate life years lost due to diseases of digestive system in Polish population in 2013. The study was based on a dataset containing 387,312 death certificates of Poles who died in 2013, provided by the Central Statistical Office in Poland. Data on deaths caused by diseases of digestive system (K00-K93 by ICD-10) were used in the study – that were 16,543 records (4.3% of all the deaths). Lost life years were assessed with the measures: SEYLL (Standard Expected Years of Life Lost), SEYLLp (Standard Expected Years of Life Lost per living person), SEYLLd (Standard Expected Years of Life Lost per death). In the analysed year among men there were 9,275 deaths caused by diseases of digestive system and in women 7,268 deaths. SEYLL in the group of men amounted to 102 230.7 and in the group of women it was 53,475.5. The number of lost life years calculated per 10 000 male inhabitants was 54.9, and for 10,000 females it was 26.9. The highest share in lost life years had alcoholic liver disease (SEYLLp for men – 20.87, for women – 6.1), fibrosis and cirrhosis of the liver (SEYLLp for men- 9.7, for women- 5.6) and acute pancreatitis (SEYLLp for men – 5.3, for women – 2.1). The results of the study indicate that diseases of digestive system have an important contribution to the loss of life-time potential in Polish population (6.6% of all SEYLL in 2013). The dominant role in this class of diseases played alcoholic liver disease – K70, fibrosis and cirrhosis of the liver – K74 and acute pancreatitis – K85.

The disease related deaths due to differentiated thyroid carcinomas treated multidisciplinary, including radioiodine

International Nuclear Information System (INIS)

Stefanovic, Lj.; Kermeci, K.; Malesevic, M.; Mihailovic, J.; Srbovan, D.; Popadic, S.

2002-01-01

Aim: To analyse the disease related deaths of differentiated thyroid carcinoma (DTC) patients treated multidisciplinary, including radioiodine. Patients and Methods: 364 DTC patients were treated from 1977 to the end of 2000. All patients were operated, treated by radioiodine and by hormonal therapy, external radiotherapy was applied in 22 and chemotherapy in 6 of them. 54 treated patients were lost from the follow-up. The course of disease and outcomes are known in 310 patients, among them 53 patients died. The disease related deaths occurred in 33 (10.6%) patients. Results: Between 33 patients whose deaths were in relation with DTC the disease progression was the cause of deaths in 30 (9.7% of treated) patients (the locoregional disease in 10, distant metastases /M1/ in 17, locoregional disease + M1 in 3 patients). From the late complications of treatment died 3 (1%) patients (all of them were in complete remission to the deaths). The mean survival of these 33 patients from the diagnosis to the end of the life was 6.9 years, median 5.1 years, range 2 months to 23.9 years. The five years survived 54.6% of them, 10 years 21.2% and more than 20 years 3%. M1 had 72.7% of patients (lung and/or bone M1 were present in 91.7% of them), N1 had 69.7% and in 30.3% local tumor was T4. In relation to all treated patients died 14.6% men compared to 9% women (p<0.05), 15.7% of patients 45 years old or older compared to 4.4% of younger then 45 years (p<0.001) and 21.3% of patients with follicular type of DTC compared to 7.3% with papillary type (p<0.001). From all patients without radioiodine accumulation in tumor tissue died 60%. Conclusion: The DTC related deaths were the consequence of M1 and less frequently the result of locoregional disease (T4 and/or N1) in about 1/10 of all treated patients. The deaths as result of the late complications of treatment were exceptional. The deaths were significantly more frequent between males, patients 45 years old or older and patients

Cardiovascular drugs inducing QT prolongation: facts and evidence.

Science.gov (United States)

Taira, Carlos A; Opezzo, Javier A W; Mayer, Marcos A; Höcht, Christian

2010-01-01

Acquired QT syndrome is mainly caused by the administration of drugs that prolong ventricular repolarization. On the other hand, the risk of drug-induced torsades de pointes is increased by numerous predisposing factors, such as genetic predisposition, female sex, hypokalemia and cardiac dysfunction. This adverse reaction is induced by different chemical compounds used for the treatment of a variety of pathologies, including arrhythmias. As it is known, antiarrhythmic agents and other cardiovascular drugs can prolong the QT interval, causing this adverse reaction. Of the 20 most commonly reported drugs, 10 were cardiovascular agents and these appeared in 348 of the reports (46%). Class Ia antiarrhythmic agents have frequently been linked to inducing arrhythmia, including torsades de pointes. Sotalol and amiodarone, class III antiarrhythmics, are known to prolong the QT interval by blocking I(Kr). Due to the severity of events caused by the therapeutic use of these drugs, in this work of revision the cardiovascular drugs that present this property and the factors and evidence will be mentioned.

Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

Science.gov (United States)

Finsterer, Josef; Stöllberger, Claudia

2014-06-01

Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000–2010: a registry based study

Directory of Open Access Journals (Sweden)

Mmbaga Blandina T

2012-12-01

Full Text Available Abstract Background Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. Methods We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE. Results Overall perinatal mortality was 57.7/1000 (1958 out of 33 929, of which 1219 (35.9/1000 were stillbirths and 739 (21.8/1000 were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000, obstetric complications (n=303, 8.9/1000, maternal disease (n=287, 8.5/1000, unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000, and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000. Obstructed/prolonged labour was the leading condition (251/303, 82.8% among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2% among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000 and maternal conditions (from 8.5 to 5.5/1000. Conclusion The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care

Prolonged storage of packed red blood cells for blood transfusion.

Science.gov (United States)

Martí-Carvajal, Arturo J; Simancas-Racines, Daniel; Peña-González, Barbra S

2015-07-14

A blood transfusion is an acute intervention, used to address life- and health-threatening conditions on a short-term basis. Packed red blood cells are most often used for blood transfusion. Sometimes blood is transfused after prolonged storage but there is continuing debate as to whether transfusion of 'older' blood is as beneficial as transfusion of 'fresher' blood. To assess the clinical benefits and harms of prolonged storage of packed red blood cells, in comparison with fresh, on recipients of blood transfusion. We ran the search on 1st May 2014. We searched the Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), CINAHL (EBSCO Host) and two other databases. We also searched clinical trials registers and screened reference lists of the retrieved publications and reviews. We updated this search in June 2015 but these results have not yet been incorporated. Randomised clinical trials including participants assessed as requiring red blood cell transfusion were eligible for inclusion. Prolonged storage was defined as red blood cells stored for ≥ 21 days in a blood bank. We did not apply limits regarding the duration of follow-up, or country where the study took place. We excluded trials where patients received a combination of short- and long-stored blood products, and also trials without a clear definition of prolonged storage. We independently performed study selection, risk of bias assessment and data extraction by at least two review authors. The major outcomes were death from any cause, transfusion-related acute lung injury, and adverse events. We estimated relative risk for dichotomous outcomes. We measured statistical heterogeneity using I(2). We used a random-effects model to synthesise the findings. We identified three randomised clinical trials, involving a total of 120 participants, comparing packed red blood cells with ≥ 21 days storage

Depressive disorders during weaning from prolonged mechanical ventilation.

Science.gov (United States)

Jubran, Amal; Lawm, Gerald; Kelly, Joanne; Duffner, Lisa A; Gungor, Gokay; Collins, Eileen G; Lanuza, Dorothy M; Hoffman, Leslie A; Tobin, Martin J

2010-05-01

Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders. Of the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score [odds ratio (OR), 1.23; P = 0.007], functional dependence before the acute illness (OR, 1.70, P = 0.03) and history of psychiatric disorders (OR, 3.04, P = 0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61 vs. 33%, P = 0.0001), as was mortality (24 vs. 10%, P = 0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; P = 0.0002); age (OR, 1.06; P = 0.001) and co-morbidity score (OR, 1.24; P = 0.02) also predicted mortality. Depressive disorders were diagnosed in 42% of patients who were being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.

QTc interval prolongation in children with Turner syndrome: the results of exercise testing and 24-h ECG.

Science.gov (United States)

Dalla Pozza, Robert; Bechtold, Susanne; Urschel, Simon; Netz, Heinrich; Schwarz, Hans-Peter

2009-01-01

Turner syndrome (TS) is the most common sex chromosome abnormality in females. Recently, a prolongation of the rate-corrected QT (QTc) interval in the electrocardiogram (ECG) of TS patients has been reported. A prolonged QTc interval has been correlated to an increased risk for sudden cardiac death, and medical treatment is warranted in patients with congenital long QT syndrome (LQTS). Additionally, several drugs of common use are contraindicated in LQTS because of their effects on myocardial repolarization. The importance of the QTc prolongation in TS patients is not known at present. Eighteen TS patients with a prolonged QTc interval (group 1) and 11 TS patients with a normal QTc interval (group 2) (mean age 12.6+/-3.1 vs. 11.8+/-2.1 years, respectively) were tested. The QTc interval was calculated during exercise testing and during 24-h ECG recordings. None of the patients experienced adverse cardiac events during the tests. The mean QTc interval decreased from 0.467 to 0.432 s in group 1 and from 0.432 to 0.412 s in group 2. During the 24-h ECG, the maximum QTc interval was significantly prolonged in group 1 (0.51 vs. 0.465 s, pinformation about the cardiac risk in the single TS patient with a prolonged QTc interval. This helps in counseling these girls, as clear therapeutic guidelines are currently lacking.

Prolonged limitation of tree growth due to warmer spring in semi-arid mountain forests of Tianshan, northwest China

International Nuclear Information System (INIS)

Wu Xiuchen; Liu Hongyan; Wang Yufu; Deng Minghua

2013-01-01

Based on radial tree growth measurements in nine plots of area 625 m 2 (369 trees in total) and climate data, we explored the possibly changing effects of climate on regional tree growth in the temperate continental semi-arid mountain forests in the Tianshan Mountains in northwest China during 1933–2005. Tree growth in our study region is generally limited by the soil water content of pre- and early growing season (February–July). Remarkably, moving correlation functions identified a clear temporal change in the relationship between tree growth and mean April temperature. Tree growth showed a significant (p < 0.05) and negative relationship to mean April temperature since approximately the beginning of the 1970s, which indicated that the semi-arid mountain forests are suffering a prolonged growth limitation in recent years accompanying spring warming. This prolonged limitation of tree growth was attributed to the effects of soil water limitation in early spring (March–April) caused by the rapid spring warming. Warming-induced prolonged drought stress contributes, to a large part, to the marked reduction of regional basal area increment (BAI) in recent years and a much slower growth rate in young trees. Our results highlight that the increasing water limitation induced by spring warming on tree growth most likely aggravated the marked reduction in tree growth. This work provides a better understanding of the effects of spring warming on tree growth in temperate continental semi-arid forests. (letter)

Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy

DEFF Research Database (Denmark)

Kowalska, Justyna D; Reekie, Joanne; Mocroft, Amanda

2012-01-01

were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or six months after last follow-up visit. Incidence rates (IR) of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time...... of exposure to cART (=3 antiretrovirals): 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. RESULTS:: 1297 patients died during 70613 PYFU (IR 18.3 per 1000 PYFU, 95%CI: 17.4-19.4), 413 due to AIDS (5.......85, 95%CI: 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95%CI: 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2-3.99 years and longer exposure time...

Prolonged use of indwelling urinary catheter following acute urinary ...

African Journals Online (AJOL)

J.O. Bello

prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlarge- ment (BPE) and urethral ... indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study .... the major health-care financing strategy in Nigeria and accounts for more than ...

Cardiotocographic and Doppler Ultrasonographic Findings in a Fetus with Brain Death Syndrome

Directory of Open Access Journals (Sweden)

Yi-Ting Chen

2006-09-01

Conclusion: The possibility of intrauterine brain death should be considered in all cases of prolonged fixed FHR pattern, accompanied by absence of neuromuscular parameters of BPP, polyhydramnios and demonstrated cessation of cerebral blood flow by Doppler US. Increased awareness of this event may prevent unnecessary emergency cesarean section.

Disability Rating, Age at Death, and Cause of Death in U.S. Veterans with Service-Connected Conditions.

Science.gov (United States)

Maynard, Charles; Trivedi, Ranak; Nelson, Karin; Fihn, Stephan D

2018-03-26

The association between disability and cause of death in Veterans with service-connected disabilities has not been studied. The objective of this study was to compare age at death, military service and disability characteristics, including disability rating, and cause of death by year of birth. We also examined cause of death for specific service-connected conditions. This study used information from the VETSNET file, which is a snapshot of selected items from the Veterans Benefits Administration corporate database. We also used the National Death Index (NDI) for Veterans which is part of the VA Suicide Data Repository. In VETSNET, there were 758,324 Veterans who had a service-connected condition and died between the years 2004 and 2014. Using the scrambled social security number to link the two files resulted in 605,493 (80%) deceased Veterans. Age at death, sex, and underlying cause of death were obtained from the NDI for Veterans and military service characteristics and types of disability were acquired from VETSNET. We constructed age categories corresponding to period of service; birth years 1938 and earlier corresponded to Korea and World War II ("oldest"), birth years 1939-1957 to the Vietnam era ("middle"), and birth years 1958 and later to post Vietnam, Gulf War, and the more recent conflicts in Iraq and Afghanistan ("youngest"). Sixty-two percent were in the oldest age category, 34% in the middle group, and 4% in the youngest one. The overall age at death was 75 ± 13 yr. Only 1.6% of decedents were women; among women 25% were in the youngest age group, while among men only 4% were in the youngest group. Most decedents were enlisted personnel, and 60% served in the U.S. Army. Nearly 61% had a disability rating of >50% and for the middle age group 54% had a disability rating of 100%. The most common service-connected conditions were tinnitus, hearing loss, and post-traumatic stress disorder (PTSD). In the oldest group, nearly half of deaths were due to

Anti-M Antibody Induced Prolonged Anemia Following Hemolytic Disease of the Newborn Due to Erythropoietic Suppression in 2 Siblings.

Science.gov (United States)

Ishida, Atsushi; Ohto, Hitoshi; Yasuda, Hiroyasu; Negishi, Yutaka; Tsuiki, Hideki; Arakawa, Takeshi; Yagi, Yoshihito; Uchimura, Daisuke; Miyazaki, Toru; Ohashi, Wataru; Takamoto, Shigeru

2015-08-01

Hemolytic disease of the newborn (HDN) arising from MNSs incompatibility is rare, with few reports of prolonged anemia and reticulocytopenia following HDN. We report the younger of 2 male siblings, both of whom had anti-M-induced HDN and anemia persisting for over a month. Peripheral reticulocytes remained inappropriately low for the degree of anemia, and they needed multiple red cell transfusions. Viral infections were ruled out. Corticosteroids were given for suspected pure red cell aplasia. Anemia and reticulocytopenia subsequently improved. Colony-forming unit erythroid assay revealed erythropoietic suppression of M antigen-positive erythroid precursor cells cultured with maternal or infant sera containing anti-M. In conclusion, maternal anti-M caused HDN and prolonged anemia by erythropoietic suppression in 2 siblings.

Specific features of the hemorrhagic syndrome manifestation under chronic, prolonged and acute irradiation

International Nuclear Information System (INIS)

Arlashchenko, N.I.; Gorlov, V.G.; Maksimova, E.N.

1978-01-01

To make the hemorrhagic syndrome manifest itself, two phenomena are necessary to coincide in time, they are: a fall in the elasticity of the vascular wall and reduction in the amount of thrombocytes in blood. Depending upon the radiation dose, the vascular wall and the thrombocytic function may be either simultaneously impaired after acute exposure) or dissociated (following prolonged irradiation). Chronic irradiation at small (subliminal) dose rates fails to induce hemorrhagic disorders and death of rats caused by pathologic hemophilia

[Ill-defined causes of death and unattended deaths, Brazil, 2003].

Science.gov (United States)

Santo, Augusto Hasiak

2008-01-01

We studied the distribution of deaths from ill-defined causes that occurred in Brazil during 2003, from which was identified the proportion of unattended deaths. Data were obtained from the Mortality Information System, coordinated by the Ministry of Health. Causes of death included in "Chapter XVIII - Symptoms, signs and abnormal clinical and laboratory findings, not classified elsewhere" of the International Statistical Classification of Diseases and Related Health Problems, tenth revision, were considered ill-defined, among which the category R98 identified "unattended deaths". In Brazil during 2003 the underlying causes of 13.3% of deaths were included in the Chapter of ill-defined causes, and the highest proportions of these deaths occurred in the Northeast and North Regions. Considering the total deaths from ill-defined causes, 53 % correspond to unattended deaths. This proportion increased to over 70% in the states of Maranhão, Piauí, Rio Grande do Norte, Pernambuco, Bahia, Paraíba and Alagoas. Due to the decentralized structure of data collection in the country, we believe that the municipalities bear the major responsibility, followed by the states, for upgrading the quality of mortality statistics.

Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

Directory of Open Access Journals (Sweden)

Rossella Marino

2013-10-01

Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

Prolonging the viability of Lactobacillus plantarum through the addition of prebiotics into the medium.

Science.gov (United States)

Altieri, Clelia; Bevilacqua, Antonio; Sinigaglia, Milena

2011-08-01

This article reports on the effects of prebiotics on the growth/death kinetics, metabolism, and biomass production by 2 strains of Lactobacillus plantarum (c19 and DSMZ 2601, isolated from table olives and purchased from a Public Collection, respectively). The research was divided into 3 different steps, in order to highlight the optimal combination for cell viability and experiments were performed under the conditions of an accelerated shelf life test; thus, 3 combinations were pointed out (fructooligosaccharides [FOS], 5 g/L; glucose + inulin, 2.5 + 2.5 g/L; glucose + FOS, 2.5 + 2.5 g/L). A sample containing only glucose was used as control. The results highlighted that the 3 combinations aforementioned prolonged cell viability over the time both under low and high inoculum conditions (3 and 9 log CFU/mL, respectively); however, FOS alone caused a reduction of biomass production, even if cell number was not affected by this compound. Therefore, as a final result of this research, the combination glucose + FOS could be proposed as a suitable mean to achieve an optimal production of biomass and prolong cell viability over the time. Food producers require a prolonged viability of probiotic bacteria in functional foods; this goal is usually achieved by refrigeration. In this article, the prolongation of cell viability through the addition of prebiotics was proposed. © 2011 Institute of Food Technologists®

MRI findings of prolonged post-traumatic sternal pain

International Nuclear Information System (INIS)

Grosse, Alexandra; Grosse, Claudia; Anderson, Suzanne; Steinbach, Lynne

2007-01-01

The objective of this study was to characterize the different causes of prolonged sternal pain following thoracic trauma with involvement of the sternum and to define criteria for sternal nonunion diagnosis using MRI. Five patients with abnormalities of the sternum were evaluated for prolonged sternal pain following thoracic trauma using MRI. MR images were evaluated by two radiologists in consensus. The patients were selected from the radiology database, which included 8 patients with post-traumatic prolonged sternal pain. Two patients (n = 2) revealed a sternal nonunion after sternal fracture. One patient had a sternal fracture with delayed union and minor displacement of the sternal halves. Abnormal signal intensity alterations adjacent to and within the manubrio-sternal joint were evident in 2 patients and considered due to trauma-related changes in the manubrio-sternal joint. The 3 patients who were not included in the study had no abnormalities of the sternum: 1 of them proved to have a well-healed sternal fracture and nonunion of a rib fracture, 1 had subtle Tietze's syndrome, and 1 patient revealed no pathological findings on imaging. Various factors may be responsible for prolonged sternal pain following thoracic trauma, and these can be viewed with MRI. In cases of sternal nonunion there was common fluid-like signal in the fracture interspace between the bony edges, and the bone marrow adjacent to the nonunion showed altered signal intensity. MRI identified sternal nonunion and other trauma-related abnormalities of the sternum following chest trauma. (orig.)

Prolonged heart xenograft survival using combined total lymphoid irradiation and cyclosporine

International Nuclear Information System (INIS)

Knechtle, S.J.; Halperin, E.C.; Saad, T.; Bollinger, R.R.

1986-01-01

Total lymphoid irradiation and cyclosporine have profound immunosuppressive properties and permit successful heart allotransplantation. Cyclosporine used alone has not permitted consistently successful transplantation between species in all cases. Total lymphoid irradiation has not been applied to xenotransplantation. The efficacy of total lymphoid irradiation alone and in combination with cyclosporine was examined using an animal model of heart xenotransplantation. Heterotopic heart transplants were performed using inbred Syrian hamsters as donors and Lewis rats as recipients. Total lymphoid irradiation was administered preoperatively over 3 weeks for a total dose of 15 gray. Cyclosporine was started on the day of surgery and was given as a daily intramuscular injection of 2.5, 5, or 10 mg/kg/day until rejection was complete. Neither total lymphoid irradiation nor cyclosporine alone markedly prolonged graft survival. However, combined total lymphoid irradiation and cyclosporine, 5 or 10 mg/kg/day, dramatically prolonged graft survival to greater than 100 days in most recipients. There were no treatment-related deaths. In conclusion, combined total lymphoid irradiation and cyclosporine permit successful long-term survival of heart xenotransplants in this hamster-to-rat model

Prolonged job strain and subsequent risk of cancer in women–a longitudinal study, based on the Danish Nurse Cohort

DEFF Research Database (Denmark)

Vesterlund, Gitte K.; Høeg, Beverley L.; Johansen, Christoffer

2017-01-01

Background: The role of psychological stress in cancer risk is continuously debated. Stress at work is the most common form of stress and previous studies have shown inconsistent results regarding cancer risk. In this longitudinal study, we examined the association between prolonged job strain......-related, digestive and lung cancers according to level of prolonged job strain. The women were followed from 1 January 2000 until cancer diagnosis, emigration, death or 31 December 2013 (mean follow-up 13 years) and models were adjusted for potential confounders. Effect modification was examined according to working...... nightshifts and full time. Results: No significant differences in the risk of overall cancer or any of the cancer subgroups were identified in relation to prolonged busyness, speed, influence, or overall job strain. Effect modification by working full time was observed when examining job influence in relation...

Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania

DEFF Research Database (Denmark)

Sorensen, Bjarke Lund; Rasch, Vibeke; Massawe, Siriel

2010-01-01

OBJECTIVE: To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training. METHODS: Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study...... conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed. RESULTS: There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention...... 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1minute of 4 or more (P=0.03). CONCLUSION: ALSO training had no effect on the management of prolonged labor. Early contact between...

Prolonged Living as a Refugee from the Area Around a Stricken Nuclear Power Plant Increases the Risk of Death.

Science.gov (United States)

Tanaka, Reiichiro

2015-08-01

Although it is well known that the Great East Japan Earthquake (March 11, 2011) resulted in a large number of disaster-related deaths, it is not common knowledge that the number of disaster-related deaths continues to increase, even four years after the earthquake, in Fukushima Prefecture, where the nuclear power plant accident occurred. There has been a lack of a minute and critical analysis for the causes for this continuous increase. In this report, the causes for the increase in disaster-related deaths in Fukushima Prefecture were analyzed by aggregating and comparing multiple data released by public organizations (the Reconstruction Agency, the National Police Agency, and Fukushima Prefecture), which may also have implications for developing response strategies to other disasters. The disaster-related death rate, the dead or missing rate, and the refugee rate (the number of disaster-related deaths, dead or missing persons, and refugees per 1,000 people) in each prefecture in stricken areas, and also each city, county, town, and village in Fukushima Prefecture, were calculated and compared with each other. The populations which were used for the calculation of each death rate in the area were based on the number of dead victims who had lived in the area when the earthquake occurred, regardless of where they were at the time of their death. The disaster-related death rate was higher than the dead or missing rate in the area around a stricken nuclear power plant in Fukushima Prefecture. These areas coincide exactly with the Areas under Evacuation Orders because of unsafe radiation levels. The external and internal radiation doses of most of the victims of the Great East Japan Earthquake have appeared not to be so high to harm their health, until now. The psychological stress associated with being displaced from one's home for a long time with an uncertain future may be the cause for these disaster-related deaths. There is an urgent need to recognize refugees

Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors.

Science.gov (United States)

Schaal, Susanne; Jacob, Nadja; Dusingizemungu, Jean-Pierre; Elbert, Thomas

2010-07-06

The concept of Prolonged Grief Disorder (PGD) has been defined in recent years by Prigerson and co-workers, who have developed and empirically tested consensus and diagnostic criteria for PGD. Using these most recent criteria defining PGD, the aim of this study was to determine rates of and risks for PGD in survivors of the 1994 Rwandan genocide who had lost a parent and/or the husband before, during or after the 1994 events. The PG-13 was administered to 206 orphans or half orphans and to 194 widows. A regression analysis was carried out to examine risk factors of PGD. 8.0% (n = 32) of the sample met criteria for PGD with an average of 12 years post-loss. All but one person had faced multiple losses and the majority indicated that their grief-related loss was due to violent death (70%). Grief was predicted mainly by time since the loss, by the violent nature of the loss, the severity of symptoms of posttraumatic stress disorder (PTSD) and the importance given to religious/spiritual beliefs. By contrast, gender, age at the time of bereavement, bereavement status (widow versus orphan), the number of different types of losses reported and participation in the funeral ceremony did not impact the severity of prolonged grief reactions. A significant portion of the interviewed sample continues to experience grief over interpersonal losses and unresolved grief may endure over time if not addressed by clinical intervention. Severity of grief reactions may be associated with a set of distinct risk factors. Subjects who lose someone through violent death seem to be at special risk as they have to deal with the loss experience as such and the traumatic aspects of the loss. Symptoms of PTSD may hinder the completion of the mourning process. Religious beliefs may facilitate the mourning process and help to find meaning in the loss. These aspects need to be considered in the treatment of PGD.

Accidental death due to complete autoerotic asphyxia associated with transvestic fetishism and anal self-stimulation - case report.

Science.gov (United States)

Atanasijević, Tatjana; Jovanović, Aleksandar A; Nikolić, Slobodan; Popović, Vesna; Jasović-Gasić, Miroslava

2009-06-01

A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum.

Death certificate data and causes of death in patients with parkinsonism.

Science.gov (United States)

Moscovich, Mariana; Boschetti, Gabriela; Moro, Adriana; Teive, Helio A G; Hassan, Anhar; Munhoz, Renato P

2017-08-01

Assessment of variables related to mortality in Parkinson disease (PD) and other parkinsonian syndromes relies, among other sources, on accurate death certificate (DC) documentation. We assessed the documentation of the degenerative disorder on DCs and evaluated comorbidities and causes of death among parkinsonian patients. Demographic and clinical data were systematically and prospectively collected on deceased patients followed at a tertiary movement disorder clinic. DCs data included the documentation of parkinsonism, causes, and place of death. Among 138 cases, 84 (60.9%) male, mean age 77.9 years, mean age of onset 66.7, and mean disease duration 10.9 years. Clinical diagnoses included PD (73.9%), progressive supranuclear palsy (10.9%), multiple system atrophy (7.2%), Lewy body dementia (7.2%) and corticobasal degeneration (0.7%). Psychosis occurred in 60.1% cases, dementia in 48.5%. Most PD patients died due to heterogeneous causes before reaching advanced stages. Non-PD parkinsonian patients died earlier due to causes linked to the advanced neurodegenerative process. PD was documented in 38.4% of DCs with different forms of inconsistencies. That improved, but remained significant when it was signed by a specialist. More than half of PD cases died while still ambulatory and independent, after a longer disease course and due to causes commonly seen in that age group. Deaths among advanced PD patients occurred due to causes similar to what we found in non-PD cases. These findings can be useful for clinical, prognostic and counseling purposes. Underlying parkinsonian disorders are poorly documented in DCs, undermining its' use as sources of data collection. Copyright © 2017 Elsevier Ltd. All rights reserved.

A retrospective study on the unseen epidemic of road traffic injuries and deaths due to accidents in Mwanza City - Tanzania.

Science.gov (United States)

Ngallaba, S E; Majinge, C; Gilyoma, J; Makerere, D J; Charles, E

2013-06-01

Sixty percent of the global deaths and injuries occur in the developing world and mostly are due to Road traffic accidents (RTAs. looking at the etiological related factors which include, carelessness of the driver, condition of the vehicle or motorcycle, poor condition of roads, risky behavior of the driver, most of these factors can be prevented to some extent. This study therefore, determined the pattern of cases and deaths due to traffic road accidents in Mwanza City Tanzania. In this retrospective study, records, registers and case notes In the surgical ward and causality, medical records and central police station from 2008 to 2011 were used. The study focused on the two referral hospitals (Sekouture regional hospital and Bugando Medical Center). There were 3450 cases due to accidents reported at both centers (Sekouture regional hospital and Bugando Medical Center of which 3224 (93.4%) had complete information for analysis.2225 (69%) were male and 999 (31%) were female, and the most affected group were male. Among the RTAs2809 cases (87%) were due to motor cycle accidents which were the leading cause of RTAs with case fatality rate of 5% while motor vehicle has case fatality rate of 24% which is 5 times that of motor cycle. Among all RTAs the leading cause of injuries is Motor cycle traffic accidents followed by motor vehicle. RTAs are on increase particularly the motor cycle traffic accidents and has claimed a good number of innocent people's lives however most of them are preventable, therefore driving course to be introduced to motor cycle drivers with emphasize on the road posters signal, rules and regular checkup of their motor cycles especially commercial motor cycle.

Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium.

Science.gov (United States)

Vandael, Eline; Vandenberk, Bert; Vandenberghe, Joris; Spriet, Isabel; Willems, Rik; Foulon, Veerle

2016-04-01

Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. Management of the risk of QTc-prolongation. Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.

Defibrillator patients should not be denied a peaceful death.

Science.gov (United States)

Westerdahl, Annika Kinch; Sutton, Richard; Frykman, Viveka

2015-03-01

Implantable defibrillators (ICDs) prevent sudden cardiac death. With declining health, ICD therapy may prolong death and expose the patient to unnecessary pain and anxiety. Few studies have addressed end of life care in ICD patients. The objective of this study was to investigate end of life in ICD patients, with respect to location of death; duration between do-not-resuscitate (DNR)-orders and deactivation of ICD therapy or DNR and time of death. A descriptive analysis of 65 deceased ICD patients, all whom had a written DNR-order before death, is presented. The majority (86%) was treated in hospitals, mainly (63%) university hospitals, and many (33%) in cardiology wards. Despite DNR-order, ICD shock therapy was active in 51% of all patients. In those with therapy deactivated at death, therapy deactivation was carried out two days or more after DNR-order in more than a third (38%). The time from DNR decision to death in patients with therapy active had a median of four days (IQR 1-38). During the last 24h of life, 24% of the patients experienced shock treatment. The majority of ICD patients with a DNR-order were treated in university hospitals. More than half still had shock treatment active at time of death with a median of four days or more between DNR decision and death. Patients with therapy deactivated, two days or more elapsed in more than a third from DNR decision to deactivation of therapy, exposing patients to a high risk of painful shocks before death. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prolonged fasting activates Nrf2 in post-weaned elephant seals.

Science.gov (United States)

Vázquez-Medina, José Pablo; Soñanez-Organis, José G; Rodriguez, Ruben; Viscarra, Jose A; Nishiyama, Akira; Crocker, Daniel E; Ortiz, Rudy M

2013-08-01

Elephant seals naturally experience prolonged periods of absolute food and water deprivation (fasting). In humans, rats and mice, prolonged food deprivation activates the renin-angiotensin system (RAS) and increases oxidative damage. In elephant seals, prolonged fasting activates RAS without increasing oxidative damage likely due to an increase in antioxidant defenses. The mechanism leading to the upregulation of antioxidant defenses during prolonged fasting remains elusive. Therefore, we investigated whether prolonged fasting activates the redox-sensitive transcription factor Nrf2, which controls the expression of antioxidant genes, and if such activation is potentially mediated by systemic increases in RAS. Blood and skeletal muscle samples were collected from seals fasting for 1, 3, 5 and 7 weeks. Nrf2 activity and nuclear content increased by 76% and 167% at week 7. Plasma angiotensin II (Ang II) and transforming growth factor β (TGF-β) were 5000% and 250% higher at week 7 than at week 1. Phosphorylation of Smad2, an effector of Ang II and TGF signaling, increased by 120% at week 7 and by 84% in response to intravenously infused Ang II. NADPH oxidase 4 (Nox4) mRNA expression, which is controlled by smad proteins, increased 430% at week 7, while Nox4 protein expression, which can activate Nrf2, was 170% higher at week 7 than at week 1. These results demonstrate that prolonged fasting activates Nrf2 in elephant seals and that RAS stimulation can potentially result in increased Nox4 through Smad phosphorylation. The results also suggest that Nox4 is essential to sustain the hormetic adaptive response to oxidative stress in fasting seals.

Prolonged excretion of a low-pathogenicity H5N2 avian influenza virus strain in the Pekin duck

Science.gov (United States)

Carranza-Flores, José Manuel; Padilla-Noriega, Luis; Loza-Rubio, Elizabeth

2013-01-01

H5N2 strains of low-pathogenicity avian influenza virus (LPAIV) have been circulating for at least 17 years in some Mexican chicken farms. We measured the rate and duration of viral excretion from Pekin ducks that were experimentally inoculated with an H5N2 LPAIV that causes death in embryonated chicken eggs (A/chicken/Mexico/2007). Leghorn chickens were used as susceptible host controls. The degree of viral excretion was evaluated with real-time reverse transcriptase-polymerase chain reaction (RRT-PCR) using samples from oropharyngeal and cloacal swabs. We observed prolonged excretion from both species of birds lasting for at least 21 days. Prolonged excretion of LPAIV A/chicken/Mexico/2007 is atypical. PMID:23820212

Death due to complications of anhidrotic ectodermal dysplasia.

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Ogden, Emily; Schandl, Cynthia; Tormos, Lee Marie

2014-11-01

Ectodermal dysplasia comprises a group of disorders affecting ectodermal tissues. Severity depends on the genetic aberration; hyperpyrexia secondary to absence of sweat glands is a common complication. Treatment is supportive. This case report describes a 1-month, 27-day-old male infant with a diagnosis of X-linked recessive anhidrotic ectodermal dysplasia. On the day of his death, his mother swaddled him in a blanket and placed him on the couch at 5:30 am. When she picked him up at 8:00 am, he was unresponsive. At the emergency department, his rectal temperature was 40°C. Postmortem blood culture was positive for group B streptococcus, a possible etiology for fever. It is vital to teach parents that close monitoring of children with ectodermal dysplasia is necessary, as an increase in body temperature can become life threatening. © 2014 American Academy of Forensic Sciences.

MRI findings of prolonged post-traumatic sternal pain

Energy Technology Data Exchange (ETDEWEB)

Grosse, Alexandra; Grosse, Claudia; Anderson, Suzanne [University Hospital of Berne, Department of Diagnostic, Pediatric and Interventional Radiology, Berne (Switzerland); Steinbach, Lynne [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)

2007-05-15

The objective of this study was to characterize the different causes of prolonged sternal pain following thoracic trauma with involvement of the sternum and to define criteria for sternal nonunion diagnosis using MRI. Five patients with abnormalities of the sternum were evaluated for prolonged sternal pain following thoracic trauma using MRI. MR images were evaluated by two radiologists in consensus. The patients were selected from the radiology database, which included 8 patients with post-traumatic prolonged sternal pain. Two patients (n = 2) revealed a sternal nonunion after sternal fracture. One patient had a sternal fracture with delayed union and minor displacement of the sternal halves. Abnormal signal intensity alterations adjacent to and within the manubrio-sternal joint were evident in 2 patients and considered due to trauma-related changes in the manubrio-sternal joint. The 3 patients who were not included in the study had no abnormalities of the sternum: 1 of them proved to have a well-healed sternal fracture and nonunion of a rib fracture, 1 had subtle Tietze's syndrome, and 1 patient revealed no pathological findings on imaging. Various factors may be responsible for prolonged sternal pain following thoracic trauma, and these can be viewed with MRI. In cases of sternal nonunion there was common fluid-like signal in the fracture interspace between the bony edges, and the bone marrow adjacent to the nonunion showed altered signal intensity. MRI identified sternal nonunion and other trauma-related abnormalities of the sternum following chest trauma. (orig.)

Cardiovascular causes of maternal sudden death. Sudden arrhythmic death syndrome is leading cause in UK.

Science.gov (United States)

Krexi, Dimitra; Sheppard, Mary N

2017-05-01

This study aims to determine the causes of sudden cardiac death during pregnancy and in the postpartum period and patients' characteristics. There are few studies in the literature. Eighty cases of sudden unexpected death due to cardiac causes in relation to pregnancy and postpartum period in a database of 4678 patients were found and examined macroscopically and microscopically. The mean age was 30±7 years with a range from 16 to 43 years. About 30% were 35 years old or older; 50% of deaths occurred during pregnancy and 50% during the postpartum period. About 59.18% were obese or overweight where body mass index data were available. The leading causes of death were sudden arrhythmic death syndrome (SADS) (53.75%) and cardiomyopathies (13.80%). Other causes include dissection of aorta or its branches (8.75%), congenital heart disease (2.50%) and valvular disease (3.75%). This study highlights sudden cardiac death in pregnancy or in the postpartum period, which is mainly due to SADS with underlying channelopathies and cardiomyopathy. We wish to raise awareness of these frequently under-recognised entities in maternal deaths and the need of cardiological screening of the family as a result of the diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

Protection during production: Problems due to prevention? Nail and skin condition after prolonged wearing of occlusive gloves.

Science.gov (United States)

Weistenhöfer, Wobbeke; Uter, Wolfgang; Drexler, Hans

2017-01-01

Wearing of occlusive gloves during the whole working shift is considered a risk factor for developing hand eczema, similar to wet work. Moreover, the increased hydration due to glove occlusion may lead to brittle nails. Two hundred and seventy clean room workers, wearing occlusive gloves for prolonged periods, and 135 administrative employees not using gloves were investigated. This included a dermatological examination of the nails and the hands, using the Hand Eczema ScoRe for Occupational Screening (HEROS), measurement of transepidermal water loss (TEWL), and a standardized interview. Of the clean room workers, 39%, mainly women, reported nail problems, mostly brittle nails with onychoschisis. Skin score values showed no significant differences between HEROS values of both groups. TEWL values of exposed subjects were similar to TEWL values of controls 40 min after taking off the occlusive gloves. In a multiple linear regression analysis, male gender and duration of employment in the clean room were associated with a significant increase in TEWL values. The effect of occlusion on TEWL seems to be predominantly transient and not be indicative of a damaged skin barrier. This study confirmed the results of a previous investigation showing no serious adverse effect of wearing of occlusive gloves on skin condition without exposure to additional hazardous substances. However, occlusion leads to softened nails prone to mechanical injury. Therefore, specific prevention instructions are required to pay attention to this side effect of occlusion.

Defining futile life-prolonging treatments through Neo-Socratic Dialogue.

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Aizawa, Kuniko; Asai, Atsushi; Bito, Seiji

2013-12-09

In Japan, people are negative towards life-prolonging treatments. Laws that regulate withholding or discontinuing life-prolonging treatments and advance directives do not exist. Physicians, however, view discontinuing life-prolonging treatments negatively due to fears of police investigations. Although ministerial guidelines were announced regarding the decision process for end-of-life care in 2007, a consensus could not be reached on the definition of end-of-life and conditions for withholding treatment. We established a forum for extended discussions and consensus building on this topic. We used the Neo-Socratic Dialogue (NSD) method which promotes philosophical discussion based on a case-study to address a question and formulate a consensus and answer in a group. The question chosen for the dialogue was: "What is a life-prolonging treatment?" A series of dialogues took place over a period of one and a half days. It was carried out by three groups in 2010 and 2011. Seven participants with diverse backgrounds were recruited per group. We analyzed the content of the discussion. Based on three case studies concerning different opinions about treatment options for an older dementia patient, a patient demanding chemotherapy, and a severely ill neonate, conditions for futile life-prolonging treatment were elucidated through NSD. Such treatments are those carried out for the sole purpose of prolonging life and are detrimental to the patient, and should be decided based foremost on the patient's lack of desire for treatment, the consensus of those involved, and through social acceptance. These arguments are essentially consistent with ones on medical futility in the United States. By expressing the objective of healthcare and the requirement of social acceptance, participants were also able to elucidate issues related to the awareness of those involved and the medical environment. Compared to the end-of-life guidelines in Japan, the objective of treatment, its effects

[Clinicopathologic characteristics and distribution of number of autopsies of patient death due to coccidioidomycosis at a referral hospital in northeastern México].

Science.gov (United States)

Calderón-Garcidueñas, Ana Laura; Piña-Osuna, Karina; Leal-Moreno, Ana María; López-Cárdenas, Adriana; Cerda-Flores, Ricardo M

2004-01-01

1. To describe clinical and pathologic characteristics of patients with coccidioidomycosis (CM) who died from 1983-2000 at a hospital in northeastern Mexico, and 2, to know distribution of number of deaths due to CM per year and month. From 4598 autopsies, 31 cases of CM were selected. Clinical chart and autopsy protocols were examined. Distribution of cases was analyzed by contingence table and Kolmogorov-Smirnov tests. There were 10 women and 21 men (aged 4 months to 60 years). In women, pregnancy was present in 40% of cases. In men, chronic renal failure (CRF) (38%) and AIDS (19%) were the pathologic conditions most frequently observed. Variation in distribution of cases throughout 18 years was not observed (p > 0.05). Mortality due to CM was 0.67% and variation in number of deaths was not found. In this endemic area, CM must be included in differential diagnosis of patients with risk factors such as pregnancy, CRF, and AIDS, especially if associated with pneumonia with miliary pattern or septicemia with splenomegaly.

Meaning and death-thought accessibility.

Science.gov (United States)

Van Tongeren, Daryl R; Green, Jeffrey D

2018-01-01

Meaning is a central feature in human life, but death can disrupt a sense of meaning. Two experiments tested the hypothesis that meaning in life and meaning in death are distinct types of meaning when mortality is salient and differentially affect death-thought accessibility (DTA). In Experiment 1, imagining a specific scenario in which meaning is preserved beyond death reduced DTA relative to a standard mortality salience prime; moreover, these effects were not due to changes in self-esteem. In Experiment 2, imagining a meaningful life when mortality is salient elicited greater DTA, whereas imagining meaning in death elicited less DTA. Imbuing death with meaning attenuates DTA, whereas meaning in life increases DTA. © 2017 The British Psychological Society.

Brain activity and fatigue during prolonged exercise in the heat

DEFF Research Database (Denmark)

Nielsen, Bodil; Hyldig, Tino; Bidstrup, F.

2001-01-01

We hypothesized that fatigue due to hyperthermia during prolonged exercise in the heat is in part related to alterations in frontal cortical brain activity. The electroencephalographic activity (EEG) of the frontal cortex of the brain was measured in seven cyclists [maximal O2 uptake (VO2max) 4...... min of exercise; P

Parent & Child Perceptions of Child Health after Sibling Death.

Science.gov (United States)

Roche, Rosa M; Brooten, Dorothy; Youngblut, JoAnne M

Understanding children's health after a sibling's death and what factors may affect it is important for treatment and clinical care. This study compared children's and their parents' perceptions of children's health and identified relationships of children's age, gender, race/ethnicity, anxiety, and depression and sibling's cause of death to these perceptions at 2 and 4 months after sibling death. 64 children and 48 parents rated the child's health "now" and "now vs before" the sibling's death in an ICU or ER or at home shortly after withdrawal of life-prolonging technology. Children completed the Child Depression Inventory and Spence Children's Anxiety Scale. Sibling cause of death was collected from hospital records. At 2 and 4 months, 45% to 54% of mothers' and 53% to 84% of fathers' ratings of their child's health "now" were higher than their children's ratings. Child health ratings were lower for: children with greater depression; fathers whose children reported greater anxiety; mothers whose child died of a chronic condition. Children's ratings of their health "now vs before" their sibling's death did not differ significantly from mothers' or fathers' ratings at 2 or 4 months. Black fathers were more likely to rate the child's health better "now vs before" the death; there were no significant differences by child gender and cause of death in child's health "now vs before" the death. Children's responses to a sibling's death may not be visually apparent or become known by asking parents. Parents often perceive their children as healthier than children perceive themselves at 2 and 4 months after sibling death, so talking with children separately is important. Children's perceptions of their health may be influenced by depression, fathers' perceptions by children's anxiety, and mother's perceptions by the cause of sibling death.

38 CFR 3.312 - Cause of death.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Cause of death. 3.312... Cause of death. (a) General. The death of a veteran will be considered as having been due to a service... contributory cause of death. The issue involved will be determined by exercise of sound judgment, without...

Mortes por doenças infecciosas em mulheres: ocorrências no ciclo gravídico-puerperal Deaths due to infectious diseases in women: occurrences in pregnancy and puerperium

Directory of Open Access Journals (Sweden)

Ruy Laurenti

2009-01-01

Full Text Available OBJETIVO: Descrever os óbitos por doenças infecciosas como causa básica ou múltipla, caracterizando os casos de doença infecciosa preexistente ou desenvolvida na gravidez, aqueles que são mortes maternas por causas obstétricas indiretas e os óbitos por Aids ou outras doenças infecciosas, ocorridos no ciclo gravídico puerperal, havendo dúvidas na classificação. MÉTODOS: Adotou-se a metodologia RAMOS (partindo-se da declaração de óbito -DO- original, dados reais são resgatados por entrevista domiciliar, consultas a prontuários hospitalares e laudos de autopsia; elaborando-se uma nova DO, com as reais causas de morte. População foi constituída pelos óbitos femininos de 10 a 49 anos, de residentes nas capitais brasileiras, do 1º semestre de 2002. As causas foram analisadas em básicas e múltiplas. RESULTADOS: Dos 7.332 óbitos, 917 apresentaram uma doença infecciosa como causa básica (Aids e tuberculose, principalmente. Em 37 casos, a falecida estava no ciclo gravídico puerperal ampliado (englobando, inclusive, mortes ocorridas de 43 dias até um ano pós-parto; 10 não foram classificadas como obstétricas indiretas permanecendo como infecciosas e 14 eram obstétricas indiretas. Quanto às causas múltiplas, para 791 mortes, cujas causas básicas não eram maternas nem infecciosas, houve 1.016 menções de doenças infecciosas (média de 1,28 menção/óbito. CONCLUSÃO: Como o número de mortes maternas é pequeno, recomenda-se, que investigações dos casos graves de complicações da gravidez, parto e puerpério que não faleceram (near-miss sejam feitas, pois, sendo mais numerosos, representam importante subsídio para estudos da mortalidade materna.OBJECTIVE: To describe deaths due to infectious diseases as an underlying or multiple cause, identifying cases of pre-existent infectious diseases or ones developed during pregnancy; deaths due to an indirect obstetric cause and deaths due to Aids or other infectious

Licence prolongations of US nuclear power plants; Les prolongations de licence des centrales nucleaires americaines

Energy Technology Data Exchange (ETDEWEB)

NONE

2004-04-01

Licences of US nuclear reactors were initially attributed for a 40 years duration. However, the vast majority of the reactors can benefit of a licence prolongation for a period of 20 years maximum. This article recalls first the procedure to follow for the licence prolongation demands (safety analysis, components aging, environmental impact statement), and then it makes a status of the accepted prolongations, of the demands under examination, and of the demands that should be presented in the next 5 years. (J.S.)

Supravalvular aortic stenosis with sudden cardiac death

Directory of Open Access Journals (Sweden)

Pradeep Vaideeswar

2015-01-01

Full Text Available Sudden cardiac death (SCD most commonly results from previously undiagnosed congenital, acquired, or hereditary cardiac diseases. Congenital aortic valvular, subvalvular, and supravalvular disease with left ventricular outflow tract obstruction is an important preventable cause of sudden death. This report documents sudden death presumably due to acute myocardial ischemia in a young male with an undiagnosed supravalvular aortic stenosis (SVAS due to a rare association of isolation of coronary sinuses of Valsalva. Congenital supravalvular pulmonary stenosis and mitral valvular dysplasia were also present.

Death cap

DEFF Research Database (Denmark)

Rudbæk, Torsten R; Kofoed, Pernille Bouteloup; Bove, Jeppe

2014-01-01

Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused...

Quality of drug label information on QT interval prolongation

DEFF Research Database (Denmark)

Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H

2014-01-01

BACKGROUND: Information regarding QT-prolongation in the drug label may vary between products. This could lead to suboptimal risk minimization strategies. OBJECTIVE: To systematically assess the variation in the extent and content of information on QT prolongation in the summary of product......-prolongation'/'QT-prolongation') and the advice on cautionary measures pertaining to QT-prolongation in the label were examined, as well as their association. RESULTS: Of the 175 screened products, 44 contained information on QT in the SPC ('no QT-prolongation': 23%, 'unclear drug-QT association': 43%, 'possibly QT-prolongation': 16%, 'QT......-prolongation': 18%). 62% contained advices to act with caution in patients with additional risk factors for QT-prolongation. Products that more likely to have QT-prolonging properties according to the SPC provided more information on QT-prolongation in the SPC ('no prolongation': 10% and for the category 'QT...

KAROSHI (WORK TO DEATH

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Moh. Toriqul Chaer

2017-05-01

Full Text Available When the tide of unemployment hit the USA and Europe, in Japan the opposite phenomenon occurs. In 2002, in Japan deaths were recorded because of excessive works. In this country, the phenomenon of death because of excessive works is called Karoshi. Karoshi is common in Japan.  It becomes deadly syndrome as a consequence of long hours works. The debate about deaths from excessive work already sticking out in Japan since the 70s. The first official case of Karoshi was reported in 1969 when a 29-year-old male worker died because of stroke. It is estimated over ten thousand workers died each year due to death by brain and stroke caused by an overload work. Karoshi often happen to male workers dominantly. The main cause of karoshi is stress due to high pressure in the work environment, and work habits of exceeding a  standard of normal working time (8 hours. In addition, their extra time to work is imbalance with and the salary they earn. In its development, the phenomenon of karoshi contributes to the term salaryman and workaholic.

Hospitalizations and deaths due to pertussis in children from 1996 to 2013

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Janayne F. Mançaneira

2016-01-01

Conclusions: There was a substantial increase in hospitalizations and deaths from pertussis in children for three consecutive years (2011, 2012, and 2013 in all Brazilian regions. The most affected age group was that of children younger than one year.

Prolonged fever in peritoneal tuberculosis: A case report

Science.gov (United States)

Zein, U.; Irwandi, S.; Habib, H.; Lim, H.; Pasha, M.; Janis, I.; Saragih, R. H.; Ginting, Y.; Effendy-Y S, R.

2018-03-01

Peritoneal tuberculosis may lead to delayed diagnosis because of the nonspecific features such as fever, abdominal distension, abdominal tenderness, ascites, and weight loss. Here, wereported a case of prolonged fever and abdominal pain which was due to peritoneal tuberculosis. Initial examinations including acomplete blood test and serologic tests did not lead to the diagnosis. A final diagnosis was made by abdominal CT-scan and laparoscopy combined with histopathological studies. Antituberculous medications provided a good clinical response in this patient.

What is a good death? Minority and non-minority perspectives.

Science.gov (United States)

Tong, Elizabeth; McGraw, Sarah A; Dobihal, Edward; Baggish, Rosemary; Cherlin, Emily; Bradley, Elizabeth H

2003-01-01

While much attention has been directed at improving the quality of care at the end of life, few studies have examined what determines a good death in different individuals. We sought to identify common domains that characterize a good death in a diverse range of community-dwelling individuals, and to describe differences that might exist between minority and non-minority community-dwelling individuals' views. Using data from 13 focus groups, we identified 10 domains that characterize the quality of the death experience: 1) physical comfort, 2) burdens on family, 3) location and environment, 4) presence of others, 5) concerns regarding prolongation of life, 6) communication, 7) completion and emotional health, 8) spiritual care, 9) cultural concerns, 10) individualization. Differences in minority compared to non-minority views were apparent within the domains of spiritual concerns, cultural concerns, and individualization. The findings may help in efforts to encourage more culturally sensitive and humane end-of-life care for both minority and non-minority individuals.

Patient deaths blamed on long waits at the Phoenix VA

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Robbins RA

2014-04-01

Full Text Available No abstract available. Article truncated at 150 words. This morning the lead article in the Arizona Republic was a report blaming as many as 40 deaths at the Phoenix VA on long waits (1. Yesterday, Rep. Jeff Miller, the chairman of the House Committee on Veterans Affairs, held a hearing titled “A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths.” “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care,” Miller announced to a stunned audience. The committee has spent months investigating patient-care scandals and allegations at VA facilities in Pittsburgh, Atlanta, Miami and other cities. said that dozens of VA hospital patients in Phoenix may have died while awaiting medical care. He went on to say that staff investigators have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for ...

Prolongation of length of stay and Clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections

Directory of Open Access Journals (Sweden)

Mitchell Brett G

2012-04-01

Full Text Available Abstract Background It is believed that Clostridium difficile infection (CDI contributes to a prolongation of length of stay (LOS. Recent literature suggests that models previously used to determine LOS due to infection have overestimated LOS, compared to newer statistical models. The purpose of this review is to understand the impact that CDI has on LOS and in doing so, describe the methodological approaches used. Aim First, to investigate and describe the reported prolongation of LOS in hospitalised patients with CDI. Second, to describe the methodologies used for determining excess LOS. Methods An integrative review method was used. Papers were reviewed and analysed individually and themes were combined using integrative methods. Results Findings from all studies suggested that CDI contributes to a longer LOS in hospital. In studies that compared persons with and without CDI, the difference in the LOS between the two groups ranged from 2.8days to 16.1days. Potential limitations with data analysis were identified, given that no study fully addressed the issue of a time-dependent bias when examining the LOS. Recent literature suggests that a multi-state model should be used to manage the issue of time-dependent bias. Conclusion Studies examining LOS attributed to CDI varied considerably in design and data collected. Future studies examining LOS related to CDI and other healthcare associated infections should consider capturing the timing of infection in order to be able to employ a multi-state model for data analysis.

Buoyancy Limitation of Filamentous Cyanobacteria under Prolonged Pressure due to the Gas Vesicles Collapse.

Science.gov (United States)

Abeynayaka, Helayaye Damitha Lakmali; Asaeda, Takashi; Kaneko, Yasuko

2017-08-01

Freshwater cyanobacterium Pseudanabaena galeata were cultured in chambers under artificially generated pressures, which correspond to the hydrostatic pressures at deep water. Variations occurred in gas vesicles volume, and buoyancy state of cells under those conditions were analyzed at different time intervals (5 min, 1 day, and 5 days). Variations in gas vesicles morphology of cells were observed by transmission electron microscopy images. Settling velocity (Vs) of cells which governs the buoyancy was observed with the aid of a modified optical microscope. Moreover, effects of the prolonged pressure on cell ballast composition (protein and polysaccharides) were examined. Elevated pressure conditions reduced the cell ballast and caused a complete disappearance of gas vesicles in Pseudanabaena galeata cells. Hence cyanobacteria cells were not able to float within the study period. Observations and findings of the study indicate the potential application of hydrostatic pressure, which naturally occurred in hypolimnion of lakes, to inhibit the re-suspension of cyanobacteria cells.

Prolonged pregnancy: Methods, Causal Determinants and Outcome

DEFF Research Database (Denmark)

Olesen, Annette Wind

Summary Prolonged pregnancy, defined as a pregnancy with a gestational length of 294 days or more, is a frequent condition. It is associated with an increased risk of fetal and maternal complications. Little is known about the aetiology of prolonged pregnancy. The aims of the thesis were 1......) to study the incidence of prolonged pregnancy as a function of methods for determining gestational age; 2) to determine the risk of obstetrical and fetal complications in prolonged pregnancy; 3) to validate the self-reported gestational age in the National Birth Cohort; 4) to determine whether...... the risk of recurrence of prolonged pregnancy as a function of change in male partner and social conditions (IV). The National Birth Cohort provided data for the study on prenatal risk indicators of prolonged pregnancy in a follow-up design (V). The self-reported gestational ages from this database...

Prolonged CT urography in duplex kidney.

Science.gov (United States)

Gong, Honghan; Gao, Lei; Dai, Xi-Jian; Zhou, Fuqing; Zhang, Ning; Zeng, Xianjun; Jiang, Jian; He, Laichang

2016-05-13

Duplex kidney is a common anomaly that is frequently associated with multiple complications. Typical computed tomography urography (CTU) includes four phases (unenhanced, arterial, parenchymal and excretory) and has been suggested to considerably aid in the duplex kidney diagnosi. Unfortunately, regarding duplex kidney with prolonged dilatation, the affected parenchyma and tortuous ureters demonstrate a lack of or delayed excretory opacification. We used prolonged-delay CTU, which consists of another prolonged-delay phase (1- to 72-h delay; mean delay: 24 h) to opacify the duplicated ureters and affected parenchyma. Seventeen patients (9 males and 8 females; age range: 2.5-56 y; mean age: 40.4 y) with duplex kidney were included in this study. Unenhanced scans did not find typical characteristics of duplex kidney, except for irregular perirenal morphology. Duplex kidney could not be confirmed on typical four-phase CTU, whereas it could be easily diagnosed in axial and CT-3D reconstruction using prolonged CTU (prolonged-delay phase). Between January 2005 and October 2010, in this review board-approved study (with waived informed consent), 17 patients (9 males and 8 females; age range: 2.5 ~ 56 y; mean age: 40.4 y) with suspicious duplex kidney underwent prolonged CTU to opacify the duplicated ureters and confirm the diagnosis. Our results suggest the validity of prolonged CTU to aid in the evaluation of the function of the affected parenchyma and in the demonstration of urinary tract malformations.

Hyperglycemia and subsequent torsades de pointes with marked QT prolongation during refeeding.

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Nakashima, Takashi; Kubota, Tomoki; Takasugi, Nobuhiro; Kitagawa, Yuichiro; Yoshida, Takahiro; Ushikoshi, Hiroaki; Kawasaki, Masanori; Nishigaki, Kazuhiko; Ogura, Shinji; Minatoguchi, Shinya

2017-01-01

A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome. However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it. A 32-y-old severely malnourished woman (body mass index 14.57 kg/m 2 ) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448). Forty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed. Hyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia. Copyright © 2016 Elsevier Inc. All rights reserved.

Postmortem ICD interrogation in mode of death classification.

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Nikolaidou, Theodora; Johnson, Miriam J; Ghosh, Justin M; Marincowitz, Carl; Shah, Saumil; Lammiman, Michael J; Schilling, Richard J; Clark, Andrew L

2018-04-01

The definition of sudden death due to arrhythmia relies on the time interval between onset of symptoms and death. However, not all sudden deaths are due to arrhythmia. In patients with an implantable cardioverter defibrillator (ICD), postmortem device interrogation may help better distinguish the mode of death compared to a time-based definition alone. This study aims to assess the proportion of "sudden" cardiac deaths in patients with an ICD that have confirmed arrhythmia. We conducted a literature search for studies using postmortem ICD interrogation and a time-based classification of the mode of death. A modified QUADAS-2 checklist was used to assess risk of bias in individual studies. Outcome data were pooled where sufficient data were available. Our search identified 22 studies undertaken between 1982 and 2015 with 23,600 participants. The pooled results (excluding studies with high risk of bias) suggest that ventricular arrhythmias are present at the time of death in 76% of "sudden" deaths (95% confidence interval [CI] 67-85; range 42-88). Postmortem ICD interrogation identifies 24% of "sudden" deaths to be nonarrhythmic. Postmortem device interrogation should be considered in all cases of unexplained sudden cardiac death. © 2018 Wiley Periodicals, Inc.

Suicidal Death due to Organophosphorus Compound Poisoning ─ an Experience of 67 Cases

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Nashid Tabassum Khan

2016-05-01

Full Text Available Background: Bangladesh is an agro-based country. Suicide by agrochemical compounds are increasing day by day in this country. Organophosphorus compounds (OPC are commonly used for suicide. Mostly these are used for suicidal purpose in rural areas in our country due to low cost, toxicity and availability. Objective: To find out the relationship of age and sex variation along with the causes that influenced different income group people to ingest OPC for committing suicide. Materials and Methods: This study was conducted in the Department of Forensic Medicine, Dhaka Medical College during January to December 2010. Data were collected at the time of autopsy and from postmortem examination report of viscera. Viscera were preserved and sent to the Chief Chemical Examiner’s Office, Dhaka for toxicological analysis. Results: In this study, middle aged subjects (20–30 years were found to commit suicide using OPC in comparison to other age groups. Among the cases male were 57% and female 43%. Poverty was found as the most common cause (20% of OPC poisoning. Conclusion: Poverty is the leading cause of death of OPC poisoning followed by failure in love and adultery. Business failure, unhappiness in conjugal life, demand for dowry and violence against women are other causes to commit suicide by OPC.

Violent Deaths and Traumatic Bereavement: The Importance of Appropriate Death Notification

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Diego de Leo

2015-10-01

Full Text Available The communication of a death due to unexpected and traumatic causes is considered a very sensitive issue that can deeply affect both operators responsible for reporting the incident and the mourning process of family members, relatives, and other survivors. By focusing particularly on cases of traumatic death, this article tries to explain how inadequate communication of death may adversely affect the course of mourning. The article also illustrates the basic principles of correct notification of death. In this way, we hope to contribute to the ongoing dialogue on this topic and the promotion of new studies aimed at setting best practices for those professionally involved in the challenging task of communicating that a life has ended. This would be important in order to safeguard the emotional integrity of notifiers whilst effectively helping the survivors to cope with the early stages of their difficult mourning process.

Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth.

Science.gov (United States)

Mwansa-Kambafwile, Judith; Cousens, Simon; Hansen, Thomas; Lawn, Joy E

2010-04-01

In high-income countries, administration of antenatal steroids is standard care for women with anticipated preterm labour. However, although >1 million deaths due to preterm birth occur annually, antenatal steroids are not routine practice in low-income countries where most of these deaths occur. To review the evidence for and estimate the effect on cause-specific neonatal mortality of administration of antenatal steroids to women with anticipated preterm labour, with additional analysis for the effect in low- and middle-income countries. We conducted systematic reviews using standardized abstraction forms. Quality of evidence was assessed using an adapted GRADE approach. Existing meta-analyses were reviewed for relevance to low/middle-income countries, and new meta-analysis was performed. We identified 44 studies, including 18 randomised control trials (RCTs) (14 in high-income countries) in a Cochrane meta-analysis, which suggested that antenatal steroids decrease neonatal mortality among preterm infants (preterm babies currently receive little or no medical care. It is plausible that antenatal steroids may be of even greater effect when tested in these settings. Based on high-grade evidence, antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity, yet remains at low coverage in low/middle-income countries. If fully scaled up, this intervention could save up to 500 000 neonatal lives annually.

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong

Science.gov (United States)

Ho, Hung Chak; Lau, Kevin Ka-Lun; Ren, Chao; Ng, Edward

2017-11-01

Extreme hot weather events are likely to increase under future climate change, and it is exacerbated in urban areas due to the complex urban settings. It causes excess mortality due to prolonged exposure to such extreme heat. However, there is lack of universal definition of prolonged heat or heat wave, which leads to inadequacies of associated risk preparedness. Previous studies focused on estimating temperature-mortality relationship based on temperature thresholds for assessing heat-related health risks but only several studies investigated the association between types of prolonged heat and excess mortality. However, most studies focused on one or a few isolated heat waves, which cannot demonstrate typical scenarios that population has experienced. In addition, there are limited studies on the difference between daytime and nighttime temperature, resulting in insufficiency to conclude the effect of prolonged heat. In sub-tropical high-density cities where prolonged heat is common in summer, it is important to obtain a comprehensive understanding of prolonged heat for a complete assessment of heat-related health risks. In this study, six types of prolonged heat were examined by using a time-stratified analysis. We found that more consecutive hot nights contribute to higher mortality risk while the number of consecutive hot days does not have significant association with excess mortality. For a day after five consecutive hot nights, there were 7.99% [7.64%, 8.35%], 7.74% [6.93%, 8.55%], and 8.14% [7.38%, 8.88%] increases in all-cause, cardiovascular, and respiratory mortality, respectively. Non-consecutive hot days or nights are also found to contribute to short-term mortality risk. For a 7-day-period with at least five non-consecutive hot days and nights, there was 15.61% [14.52%, 16.70%] increase in all-cause mortality at lag 0-1, but only -2.00% [-2.83%, -1.17%] at lag 2-3. Differences in the temperature-mortality relationship caused by hot days and hot nights

Early death, late death and repair factor in three human tumour cell lines

International Nuclear Information System (INIS)

Courdi, A.; Gioanni, J.; Mari, D.; Chauvel, P.

1997-01-01

The in vivo colony method used to generate survival curves following exposure to ionizing irradiation allows to score large clones, representing surviving cells, and small colonies, representing late reproductive death. By subtraction, early-dying cells can be estimated. In the three human tumour cell lines examined, we have observed that early cell death is a major mode of action of irradiation. The contribution of early cell death to total mortality increases as the dose increases. Moreover, repair due to dose-splitting and delayed plating in densely-inhibited cells is not observed in early-dying cells. (authors)

Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

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Jose Orsini

2016-09-01

Full Text Available Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences. Marijuana is increasingly becoming legal in the United States for both medical and recreational use. Although the most commonly seen adverse effects resulting from its consumption are typically associated with neurobehavioral and gastrointestinal symptoms, cases of severe toxicity involving the cardiovascular system have been reported. In this report, the authors describe a case of cannabis-associated ST-segment elevation myocardial infarction leading to a prolonged cardiac arrest.

Transient simulation of coolant peak temperature due to prolonged fan and/or water pump operation after the vehicle is keyed-off

Science.gov (United States)

Pang, Suh Chyn; Masjuki, Haji Hassan; Kalam, Md. Abul; Hazrat, Md. Ali

2014-01-01

Automotive designers should design a robust engine cooling system which works well in both normal and severe driving conditions. When vehicles are keyed-off suddenly after some distance of hill-climbing driving, the coolant temperature tends to increase drastically. This is because heat soak in the engine could not be transferred away in a timely manner, as both the water pump and cooling fan stop working after the vehicle is keyed-off. In this research, we aimed to visualize the coolant temperature trend over time before and after the vehicles were keyed-off. In order to prevent coolant temperature from exceeding its boiling point and jeopardizing engine life, a numerical model was further tested with prolonged fan and/or water pump operation after keying-off. One dimensional thermal-fluid simulation was exploited to model the vehicle's cooling system. The behaviour of engine heat, air flow, and coolant flow over time were varied to observe the corresponding transient coolant temperatures. The robustness of this model was proven by validation with industry field test data. The numerical results provided sensible insights into the proposed solution. In short, prolonging fan operation for 500 s and prolonging both fan and water pump operation for 300 s could reduce coolant peak temperature efficiently. The physical implementation plan and benefits yielded from implementation of the electrical fan and electrical water pump are discussed.

Maternal mortality following caesarean sections.

Science.gov (United States)

Sikdar, K; Kundu, S; Mandal, G S

1979-08-01

A study of 26 maternal deaths following 3647 caesarean sections was conducted in Eden Hospital from 1974-1977. During the time period there were 35,544 births and 308 total maternal deaths (8.74/1000). Indications for Caesarean sections included: 1) abnormal presentation; 2) cephalopelvic disproportion; 3) toxemia; 4) prolonged labor; 5) fetal distress; and 6) post-caesarean pregnancies. Highest mortality rates were among cephalopelvic disproportion, toxemia, and prolonged labor patients. 38.4% of the patients died due to septicaemia and peritonitis, but other deaths were due to preclampsia, shock, and hemorrhage. Proper antenatal care may have prevented anemia and preclampsia and treated other pre-existing or superimposed diseases.

[Sudden death from hypoglycemia].

Science.gov (United States)

Asmundo, A; Aragona, M; Gualniera, P; Aragona, F

1995-12-01

The sudden death by hypoglycemia is an aspect of the forensic pathology frequently neglected. Authors initially described the pathogenesis of different hypoglycemia forms, distinguishing the primary ones due to hyperinsulinism and the secondary ones due to functional insufficiency of other organs (hypophysis, thyroid, adrenal gland, liver); after that Authors described three cases of sudden death induced hypoglycemia by hyperinsulinism: two were unweaned with nesidioblastosis and one adolescent. In any form of hypoglycemia the central nervous system damage is present with evident neuronal degenerative-necrotic phenomena, widespread edema with microhemorrhage, swollen and dissociation of myelin sheath, glial cells hyperplasia. Death caused by primary hypoglycemia is histopathologically different from the secondary one because of the maintenance of hepatic glycogen content in the former, that increase in striated muscles, including the heart, in spite of the constant secretion of catecholamine from the adrenal medulla. Glycogen is depleted in secondary hypoglycemia. In the primary form, behind the adrenal medulla hyperfunction, the increased functional activity of the adrenal cortex is moderate, contrasting with the seriousness of the syndrome, due prevalently to inhibit the gluconeogenesis response conditioned by the persistence of stored glycogen in the liver, heart and striated muscles. The rare anoxic processes coming with resynthesis of hepatic glycogen have to be considered in the differential diagnosis. The primary hypoglycemic death, especially in unweaned, is frequently promoted by other processes inducing hypoxia (fetal asphyxia outcome, pneumonia, etc.) or worsening the hypoglycemia (hypothyroidism, etc.). The secondary hypoglycemias are characterized by the normality of exocrine pancreas and by organic alterations that cause glycogen depletion from the liver.

[Brain function recovery after prolonged posttraumatic coma].

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Klimash, A V; Zhanaidarov, Z S

2016-01-01

To explore the characteristics of brain function recovery in patients after prolonged posttraumatic coma and with long-unconscious states. Eighty-seven patients after prolonged posttraumatic coma were followed-up for two years. An analysis of a clinical/neurological picture after a prolonged episode of coma was based on the dynamics of vital functions, neurological status and patient's reactions to external stimuli. Based on the dynamics of the clinical/neurological picture that shows the recovery of functions of the certain brain areas, three stages of brain function recovery after a prolonged episode of coma were singled out: brain stem areas, diencephalic areas and telencephalic areas. These functional/anatomic areas of brain function recovery after prolonged coma were compared to the present classifications.

Adrenergic Blockade Bi-directionally and Asymmetrically Alters Functional Brain-Heart Communication and Prolongs Electrical Activities of the Brain and Heart during Asphyxic Cardiac Arrest

Science.gov (United States)

Tian, Fangyun; Liu, Tiecheng; Xu, Gang; Li, Duan; Ghazi, Talha; Shick, Trevor; Sajjad, Azeem; Wang, Michael M.; Farrehi, Peter; Borjigin, Jimo

2018-01-01

Sudden cardiac arrest is a leading cause of death in the United States. The neurophysiological mechanism underlying sudden death is not well understood. Previously we have shown that the brain is highly stimulated in dying animals and that asphyxia-induced death could be delayed by blocking the intact brain-heart neuronal connection. These studies suggest that the autonomic nervous system plays an important role in mediating sudden cardiac arrest. In this study, we tested the effectiveness of phentolamine and atenolol, individually or combined, in prolonging functionality of the vital organs in CO2-mediated asphyxic cardiac arrest model. Rats received either saline, phentolamine, atenolol, or phentolamine plus atenolol, 30 min before the onset of asphyxia. Electrocardiogram (ECG) and electroencephalogram (EEG) signals were simultaneously collected from each rat during the entire process and investigated for cardiac and brain functions using a battery of analytic tools. We found that adrenergic blockade significantly suppressed the initial decline of cardiac output, prolonged electrical activities of both brain and heart, asymmetrically altered functional connectivity within the brain, and altered, bi-directionally and asymmetrically, functional, and effective connectivity between the brain and heart. The protective effects of adrenergic blockers paralleled the suppression of brain and heart connectivity, especially in the right hemisphere associated with central regulation of sympathetic function. Collectively, our results demonstrate that blockade of brain-heart connection via alpha- and beta-adrenergic blockers significantly prolonged the detectable activities of both the heart and the brain in asphyxic rat. The beneficial effects of combined alpha and beta blockers may help extend the survival of cardiac arrest patients. PMID:29487541

Adrenergic Blockade Bi-directionally and Asymmetrically Alters Functional Brain-Heart Communication and Prolongs Electrical Activities of the Brain and Heart during Asphyxic Cardiac Arrest

Directory of Open Access Journals (Sweden)

Fangyun Tian

2018-02-01

Full Text Available Sudden cardiac arrest is a leading cause of death in the United States. The neurophysiological mechanism underlying sudden death is not well understood. Previously we have shown that the brain is highly stimulated in dying animals and that asphyxia-induced death could be delayed by blocking the intact brain-heart neuronal connection. These studies suggest that the autonomic nervous system plays an important role in mediating sudden cardiac arrest. In this study, we tested the effectiveness of phentolamine and atenolol, individually or combined, in prolonging functionality of the vital organs in CO2-mediated asphyxic cardiac arrest model. Rats received either saline, phentolamine, atenolol, or phentolamine plus atenolol, 30 min before the onset of asphyxia. Electrocardiogram (ECG and electroencephalogram (EEG signals were simultaneously collected from each rat during the entire process and investigated for cardiac and brain functions using a battery of analytic tools. We found that adrenergic blockade significantly suppressed the initial decline of cardiac output, prolonged electrical activities of both brain and heart, asymmetrically altered functional connectivity within the brain, and altered, bi-directionally and asymmetrically, functional, and effective connectivity between the brain and heart. The protective effects of adrenergic blockers paralleled the suppression of brain and heart connectivity, especially in the right hemisphere associated with central regulation of sympathetic function. Collectively, our results demonstrate that blockade of brain-heart connection via alpha- and beta-adrenergic blockers significantly prolonged the detectable activities of both the heart and the brain in asphyxic rat. The beneficial effects of combined alpha and beta blockers may help extend the survival of cardiac arrest patients.

[Pathophysiology of prolonged hypokinesia].

Science.gov (United States)

Kovalenko, E A

1976-01-01

Hypokinesia is an important problem in modern medicine. In the pathogenetic effect of prolonged hypokinesia the main etiological factor is diminished motor activity; of major importance are disorders in the energy and plastic metabolism which affect the muscle system; the contributing factors are cardiovascular deconditioning and orthostatic intolerance. This is attributed to a decreased oxygen supply and eliminated hydrostatic influences during a prolonged recumbency. Blood redistribution in the vascular bed is related to the Gauer-Henry reflex and subsequent changes in the fluid-electrolyte balance. Decreased load on the bone system induces changes in the protein-phosphate-calcium metabolism, diminished bone density and increased calcium content in the blood and urine. Changes in the calcium metabolism are systemic. The activity of the higher nervous system and reflex functions is lowered. Changes in the function of the autonomic nervous system which include a noticeable decline of its adaptive-trophic role as a result of the decrease of afferent and efferent impulsation are of great importance. Changes in the hormonal function involve a peculiar stress-reaction which develops at an early stage of hypokinesia as a response to an unusual situation. Prolonged hypokinesia may result in a disturbed function of the pituitary-adrenal system. It is assumed that prolonged hypokinesia may induce a specific disease of hypokinesia during which man cannot lead a normal mode of life and work.

A common single nucleotide polymorphism can exacerbate long-QT type 2 syndrome leading to sudden infant death

DEFF Research Database (Denmark)

Nof, Eyal; Cordeiro, Jonathan M; Pérez, Guillermo J

2010-01-01

the mother (both asymptomatic), led to 2 cases of sudden infant death. METHODS AND RESULTS: KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, CACNA1c, CACNB2b, and KCNJ2 genes were amplified and analyzed by direct sequencing. Functional electrophysiological studies were performed with the single nucleotide polymorphism...... and mutation expressed singly and in combination in Chinese ovary (CHO-K1) and COS-1 cells. An asymptomatic woman presenting after the death of her 2-day-old infant and spontaneous abortion of a second baby in the first trimester was referred for genetic analysis. The newborn infant had nearly incessant...... ventricular tachycardia while in utero and a prolonged QTc (560 ms). The mother was asymptomatic but displayed a prolonged QTc. Genetic screening of the mother revealed a heterozygous nonsense mutation (P926AfsX14) in KCNH2, predicting a stop codon. The father was asymptomatic with a normal QTc but had...

Death and Death Anxiety

OpenAIRE

Gonca Karakus; Zehra Ozturk; Lut Tamam

2012-01-01

Although death and life concepts seem so different from each other, some believe that death and life as a whole that death is accepted as the goal of life and death completes life. In different cultures, societies and disciplines, there have been very different definitions of death which changes according to personality, age, religion and cultural status of the individual. Attitudes towards death vary dramatically according to individuals. As for the death anxiety, it is a feeling which start...

Sudden Death in Young People--Heart Problems Often Blamed

Science.gov (United States)

Sudden death in young people: Heart problems often blamed Sudden death in young people is rare, but those at ... causes and treatments. By Mayo Clinic Staff Sudden death in people younger than 35, often due to ...

[Causes of the people death from drunkenness and alcoholism].

Science.gov (United States)

Erokhin, Iu A; Paukov, V S; Kirillov, Iu A

2012-01-01

We analyzed causes of 1008 people death, who abused by alcohol. Among them 2 groups were separated out: people died due to drunkenness and due to alcoholism. The structure of the death was similar in the both groups, however depended on alcoholism stages. The major cause of the death in group of drunkenness people was acute heart insufficiency, less commonly--lung pathology, and very rarely--brain vessels pathology and liver cirrhosis. In group of people, who died due to alcoholism, lung pathology was the major cause of these deaths, acute heart insufficiency was occurred less commonly, and very rare brain pathology because of delirium tremens or alcohol withdrawal syndrome, as so liver cirrhosis with complications. Hemorrhagic pancreonecrosis after alcoholic excess was found out in both groups, but it was more often in people, who died due to drunkenness. Obtained results show importance of chronic alcoholism identification as a disease with several stages including drunkenness and alcoholism.

Can deaths in police cells be prevented? Experience from Norway and death rates in other countries.

Science.gov (United States)

Aasebø, Willy; Orskaug, Gunnar; Erikssen, Jan

2016-01-01

To describe the changes in death rates and causes of deaths in Norwegian police cells during the last 2 decades. To review reports on death rates in police cells that have been published in medical journals and elsewhere, and discuss the difficulties of comparing death rates between countries. Data on deaths in Norwegian police cells were collected retrospectively in 2002 and 2012 for two time periods: 1993-2001 (period 1) and 2003-2012 (period 2). Several databases were searched to find reports on deaths in police cells from as many countries as possible. The death rates in Norwegian police cells reduced significantly from 0.83 deaths per year per million inhabitants (DYM) in period 1 to 0.22 DYM in period 2 (p police cells reduced by about 75% over a period of approximately 10 years. This is probably mainly due to individuals with severe alcohol intoxication no longer being placed in police cells. However, there remain large methodology difficulties in comparing deaths rates between countries. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Exhaustion from prolonged gambling

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Fatimah Lateef

2013-01-01

Full Text Available Complaints of fatigue and physical exhaustion are frequently seen in the acute medical setting, especially amongst athletes, army recruits and persons involved in strenuous and exertional physical activities. Stress-induced exhaustion, on the other hand, is less often seen, but can present with very similar symptoms to physical exhaustion. Recently, three patients were seen at the Department of Emergency Medicine, presenting with exhaustion from prolonged involvement in gambling activities. The cases serve to highlight some of the physical consequences of prolonged gambling.

ERYTHEMA NODOSUM AND PROLONGED FEVER ASSOCIATED TO SECONDARY HYPERPARATHYROIDISM

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Galimberti R

2005-08-01

Full Text Available SUMMARYSecondary hyperparathyroidism is one of the main deragements caused by chronic renal failure, and parathyroid hormone is considered one of the toxins of the uremic syndrome. Prolonged fever due to primary hyperparathyroidism have already been described in the literature but not yet as induced by secondary hyperparathyroidism. In this case report a patient suffering from an erythema nodosum and prolonged fever associated to secondary hyperparathyroidism that disappeared through subtotal parathyroidectomy is presented.RESUMENEl hiperparatiroidismo secundario es uno de los principales disturbios causados por la insuficiencia renal crónica, y la paratohormona es considerada una de las toxinas del sindrome urémico. El sindrome febril prolongado secundario a hiperparatiroidismo primario ya ha sido descripto en la literatura, aunque no lo ha sido aun el inducido por hiperparatiroidismo secundario. En el presente reporte se presenta un caso de eritema nodoso y sindrome febril prolongado asociado a hiperparatiroidismo secundario y que resolvió luego de efectuada una paratiroidectomía subtotal.

Anti-HERG activity and the risk of drug-induced arrhythmias and sudden death

DEFF Research Database (Denmark)

De Bruin, M L; Pettersson, M; Meyboom, R H B

2005-01-01

AIMS: Drug-induced QTc-prolongation, resulting from inhibition of HERG potassium channels may lead to serious ventricular arrhythmias and sudden death. We studied the quantitative anti-HERG activity of pro-arrhythmic drugs as a risk factor for this outcome in day-to-day practice. METHODS...... defined as reports of cardiac arrest, sudden death, torsade de pointes, ventricular fibrillation, and ventricular tachycardia (n = 5591), and compared with non-cases regarding the anti-HERG activity, defined as the effective therapeutic plasma concentration (ETCPunbound) divided by the HERG IC50 value......, of suspected drugs. We identified a significant association of 1.93 (95% CI: 1.89-1.98) between the anti-HERG activity of drugs, measured as log10 (ETCPunbound/IC50), and reporting of serious ventricular arrhythmias and sudden death to the WHO-UMC database. CONCLUSION: Anti-HERG activity is associated...

9. Nuclear power plant service life prolongation

International Nuclear Information System (INIS)

Evropin, S.V.

1998-01-01

The problem of prolongation of nuclear power plant service life duration is discussed. A schematic diagram of the program developed in the course of activities dealing with NPP service time prolongation is shown and analyzed in details. It is shown that the basic moment when determining the strategy for NPP service time prolongation is the positive confirmation of the agreement between the NPP safety provisions and modern safety requirements. The other very important aspect of the problem is engineering substantiation of the measures assuring the reactor operation prolongation. The conclusion is made that available methods of recovering reactor materials properties, main components repair and replacement, the modern techniques for nondestructive testing of metals and NPP pipelines, as well as the developed approaches to reactor facility safety improvements make the prolongation of the Russian NPP service lifetimes possible from engineering viewpoint and economically desirable

Prevention of hypoglycemia-induced neuronal death by minocycline

Science.gov (United States)

2012-01-01

Diabetic patients who attempt strict management of blood glucose levels frequently experience hypoglycemia. Severe and prolonged hypoglycemia causes neuronal death and cognitive impairment. There is no effective tool for prevention of these unwanted clinical sequelae. Minocycline, a second-generation tetracycline derivative, has been recognized as an anti-inflammatory and neuroprotective agent in several animal models such as stroke and traumatic brain injury. In the present study, we tested whether minocycline also has protective effects on hypoglycemia-induced neuronal death and cognitive impairment. To test our hypothesis we used an animal model of insulin-induced acute hypoglycemia. Minocycline was injected intraperitoneally at 6 hours after hypoglycemia/glucose reperfusion and injected once per day for the following 1 week. Histological evaluation for neuronal death and microglial activation was performed from 1 day to 1 week after hypoglycemia. Cognitive evaluation was conducted 6 weeks after hypoglycemia. Microglial activation began to be evident in the hippocampal area at 1 day after hypoglycemia and persisted for 1 week. Minocycline injection significantly reduced hypoglycemia-induced microglial activation and myeloperoxidase (MPO) immunoreactivity. Neuronal death was significantly reduced by minocycline treatment when evaluated at 1 week after hypoglycemia. Hypoglycemia-induced cognitive impairment is also significantly prevented by the same minocycline regimen when subjects were evaluated at 6 weeks after hypoglycemia. Therefore, these results suggest that delayed treatment (6 hours post-insult) with minocycline protects against microglial activation, neuronal death and cognitive impairment caused by severe hypoglycemia. The present study suggests that minocycline has therapeutic potential to prevent hypoglycemia-induced brain injury in diabetic patients. PMID:22998689

Brain death and related issues

International Nuclear Information System (INIS)

Akhtar, M.; Mushtaq, S.; Jamil, K.; Ahmed, S.

2003-01-01

Concerns about the erroneous diagnosis of death and premature burial have been expressed from times immemorial. Patients with brain stem death have absolutely no chance of recovery. Brain death is considered at par with death in most of the countries. General public in most parts of the world shows reluctance to accept this concept due to different social, cultural and religious backgrounds and state of literacy and awareness. The criteria for the diagnosis of brain death have been established which include certain pre-conditions, exclusions and tests of the brain stem function. These criteria are universally accepted. The criteria in children are somewhat different from the adults. The subject is intimately related with organ transplantation. If the patients is registered as organ donor or the family consents, organs can be harvested from brain dead patients for transplantation. Pakistan is amongst the few countries where no legislation exists to accept brain death as being at par with death of an individual, and to facilitate and regulate, cadaveric organ donation and transplantation. (author)

Sudden unexpected death caused by stroke

DEFF Research Database (Denmark)

Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára

2017-01-01

Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered....... There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1-49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke...

Safety information on QT-interval prolongation

DEFF Research Database (Denmark)

Warnier, Miriam J; Holtkamp, Frank A; Rutten, Frans H

2014-01-01

Prolongation of the QT interval can predispose to fatal ventricular arrhythmias. Differences in QT-labeling language can result in miscommunication and suboptimal risk mitigation. We systematically compared the phraseology used to communicate on QT-prolonging properties of 144 drugs newly approve...

Sudden death of an Indian peafowl (Pavo cristatus) at a zoo due to non-pigmented Serratia marcescens infection.

Science.gov (United States)

Lee, Seung-Hun; Park, Sang-Joon; Kwak, Dongmi; Kim, Kyoo-Tae

2017-12-22

A 16-year-old female Indian peafowl (Pavo cristatus) died two days after recognition of conjunctivitis in the right eye, anorexia and depression. Gross necropsy revealed a thick pseudomembrane under the eyelid and hydropericardium. Histopathological examination revealed hepatocellular necrosis, sinusoidal and vascular congestion and infiltrated inflammatory cells. Infiltration by inflammatory cells was noted in the epicardium. The lungs had mild interstitial pneumonia with the extensive congestion within the capillaries of the air sacs. Tubular interstitial congestion and necrosis was noted in the kidneys. Bacterial culture and nucleotide sequencing of the inflammatory specimens identified the causative agent as Serratia marcescens, an uncommon bacterium in birds. In summary, this study describes the sudden death of an Indian peafowl due to S. marcescens infection, which is rarely seen in animals.

Causes of death in familial adenomatous polyposis

DEFF Research Database (Denmark)

Galle, T S; Juel, K; Bülow, S

1999-01-01

The prognosis in familial adenomatous polyposis (FAP) has improved over the past decades owing to a reduction in the prevalence of colorectal cancer, resulting from effective early screening. During the same period several polyposis registers have recorded an increasing number of deaths due to du...... to duodenal/periampullary cancer and desmoid tumours. The aim of this study was to examine the causes of death with special emphasis on duodenal/periampullary cancer.......The prognosis in familial adenomatous polyposis (FAP) has improved over the past decades owing to a reduction in the prevalence of colorectal cancer, resulting from effective early screening. During the same period several polyposis registers have recorded an increasing number of deaths due...

Genetic influence on prolonged gestation

DEFF Research Database (Denmark)

Laursen, Maja; Bille, Camilla; Olesen, Annette Wind

2004-01-01

OBJECTIVE: The purpose of this study was to test a possible genetic component to prolonged gestation. STUDY DESIGN: The gestational duration of single, first pregnancies by both female and male twins was obtained by linking the Danish Twin Registry, The Danish Civil Registration System, and the D...... factors. CONCLUSION: Maternal genes influence prolonged gestation. However, a substantial paternal genetic influence through the fetus was not found....

Causes of death in very preterm infants cared for in neonatal intensive care units: a population-based retrospective cohort study.

Science.gov (United States)

Schindler, Tim; Koller-Smith, Louise; Lui, Kei; Bajuk, Barbara; Bolisetty, Srinivas

2017-02-21

While there are good data to describe changing trends in mortality and morbidity rates for preterm populations, there is very little information on the specific causes and pattern of death in terms of age of vulnerability. It is well established that mortality increases with decreasing gestational age but there are limited data on the specific causes that account for this increased mortality. The aim of this study was to establish the common causes of hospital mortality in a regional preterm population admitted to a neonatal intensive care unit (NICU). Retrospective analysis of prospectively collected data of the Neonatal Intensive Care Units' (NICUS) Data Collection of all 10 NICUs in the region. Infants cause of death. There were 345 (7.7%) deaths out of 4454 infants. The most common cause of death across all gestational groups was major IVH (cause-specific mortality rate [CMR] 22 per 1000 infants), followed by acute respiratory illnesses [ARI] (CMR 21 per 1000 infants) and sepsis (CMR 12 per 1000 infants). The most common cause of death was different in each gestational group (22-25 weeks [ARI], 26-28 weeks [IVH] and 29-31 weeks [perinatal asphyxia]). Pregnancy induced hypertension, antenatal steroids and chorioamnionitis were all associated with changes in CMRs. Deaths due to ARI or major IVH were more likely to occur at an earlier age (median [quartiles] 1.4 [0.3-4.4] and 3.6 [1.9-6.6] days respectively) in comparison to NEC and miscellaneous causes (25.2 [15.4-37.3] and 25.8 [3.2-68.9] days respectively). Major IVH and ARI were the most common causes of hospital mortality in this extreme to very preterm population. Perinatal factors have a significant impact on cause-specific mortality. The varying timing of death provides insight into the prolonged vulnerability for diseases such as necrotising enterocolitis in our preterm population.

Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

Directory of Open Access Journals (Sweden)

Wei-Hua Tang

Full Text Available Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD. In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

Malnutrition related deaths.

Science.gov (United States)

Sparre-Sørensen, Maja; Kristensen, Gustav N

2016-10-01

Studies have shown that malnutrition increases the risk of morbidity, mortality, the length of hospital stay, and costs in the elderly population. Approximately one third of all patients admitted to geriatric wards in Denmark are malnourished according to the Danish Geriatric database. The aim of this study is to describe and examine the sudden increase in deaths due to malnutrition in the elderly population in Denmark from 1999 and, similarly, the sudden decline in malnutrition related deaths in 2007. A descriptive epidemiologic study was performed. All Danes listed in the national death registry who died from malnutrition in the period from 1994 to 2012 are included. The number of deaths from malnutrition increased significantly during the period from 1999 to 2007, especially in the age group 70 years and over. Additionally, we document a surprising similarity between the development in excess mortality from malnutrition in the five Danish regions during the same period. During the period 1999-2007 malnutrition was the direct cause of 340 extra deaths, and probably ten times more registered under other diseases. This development in excess mortality runs parallel in all five Danish regions over time. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Genetic and environmental influences on risk of death due to infections assessed in Danish twins, 1943-2001

DEFF Research Database (Denmark)

Obel, Niels; Christensen, Kaare; Petersen, Inge

2010-01-01

Genetic differences have been proposed to play a strong role in risk of death from infectious diseases. The study base of 44,005 included all same-sex twin pairs born in 1870-2001, with both twins alive on January 1, 1943, or those born thereafter. Cause of death was obtained from the Danish Cause...... from infectious diseases could be demonstrated, the absolute effect of the genetic component on mortality was small....... genetic influence on the risk of death...

Dyadic death due to family custom in marriage

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Muhammet Mustafa Arslan

2012-06-01

Full Text Available In dyadic death, a there is a lack of studies addressingthe effectiveness of the family pressure through thesedeaths. In this study, the effectiveness of the customs onthe marriages is discussed with a related case of dyadicdeath.A 27 years old male and a 19 years old female were founddead in a car out of a city center away from hometown. Inthe external examination, there was an entrance woundon the right temporal region and an exit wound on theleft temporal region of the man, and the contrary for thewoman. Both of the exit wounds were contact wound.Both of the deceased were originally from the east partof Turkey and stated to be single; and the woman wasreported to the security units as missing two days beforethe incident. As the motivation of the suicide, a note nearto the man was explaining that the deceased couple lovedeach other for one year yet the family of the women hadnot let them to get married.Being an obstacle for the marriage even for adults and acause of suicide because of family pressure is indicativeof strict application of the family customs, in Turkey. Theauthors propose that issue of whether the 84. Article ofthe Turkish Penal Code should be or not applied as a deterrentfactor reducing pressure of family customs.

Forced migration and mental health: prolonged internal displacement, return migration and resilience.

Science.gov (United States)

Siriwardhana, Chesmal; Stewart, Robert

2013-03-01

Forced internal displacement has been rising steadily, mainly due to conflict. Many internally displaced people (IDP) experience prolonged displacement. Global research evidence suggests that many of these IDP are at high risk for developing mental disorders, adding weight to the global burden of disease. However, individual and community resilience may act as protective factors. Return migration may be an option for some IDP populations, especially when conflicts end, although return migration may itself be associated with worse mental health. Limited evidence is available on effects of resettlement or return migration following prolonged forced internal displacement on mental health. Also, the role of resilience factors remains to be clarified following situations of prolonged displacement. The public health impact of internal displacement is not clearly understood. Epidemiological and interventional research in IDP mental health needs to look beyond medicalised models and encompass broader social and cultural aspects. The resilience factor should be integrated and explored more in mental health research among IDP and a clearly focused multidisciplinary approach is advocated.

Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

Directory of Open Access Journals (Sweden)

Dhammapal Sahebrao Bhamare

2013-01-01

Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

Brugada Syndrome: Are we doing enough to prevent sudden death?

International Nuclear Information System (INIS)

Buksh, Jahangir A.; Al-Hersi, Ahmad S.; Al-Nozha, Mansour M.

2007-01-01

Burgada syndrome (BS) is an inherited arrythmogenic disease characterized by typical ECG changes in the form of an SR pattern in VI to V2, and ST segment elevation in VI to V3 and prolongation of the QT interval in right precordial leads. This syndrome carries an increased risk of sudden death due to arrhythmias. This disease was first described in 1992 by Joseph Brugada et al and was named Brugada syndrome by Yan and Antzelvich in 1996. By 2003 more than 600 patients had been reported by Brugada et al and hundreds by others. A genetic aspect to BS is now recognized and been linked to the alpha subunit of the cardiac sodium channel gene SCN5A. Over five dozen mutations in SCN5A have been identified. Accentuation of the right ventricular notch under pathophysiological conditions leads to exaggeration of the J-wave or J-point elevation and a saddle-shaped configuration of the repolarisation waves. Diagnosis is essentially by electrocardiogram either by spontaneous changes or by provocation by sodium channel blockers drugs, e.g., procainamide, flecainide. The role of electrophysiological studies in induction of arrhythmia in asymptomatic individuals by electron beam computed tomography and signal-averaged electrocardiogram is not settled. Unfortunately, an effective drug is not available is not available at present, but quinidine has a place in treatment. New promising drugs are emerging like cilostazol and tedisamil. At present, implantation of an ICD is the only effective means of preventing sudden death. (author)

Late-life depression and the death of Queen Victoria.

Science.gov (United States)

Abrams, Robert C

2010-12-01

The objective of this study was to evaluate relationships between the death of Queen Victoria and the depressive episode she experienced during the last year of her life. The last volume of Queen Victoria's personal Journal was reviewed from a geriatrician's perspective, tracing the onset and course of depressive symptoms from entries beginning on 17 August 1900 and ending on 13 January 1901, 9 days before her death. The Queen's own words are supplemented with observations from contemporaneous secondary sources. The antecedents of Queen Victoria's late-life depression, including multiple losses, disabilities, and chronic pain, taken together with the presentation of vegetative, affective, and late cognitive symptoms, suggested the presence of a distinctively geriatric major depressive disorder. The absence of any other medical condition to explain the clinical picture seemed probable but not certain. Although historians and biographers have long been aware of Queen Victoria's final depression, the emphasis has mostly been on her earlier and prolonged mourning for her husband Prince Albert. Re-examined now, the Queen's Journal suggests that a severe late-life depressive episode occurring approximately in her last 5 months contributed meaningfully to her death. Copyright © 2010 John Wiley & Sons, Ltd.

Current asthma deaths among adults in Japan

Directory of Open Access Journals (Sweden)

Tsugio Nakazawa

2004-01-01

Full Text Available Recent asthma deaths were examined from yearly reports of the Ministry of Health, Labor and Welfare of Japan and from reports published by the Japan Asthma Death Investigation Committee on 811 deaths over the period 1992–2000. The rate and number of recent asthma deaths in Japan have been decreasing rapidly. Most asthma deaths were of patients aged 70–90 years and there has been a marked trend for increased asthma deaths in the elderly. As for the circumstances surrounding the deaths, sudden death, unstable sudden aggravation and intermittent aggravation were mainly noted. Respiratory infections, fatigue and stress were the major courses of fatal attacks contributing to deaths due to asthma. Many of the patients who died from asthma had been diagnosed as having as moderate to severe asthma and many had non-atopic asthma. There are some reports that suggest that the recent decrease in asthma deaths in Japan is correlated with the use of inhaled cortico- steroids.

Was the death of Alexander the Great due to poisoning? Was it Veratrum album?

Science.gov (United States)

Schep, Leo J; Slaughter, Robin J; Vale, J Allister; Wheatley, Pat

2014-01-01

To investigate the death of Alexander the Great to determine if he died from natural causes or was poisoned and, if the latter, what was the most likely poison. OVID MEDLINE (January 1950-May 2013) and ISI Web of Science (1900-May 2013) databases were searched and bibliographies of identified articles were screened for additional relevant studies. These searches identified 53 relevant citations. Classical literature associated with Alexander's death. There are two divergent accounts of Alexander's death. The first has its origins in the Royal Diary, allegedly kept in Alexander's court. The second account survives in various versions of the Alexander Romance. Nature of the terminal illness. The Royal Diary describes a gradual onset of fever, with a progressive inability to walk, leading to Alexander's death, without offering a cause of his demise. In contrast, the Romance implies that members of Alexander's inner circle conspired to poison him. The various medical hypotheses include cumulative debilitation from his previous wounds, the complications of alcohol imbibing (resulting in alcohol hepatitis, acute pancreatitis, or perforated peptic ulcer), grief, a congenital abnormality, and an unhealthy environment in Babylon possibly exacerbated by malaria, typhoid fever, or some other parasitic or viral illness. Was it poisoning? Of all the chemical and botanical poisons reviewed, we believe the alkaloids present in the various Veratrum species, notably Veratrum album, were capable of killing Alexander with comparable symptoms to those Alexander reportedly experienced over the 12 days of his illness. Veratrum poisoning is heralded by the sudden onset of epigastric and substernal pain, which may also be accompanied by nausea and vomiting, followed by bradycardia and hypotension with severe muscular weakness. Alexander suffered similar features for the duration of his illness. If Alexander the Great was poisoned, Veratrum album offers a more plausible cause than arsenic

Geographic distribution of risk of death due to homicide in Puerto Rico, 2001-2010.

Science.gov (United States)

Zavala-Zegarra, Diego E; López-Charneco, Magdalena; Garcia-Rivera, Enid J; Concha-Eastman, Alberto; Rodriguez, José F; Conte-Miller, María

2012-11-01

To raise awareness of the impact of homicides in Puerto Rico based on the findings of the spatial and temporal distribution of homicides and the use of firearms, by age and gender, using reports of interpersonal violent deaths from the Institute of Forensic Science (IFS) headquartered in San Juan, Puerto Rico. This was a descriptive study of all homicide incidents in Puerto Rico reported by the IFS for the period 2001-2010. For each of the 8 542 cases, data analyzed included age, sex, municipality of incident, date of death, and mechanism. Crude sex- and age-specific mortality rates for Puerto Rico and for each municipality per year and for the 10-year period were calculated. Cumulative rate and cumulative risks were estimated and defined as lifetime risk. The relative distribution of cumulative rates for each municipality was categorized into quartiles of highest to lowest risk and displayed as a map. The risk of homicide death among males is 13 times greater than among females. The highest rates were observed among males 20-24 years of age (198.4 homicides per 100 000). In any given year, firearms were used in at least 80% of homicides. The average lifetime risk of homicide death for males is 1 in 34. Young adult males with access to firearms are at greatest risk of homicide in Puerto Rico. Also, highly urbanized municipalities are at highest risk; however, certain non-urban municipalities along the coast also have a very high homicide risk. Top priorities should be applying the WHO "ecological model" for violent injury prevention and establishing a surveillance system that will assist in identifying the role that socioeconomics, illegal firearms trade, and drug trafficking are playing.

Prolonged Intermittent Renal Replacement Therapy.

Science.gov (United States)

Edrees, Fahad; Li, Tingting; Vijayan, Anitha

2016-05-01

Prolonged intermittent renal replacement therapy (PIRRT) is becoming an increasingly popular alternative to continuous renal replacement therapy in critically ill patients with acute kidney injury. There are significant practice variations in the provision of PIRRT across institutions, with respect to prescription, technology, and delivery of therapy. Clinical trials have generally demonstrated that PIRRT is non-inferior to continuous renal replacement therapy regarding patient outcomes. PIRRT offers cost-effective renal replacement therapy along with other advantages such as early patient mobilization and decreased nursing time. However, due to lack of standardization of the procedure, PIRRT still poses significant challenges, especially pertaining to appropriate drug dosing. Future guidelines and clinical trials should work toward developing consensus definitions for PIRRT and ensure optimal delivery of therapy. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Risk factors for QTc interval prolongation

NARCIS (Netherlands)

Heemskerk, Charlotte P.M.; Pereboom, Marieke; van Stralen, Karlijn; Berger, Florine A.; van den Bemt, Patricia M.L.A.; Kuijper, Aaf F.M.; van der Hoeven, Ruud T M; Mantel-Teeuwisse, Aukje K.; Becker, Matthijs L

2018-01-01

Purpose: Prolongation of the QTc interval may result in Torsade de Pointes, a ventricular arrhythmia. Numerous risk factors for QTc interval prolongation have been described, including the use of certain drugs. In clinical practice, there is much debate about the management of the risks involved. In

Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012.

Science.gov (United States)

Xu, Haiqing; Dai, Qiong; Xu, Yusong; Gong, Zhengtao; Dai, Guohong; Ding, Ming; Duggan, Christopher; Hu, Zubin; Hu, Frank B

2015-12-10

The nutrition and epidemiologic transition has been associated with an increasing incidence of preterm birth in developing countries, but data from large observational studies in China have been limited. Our study was to describe the trends and factors associated with the incidence of preterm birth and infant mortality due to prematurity in Hubei Province, China. We conducted a population-based survey through the Maternal and Child Health Care Network in Hubei Province from January 2001 to December 2012. We used data from 16 monitoring sites to examine the trend and risk factors for premature birth as well as infant mortality associated with prematurity. A total of 818,481 live births were documented, including 76,923 preterm infants (94 preterm infants per 1,000 live births) and 2,248 deaths due to prematurity (2.75 preterm deaths per 1,000 live births). From 2001 to 2012, the incidence of preterm birth increased from 56.7 to 105.2 per 1,000 live births (P for trend prematurity declined from 95.0 to 13.4 per 1,000 live births (P for trend prematurity were observed in Hubei Province from 2001 to 2012. Our results provide important information for areas of improvements in reducing incidence and mortality of premature birth.

Death qualification and prejudice: the effect of implicit racism, sexism, and homophobia on capital defendants' right to due process.

Science.gov (United States)

Butler, Brooke

2007-01-01

Two hundred venirepersons from the 12th Judicial Circuit in Bradenton, Florida completed the following measures: (1) one question that measured their level of support for the death penalty; (2) one question that categorized their death-qualification status; (3) 23 questions that measured their attitudes toward the death penalty (ATDP); (4) 22 questions that assessed their attitudes toward women (ATW); (5) 25 questions that measured their level of homophobia (H); (6) seven questions that assessed their level of modern racism (MR); (7) eight questions that measured their level of modern sexism (MS); and (8) standard demographic questions. Results indicated that as death-penalty support increased participants exhibited more positive attitudes toward the death penalty, more negative attitudes toward women, and higher levels of homophobia, modern racism, and modern sexism. Findings also suggested that death-qualified venirepersons exhibited more positive attitudes toward the death penalty and higher levels of homophobia, modern racism, and modern sexism. Finally, more positive attitudes toward the death penalty were correlated with more negative attitudes toward women and higher levels of homophobia, modern racism, and modern sexism. Legal implications are discussed. Copyright (c) 2007 John Wiley & Sons, Ltd.

Prolongation of islet allograft survival

International Nuclear Information System (INIS)

Lacy, P.E.; Davie, J.M.; Finke, E.H.; Scharp, D.W.

1979-01-01

Pretreatment of donor rats with irradiation and silica followed by in vitro culture of the islets for 1 to 2 days prolonged survival of allografts across a minor histocompatibility barrier if hand-picked, clean islets were used for transplantation. Pretreatment of donor rats with irradiation and silica in conjunction with a single injection of antilymphocyte serum (ALS) into the recipient produced a prolongation of survival of hand-picked islets transplanted across a major histocompatibility barrier

[Excess mortality due to tuberculosis and factors associated to death in and annual cohort of patients diagnosed of tuberculosis].

Science.gov (United States)

Pina, J M; Domínguez, A; Alcaide, J; Alvarez, J; Camps, N; Díez, M; Godoy, P; Jansá, J M; Minquell, S; Arias, C

2006-12-01

To calculate excess mortality in an annual cohort of tuberculosis patients and study the factors associated with death. Cases of tuberculosis reported in Catalonia (May 1996-April 1997). Patients were classified as completed treatment/cured (compliant), non-compliant, failures, transfers out and deaths. Excess mortality was defined as the ratio actual deaths/expected deaths (according to general mortality figures for Catalonia, May 1996-April 1997). Factors associated with death were determined by a comparative study of variables (demographic, substance abuse, comorbidity, tuberculosis-related disease) in deaths after diagnosis and survivors. Time from diagnosis to death was recorded. Patients included: 2,085. Patients classified as: completed treatment/cured (compliant), 1,406 (67.43 %); noncompliant, 165 (7, 91%); failures, 5 (0.24%); transfers out, 25 (1.21%); deaths, 133 (6.38%), 28 of which occurred before diagnosis and 105 after diagnosis. Insufficient data in medical record for classification, 351 (16.83%) patients. Excess mortality: 5.98 (95% CI: 4.96-7.0). Factors associated with death: treatment with non-standardized guidelines, 46%; OR: 10.3 (6.2-17.4); HIV infection, 40%; OR: 13.0 (6.6-25.8); age greater than 64 years, 40%; OR: 14.6 (3.0-69.8); alcoholism, 25%; OR: 2.0 (1.1-3.6); neoplasm, 16%; OR: 3.9 (1.8-8.6; renal failure, 8%; OR: 10.1 (3.1-32.3). The shortest time from diagnosis to death was in patients with only one risk factor, except for HIV infection, where the time passed was the longest observed. We found substantial excess mortality in tuberculosis patients. Death was associated with the efficacy of treatment, HIV coinfection, advanced age, alcoholism and the coexistence of neoplasms or renal failure.

Prolonged pain and disability are common after rib fractures.

Science.gov (United States)

Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

2013-05-01

The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

Impact of prolonged leucine supplementation on protein synthesis and lean growth in neonatal pigs

Science.gov (United States)

Most low-birth weight infants experience extrauterine growth failure due to reduced nutrient intake as a result of feeding intolerance. The objective of this study was to determine whether prolonged enteral leucine supplementation improves lean growth in neonatal pigs fed a restricted protein diet. ...

A population-based study of homicide deaths in Ontario, Canada using linked death records.

Science.gov (United States)

Lachaud, James; Donnelly, Peter D; Henry, David; Kornas, Kathy; Calzavara, Andrew; Bornbaum, Catherine; Rosella, Laura

2017-07-24

Homicide - a lethal expression of violence - has garnered little attention from public health researchers and health policy makers, despite the fact that homicides are a cause of preventable and premature death. Identifying populations at risk and the upstream determinants of homicide are important for addressing inequalities that hinder population health. This population-based study investigates the public health significance of homicides in Ontario, Canada, over the period of 1999-2012. We quantified the relative burden of homicides by comparing the socioeconomic gradient in homicides with the leading causes of death, cardiovascular disease (CVD) and neoplasm, and estimated the potential years of life lost (PYLL) due to homicide. We linked vital statistics from the Office of the Registrar General Deaths register (ORG-D) with Census and administrative data for all Ontario residents. We extracted all homicide, neoplasm, and cardiovascular deaths from 1999 to 2012, using International Classification of Diseases codes. For socioeconomic status (SES), we used two dimensions of the Ontario Marginalization Index (ON-Marg): material deprivation and residential instability. Trends were summarized across deprivation indices using age-specific rates, rate ratios, and PYLL. Young males, 15-29 years old, were the main victims of homicide with a rate of 3.85 [IC 95%: 3.56; 4.13] per 100,000 population and experienced an upward trend over the study period. The socioeconomic neighbourhood gradient was substantial and higher than the gradient for both cardiovascular and neoplasms. Finally, the PYLL due to homicide were 63,512 and 24,066 years for males and females, respectively. Homicides are an important cause of death among young males, and populations living in disadvantaged neighbourhoods. Our findings raise concerns about the burden of homicides in the Canadian population and the importance of addressing social determinants to address these premature deaths.

An epidemiology of homicidal deaths due to rifled firearms in Peshawar Pakistan.

Science.gov (United States)

Marri, Murad Zafar; Bashir, Muhammad Zahid

2010-02-01

To determine the pattern of homicidal deaths caused by rifled weapons in Peshawar as regards the parameters of age, gender, place of occurrence and the number and location of injuries on the body. Descriptive study. The study was conducted at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar, from June 2005 to February 2006. The subjects were selected from victims presenting for autopsy at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. One hundred cases were selected where the weapon of offence was a rifled weapon and the manner of death was homicide on the basis of the police inquest, the autopsy and an interview with the relatives of the victim. After the autopsy, the findings were tabulated and analyzed. Homicides predominantly occurred in young males residing in a rural locality. The peak incidence was between 20-29 years in males and in females the age group most prone was 30-39 years. Male to female ratio was 6:1. The chest (33.8%) followed by the head and abdomen were the areas primarily targeted. High velocity automatic weapons are primarily being used to kill young people in rural areas. Prevention can be through strict gun control laws coupled with education and awareness.

Immigrants Coping with Transnational Deaths and Bereavement: The Influence of Migratory Loss and Anticipatory Grief.

Science.gov (United States)

Nesteruk, Olena

2017-12-14

This study examines immigrants' experiences of bereavement and coping with the deaths of family members in a transnational context. Data were collected through in-depth personal interviews with middle-aged and older immigrants from different countries of origin, who have been living in the United States for a majority of their adult lives. Thematic analysis of participants' narratives showed that immigrants' geographic distance from family complicated caregiving circumstances and rituals surrounding burial, and impacted the grieving process. At the same time, this distance also served as an emotional barrier and provided protection from prolonged grief. Immigrants' U.S.-based family and work responsibilities served as buffers from prolonged grief. Over time, immigrants became Americanized in their attitudes toward coping with death and favored a fast return to productive activities. Finally, immigrants' experience of migratory loss and anticipatory grief early in immigration, along with their personal growth and resilience developed over time, impacted their bereavement experiences later in life. Considering the limitations and the exploratory nature of the present study, further research is needed to investigate the specifics of coping with loss and bereavement among immigrants. © 2017 Family Process Institute.

QT interval prolongation associated with sibutramine treatment

Science.gov (United States)

Harrison-Woolrych, Mira; Clark, David W J; Hill, Geraldine R; Rees, Mark I; Skinner, Jonathan R

2006-01-01

Aims To investigate a possible association of sibutramine with QT interval prolongation. Methods Post-marketing surveillance using prescription event monitoring in the New Zealand Intensive Medicines Monitoring Programme (IMMP) identified a case of QT prolongation and associated cardiac arrest in a patient taking sibutramine for 25 days. This patient was further investigated, including genotyping for long QT syndrome. Other IMMP case reports suggesting arrhythmias associated with sibutramine were assessed and further reports were obtained from the World Health Organisation (WHO) adverse drug reactions database. Results The index case displayed a novel mutation in a cardiac potassium channel subunit gene, KCNQ1, which is likely to prolong cardiac membrane depolarization and increase susceptibility to long QT intervals. Assessment of further IMMP reports identified five additional patients who experienced palpitations associated with syncope or presyncopal symptoms, one of whom had a QTc at the upper limit of normal. Assessment of reports from the WHO database identified three reports of QT prolongation and one fatal case of torsade de pointes in a patient also taking cisapride. Conclusions This case series suggests that sibutramine may be associated with QT prolongation and related dysrhythmias. Further studies are required, but in the meantime we would recommend that sibutramine should be avoided in patients with long QT syndrome and in patients taking other medicines that may prolong the QT interval. PMID:16542208

An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice.

Science.gov (United States)

Tziatzios, Georgios; Gkolfakis, Paraskevas; Papanikolaou, Ioannis S; Dimitriadis, George; Triantafyllou, Konstantinos

2016-04-01

Despite the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient's liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

The role of ethanol in heroin deaths.

Science.gov (United States)

Levine, B; Green, D; Smialek, J E

1995-09-01

The purpose of this study was to evaluate the role of ethanol in deaths due to heroin intoxication. Over a 12 month period, all cases investigated by the Office of the Chief Medical Examiner, State of Maryland where a blood screen by Roche Abuscreen radioimmunoassay (RIA) was positive at a cutoff of 100 ng/mL were included in the study. Free morphine was quantitated using the Coat-A-Count RIA and ethanol was quantitated by head space gas chromatography. All presumptive morphine positive cases were confirmed by gas chromatography/mass spectrometry. Seventy of the 119 cases where death was attributed to narcotic or alcohol and narcotic intoxication had blood ethanol concentrations (BAC) greater than or equal to 0.02 g/dL; 48 had BAC > or = 0.10 g/dL. Only 3 of 45 cases where morphine was identified but was unrelated to death had BAC > or = 0.02 g/dL. At all ranges of free morphine concentrations, there was a greater percentage of narcotic deaths when ethanol was present. From the data, we conclude that 1) the use of even small amounts of ethanol with heroin is clearly a risk factor in deaths due to heroin, 2) there are some heroin deaths where no free morphine is identified in the blood. In these deaths, ethanol is unlikely to be present, 3) at blood ethanol concentrations between 0.20 and 0.29 g/dL, the morphine concentrations in heroin deaths increased significantly, 4) at blood ethanol concentrations greater than 0.30 g/dL, morphine became less of a factor than the ethanol in causing death.

Heterozygous genotype at codon 129 correlates with prolonged disease course in Heidenhain variant sporadic CJD: case report.

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Townley, Ryan A; Dawson, Elliot T; Drubach, Daniel A

2018-02-01

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapid and fatal neurodegenerative disease defined by misfolded prion proteins accumulating in the brain. A minority of cases initially present with posterior cortical atrophy (PCA) phenotype, also known as Heidenhain variant or visual variant CJD. This case provides further evidence of sCJD presenting as PCA. The case also provides evidence for early DWI changes and cortical atrophy over 30 months before neurologic decline and subsequent death. The prolonged disease course correlates with prion protein codon 129 heterozygosity and coexistence of multiple prion strains.

Precisely Tracking Childhood Death.

Science.gov (United States)

Farag, Tamer H; Koplan, Jeffrey P; Breiman, Robert F; Madhi, Shabir A; Heaton, Penny M; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F

2017-07-01

Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12-15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.

Licence prolongations of US nuclear power plants

International Nuclear Information System (INIS)

2004-04-01

Licences of US nuclear reactors were initially attributed for a 40 years duration. However, the vast majority of the reactors can benefit of a licence prolongation for a period of 20 years maximum. This article recalls first the procedure to follow for the licence prolongation demands (safety analysis, components aging, environmental impact statement), and then it makes a status of the accepted prolongations, of the demands under examination, and of the demands that should be presented in the next 5 years. (J.S.)

Hsp27, Hsp70, and metallothionein in MDCK and LLC-PK1 renal epithelial cells: effects of prolonged exposure to cadmium

International Nuclear Information System (INIS)

Bonham, Rita T.; Fine, Michael R.; Pollock, Fiona M.; Shelden, Eric A.

2003-01-01

Cadmium is a widely distributed industrial and environmental toxin. The principal target organ of chronic sublethal cadmium exposure is the kidney. In renal epithelial cells, acute high-dose cadmium exposure induces differential expression of proteins, including heat shock proteins. However, few studies have examined heat shock protein expression in cells after prolonged exposure to cadmium at sublethal concentrations. Here, we assayed total cell protein, neutral red uptake, cell death, and levels of metallothionein and heat shock proteins Hsp27 and inducible Hsp70 in cultures of MDCK and LLC-PK1 renal epithelial cells treated with cadmium for 3 days. Treatment with cadmium at concentrations equal to or greater than 10 μM (LLC-PK1) or 25 μM (MDCK) reduced measures of cell vitality and induced cell death. However, a concentration-dependent increase in Hsp27 was detected in both cell types treated with as little as 5 μM cadmium. Accumulation of Hsp70 was correlated only with cadmium treatment at concentrations also causing cell death. Metallothionein was maximally detected in cells treated with cadmium at concentrations that did not reduce cell vitality, and further increases were not detected at greater concentrations. These results reveal that heat shock proteins accumulate in renal epithelial cells during prolonged cadmium exposure, that cadmium induces differential expression of heat shock protein in epithelial cells, and that protein expression patterns in epithelial cells are specific to the cadmium concentration and degree of cellular injury. A potential role for Hsp27 in the cellular response to sublethal cadmium-induced injury is also implicated by our results

Effect of 34 kinds of traditional Japanese herbal medicines on prolongation of cardiac allograft survival.

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Jin, X; Uchiyama, M; Zhang, Q; Harada, T; Otsuka, K; Shimokawa, T; Niimi, M

2014-05-01

Herbal medicines have been used for over 3,000 years in Asian as alternative therapy for their variety effects and have recently become popular in Europe and the United States. In the last 30 years, Japanese herbal medicines were widely used for treatment of diseases after been recognized officially by Japanese government. In this study, we investigated the effect of 34 kinds of traditional Japanese herbal medicines on alloimmune responses in a murine model of cardiac allograft transplantation. CBA mice (H2(k)) underwent transplantation of a C57BL/6 (H2(b)) heart and received oral administration of 2 g/kg/d of the 34 kinds of herbal medicines from the day of transplantation until 7 days afterward. Naïve CBA mice rejected B6 cardiac grafts acutely (median survival time [MST], 7 days). CBA transplant recipients given 2 g/kg/d of Sairei-to (TJ-114) and Tokishakuyaku-san (TJ-23) had prolonged C57BL/6 allograft survival indefinitely (both MSTs > 100 days). Moreover, CBA transplant recipients given Seisinrensiin (TJ-111), Tokishigyakukagoshuyushokyoto (TJ-38), Rikkunshito (TJ-43), Maobushisaishinto (TJ-127), Ninjin-yoei-to (TJ-108), Ryokan-kyomi-shinge-nin-to (TJ-119), Inchingorei-san (TJ-117), Hochuekkito (TJ-41), Kihi-to (TJ-65), and Sinbu-to (TJ-30) had also prolonged C57BL/6 allograft survival significantly (MSTs of 28, 22, 16, 14, 14, 13, 12, 9.5, 9 and 9 days, respectively). However, none of other 22 kinds of herbal medicines could prolong the allograft survival. Furthermore, oral administration of 2 g/kg/d of Daikenchuto (TJ-100) induced sudden death (within 1 minute) in CBA mice. In conclusion, 12 kinds of Japanese herbal medicines prolonged allograft survival and one showed toxic effect in mice. Copyright © 2014 Elsevier Inc. All rights reserved.

Mitigating prolonged QT interval in cancer nanodrug development for accelerated clinical translation.

Science.gov (United States)

Ranjan, Amalendu P; Mukerjee, Anindita; Helson, Lawrence; Vishwanatha, Jamboor K

2013-12-14

Cardiac toxicity is the foremost reason for drug discontinuation from development to clinical evaluation and post market surveillance [Fung 35:293-317, 2001; Piccini 158:317-326 2009]. The Food and Drug Administration (FDA) has rejected many potential pharmaceutical agents due to QT prolongation effects. Since drug development and FDA approval takes an enormous amount of time, money and effort with high failure rates, there is an increased focus on rescuing drugs that cause QT prolongation. If these otherwise safe and potent drugs were formulated in a unique way so as to mitigate the QT prolongation associated with them, these potent drugs may get FDA approval for clinical use. Rescuing these compounds not only benefit the patients who need them but also require much less time and money thus leading to faster clinical translation. In this study, we chose curcumin as our drug of choice since it has been shown to posses anti-tumor properties against various cancers with limited toxicity. The major limitations with this pharmacologically active drug are (a) its ability to prolong QT by inhibiting the hERG channel and (b) its low bioavailability. In our previous studies, we found that lipids have protective actions against hERG channel inhibition and therefore QT prolongation. Results of the manual patch clamp assay of HEK 293 cells clearly illustrated that our hybrid nanocurcumin formulation prevented the curcumin induced inhibition of hERG K+ channel at concentrations higher than the therapeutic concentrations of curcumin. Comparing the percent inhibition, the hybrid nanocurcumin limited inhibition to 24.8% at a high curcumin equivalent concentration of 18 μM. Liposomal curcumin could only decrease this inhibition upto 30% only at lower curcumin concentration of 6 μM but not at 18 μM concentration. Here we show a curcumin encapsulated lipopolymeric hybrid nanoparticle formulation which could protect against QT prolongation and also render increased

Causes of death among cancer patients.

Science.gov (United States)

Zaorsky, N G; Churilla, T M; Egleston, B L; Fisher, S G; Ridge, J A; Horwitz, E M; Meyer, J E

2017-02-01

The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis. US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons. The greatest relative decrease in index-cancer death (generally from > 60% to deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among 1,000 for lymphomas, P death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Deaths in hotels].

Science.gov (United States)

Risse, Manfred; Weilbächer, Nadine; Birngruber, Christoph; Verhoff, Marcel A

2010-01-01

There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.

Prevalence and predictors of parental grief and depression after the death of a child from cancer.

Science.gov (United States)

McCarthy, Maria C; Clarke, Naomi E; Ting, Cheng Lin; Conroy, Rowena; Anderson, Vicki A; Heath, John A

2010-11-01

To investigate patterns of grief and depression in a sample of parents whose child had died of cancer, and to examine factors related to burden of illness and end-of-life care as potential predictors of parental grief and depression outcomes. Fifty-eight parents completed standardized self-report questionnaires measuring prolonged grief disorder (Inventory of Complicated Grief-Revised [ICG-R]) and depression (Beck Depression Inventory-Second Edition [BDI-II]) and participated in structured interviews designed to elicit their perceptions of their child's end-of-life care and burden of illness. The majority of participants were mothers (84%) and the mean length of time since child death was 4.5 (standard deviation [SD] = 2.4) years (range, 1.0-9.8 years). Rates of prolonged grief disorder (PGD) were similar to those reported in other bereaved populations (10.3%); however, 41% of parents met diagnostic criteria for grief-related separation distress. Twenty-two percent of parents reported clinically significant depressive symptoms. Time since death and parental perception of the oncologist's care predicted parental grief symptoms but not depressive symptoms. Perceptions of the child's quality of life during the last month, preparedness for the child's death, and economic hardship also predicted grief and depression outcomes. A minority of parents met criteria for PGD and depression, however, almost half the sample was experiencing significant separation distress associated with persistent longing and yearning for their child. Time since death is a significant predictor of parental psychological distress. This study also highlights the importance of end-of-life factors in parents' long-term adjustment and the need for optimal palliative care to ensure the best possible outcomes for parents.

Thyroid gland and cerebella lesions: New risk factors for sudden cardiac death in schizophrenia?

Science.gov (United States)

Scorza, Fulvio A; Cavalheiro, Esper A; de Albuquerque, Marly; de Albuquerque, Juliana; Cysneiros, Roberta M; Terra, Vera C; Arida, Ricardo M

2011-02-01

People with schizophrenia show a two to threefold increased risk to die prematurely than those without schizophrenia. Patients' life style, suicide, premature development of cardiovascular disease, high prevalence of metabolic syndrome and sudden cardiac death are well-known causes of the excess mortality. The exact pathophysiological cause of sudden death in schizophrenia is unknown, but it is likely that cardiac arrhythmia and respiratory abnormalities play potential role. Some antipsychotics may be associated with cardiovascular adverse events (e.g., QT interval prolongation) and lesions in specific brain regions, such as cerebella may be associated with respiratory abnormalities, suggesting that metabolic and brain dysfunction could lead to sudden cardiac death in patients with schizophrenia. However, exact knowledge regarding the association of these findings and schizophrenia is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease and cerebella progressive atrophy has been observed in patients with schizophrenia, we propose in this paper that subclinical thyroid dysfunction and cerebella volume loss could be considered as new risk factor for sudden cardiac death in schizophrenia. Copyright © 2010 Elsevier Ltd. All rights reserved.

Prolonged response without prolonged chemotherapy: a lesson from PCV chemotherapy in low-grade gliomas

Science.gov (United States)

Peyre, Matthieu; Cartalat-Carel, Stéphanie; Meyronet, David; Ricard, Damien; Jouvet, Anne; Pallud, Johan; Mokhtari, Karima; Guyotat, Jacques; Jouanneau, Emmanuel; Sunyach, Marie-Pierre; Frappaz, Didier; Honnorat, Jérôme; Ducray, François

2010-01-01

Previous studies with temozolomide suggest that a prolonged duration of chemotherapy is important for treating low-grade gliomas (LGGs). PCV (procarbazine, CCNU, vincristine) chemotherapy has demonstrated efficacy in treating LGGs, but this therapy cannot be used for a prolonged period because of the cumulative toxicity. The aim of the present study was to evaluate the impact of first-line PCV chemotherapy on LGGs growth kinetics. The mean tumor diameter (MTD) of 21 LGGs was measured on serial magnetic resonance images before (n=13), during, and after PCV onset (n=21). During PCV treatment, a decrease in the MTD was observed in all patients. After PCV discontinuation, an ongoing decrease in MTD was observed in 20 of the 21 patients. Median duration of the MTD decrease was 3.4 years (range, 0.8–7.7) after PCV onset and 2.7 years (range, 0–7) after the end of PCV treatment with 60% of LGGs, demonstrating an ongoing and prolonged (>2 years) response despite chemotherapy no longer being administered. According to McDonald's criteria, the rates of partial and minor responses were 5% and 38% at the end of PCV but 38% and 42% at the time of maximal MTD decrease, which occurred after a median period of 3.4 years after PCV onset. These results challenge the idea that a prolonged duration of chemotherapy is necessary for treating LGGs and raise the issue of understanding the mechanisms involved in the persistent tumor volume decrease once chemotherapy is terminated. PMID:20488959

Spatial pattern and temporal trend of mortality due to tuberculosis

Directory of Open Access Journals (Sweden)

Ana Angélica Rêgo de Queiroz

2018-05-01

Full Text Available ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB, to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Prenatal risk indicators of a prolonged pregnancy

DEFF Research Database (Denmark)

Olesen, Annette Wind; Westergaard, Jes Grabow; Olsen, Jørn

2006-01-01

BACKGROUND: Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. METHODS: Data from...

Tecnologia e "Morte Natural": o morrer na contemporaneidade Technology and "Natural Death": dying in contemporary society

Directory of Open Access Journals (Sweden)

Rachel Aisengart Menezes

2003-12-01

Full Text Available O desenvolvimento de técnicas voltadas ao prolongamento da vida acarretou mudanças significativas na concepção de morte. Este artigo analisa as representações contemporâneas da "morte natural" e sua relação com o uso de tecnologias médicas. Através de revisão bibliográfica, são examinadas as concepções de "morte natural" e de "morrer bem" construídas pelos diversos atores sociais envolvidos no processo do morrer. A literatura evidencia a construção contemporânea de um ideário e de uma trajetória necessários à realização do modelo da "boa morte". Esse modelo do "morrer bem" é construído em contraposição ao uso de técnicas para o prolongamento da vida. Estudos apontam a complexidade e ambivalência presentes no que seriam a morte natural ou não-natural, pois essas representações se encontram imbricadas com a concepção da "boa morte" como escolhida e produzida pelo doente. Deste modo, a tecnologia médica torna-se intrinsecamente constitutiva do "morrer natural".The development of techniques to prolong life has brought significant changes in the conceptualization of death. This article analyzes contemporary representations of "natural death" and their relationship to the use of medical technologies. Based on a literature review, the article examines the concepts of "natural death" and "dying well" constructed by the various social actors involved in the process of dying. The literature reveals the contemporary construction of a necessary set of ideals and pathway for achieving the model of a "good death". The "dying well" model is constructed in opposition to techniques for prolonging life. The studies point to the complexity and ambivalence of what is presented as "natural" versus "unnatural" death, since such representations are intertwined with the concept of a "good death" as that which is "chosen and produced" by the patient. Thus, medical technology becomes intrinsically constitutive for a "natural death".

Quantitative evaluation of the lung cancer deaths attributable to residential radon: A simple method and results for all the 21 Italian Regions

International Nuclear Information System (INIS)

Bochicchio, F.; Antignani, S.; Venoso, G.; Forastiere, F.

2013-01-01

Pooled analyses of epidemiological case-control studies on lung cancer and residential radon have shown that radon exposure in dwellings increases lung cancer risk, and that the increase is statistically significant also for prolonged exposures to low-medium level of radon concentration, i.e. levels commonly found in many dwellings. In this paper, a simple method to evaluate the health burden due to the presence of radon in homes (i.e. the number of lung cancer deaths attributable to radon exposure in dwellings) was presented. This method is based on the following parameters: i) the excess relative risk per unit of exposure evaluated in case-control studies; ii) the average radon concentration that can be considered representative of population exposure in dwellings; iii) the total number of lung cancer deaths occurring each year. Moreover, the interaction between radon and cigarette smoking is needed to be taken into account: in fact, although most of the persons are non-smokers, most of the lung cancer deaths attributed to radon are actually due to the multiplicative effect of radon and cigarette smoking. To show this effect, the number of radon related lung cancer deaths estimated to occur among current, former and never smokers was calculated separately for males and females, taking into account the relative risk of lung cancer for the different smoking categories and the prevalence of smoking habits. The methodology described in this work was applied to all the 21 Italian Regions in order to illustrate it. The overall fraction of lung cancer deaths attributable to radon in Italy is about 10%, with values in individual Regions ranging from 4% to 16%. The greater part of the lung cancers attributable to radon is estimated to occur among current smokers for both males and females (72% and 60%, respectively, at national level). This is due to the synergistic effects of radon and cigarette smoking, which should therefore be taken into account in policies aimed to

[Representation of Internal Medicine in G-DRG System - Analysis of Reasons for Prolonged Length of Stay].

Science.gov (United States)

Siam, Kristina; Roeder, Norbert; Fölsch, Ulrich R; Spies, Hans-Friedrich

2017-08-01

Background  There is an ongoing discussion within the German Society of Internal Medicine (DGIM) and the Professional Association of German Internists (BDI) about the appropriate depiction and remuneration of internal medicine in the G-DRG. Method  Therefore, cases with a significantly prolonged length of stay were analyzed in a multicenter study. 124 cases from 6 hospitals were collected for evaluation. Results  The results show that the observed prolongation of hospitalization was mainly due to medical reasons. Discussion  Thus, patients with unclear symptoms and consequently need for a thorough workup could not be identified to cause longer inpatient stay. Instead, treatment complications and comorbidities led to extended hospitalization. The results also reveal prolonged hospitalization as a consequence of unsettled or delayed postdischarge care e. g. in rehabilitation facilities. © Georg Thieme Verlag KG Stuttgart · New York.

Does UTI cause prolonged jaundice in otherwise well infants?

Science.gov (United States)

Chowdhury, Tanzila; Kisat, Hamudi; Tullus, Kjell

2015-07-01

The symptoms of urinary tract infections in infants are very non-specific and have historically included prolonged hyperbilirubinaemia. We studied the results of routine urine samples in 319 infants with prolonged jaundice. Convincing findings of UTI was not found in any of these children even if one of them was treated with antibiotics after four consecutive urine cultures with different bacteria. A urine culture might thus not be an appropriate investigation in a child with prolonged jaundice without any other symptoms of UTI. • The symptoms of UTI in infancy are very non-specific. • Old studies suggest that prolonged hyperbilirubinaemia is one such symptom; more modern studies give more conflicting results. What is New: • Our study could not confirm that children with prolonged jaundice have an increased risk of UTI. • Routine urine testing is thus not needed in otherwise healthy infants with prolonged jaundice.

Modelling radiation-induced cell death and tumour re-oxygenation: local versus global and instant versus delayed cell death

International Nuclear Information System (INIS)

Gago-Arias, Araceli; Espinoza, Ignacio; Sánchez-Nieto, Beatriz; Aguiar, Pablo; Pardo-Montero, Juan

2016-01-01

The resistance of hypoxic cells to radiation, due to the oxygen dependence of radiosensitivity, is well known and must be taken into account to accurately calculate the radiation induced cell death. A proper modelling of the response of tumours to radiation requires deriving the distribution of oxygen at a microscopic scale. This usually involves solving the reaction-diffusion equation in tumour voxels using a vascularization distribution model. Moreover, re-oxygenation arises during the course of radiotherapy, one reason being the increase of available oxygen caused by cell killing, which can turn hypoxic tumours into oxic. In this work we study the effect of cell death kinetics in tumour oxygenation modelling, analysing how it affects the timing of re-oxygenation, surviving fraction and tumour control. Two models of cell death are compared, an instantaneous cell killing, mimicking early apoptosis, and a delayed cell death scenario in which cells can die shortly after being damaged, as well as long after irradiation. For each of these scenarios, the decrease in oxygen consumption due to cell death can be computed globally (macroscopic voxel average) or locally (microscopic). A re-oxygenation model already used in the literature, the so called full re-oxygenation, is also considered. The impact of cell death kinetics and re-oxygenation on tumour responses is illustrated for two radiotherapy fractionation schemes: a conventional schedule, and a hypofractionated treatment. The results show large differences in the doses needed to achieve 50% tumour control for the investigated cell death models. Moreover, the models affect the tumour responses differently depending on the treatment schedule. This corroborates the complex nature of re-oxygenation, showing the need to take into account the kinetics of cell death in radiation response models. (paper)

Effects of low dose rate irradiation on life span prolongation of human premature-aging syndrome model mice

International Nuclear Information System (INIS)

Nomura, Takaharu

2006-01-01

We previously showed that Type II diabetes model mice prolonged of their life span by life long low dose rate irradiation. We also found that antioxidant function in variety tissues of some strain of mice were enhancement after low dose/low dose rate irradiation. The prolongation of life span might depend on certain damaged level of reactive oxygen species. We thought the effect of the prolongation was due to the enhancement of the antioxidant activities after irradiation. We investigated whether the enhancement of antioxidant activities after low dose rate irradiation had an effect on life span prolongation. Four-week-old female human premature-aging syndrome model mice, kl/kl (klotho) mice, which the life span of this model mouse is about 65 days, were irradiated with gamma rays at 0.35, 0.70 or 1.2 mGy/hr. The 0.70 mGy/hr-irradiated group remarkably effected on the prolongation of their life span. Some mice of the group were extremely survived for about and more 100 days. Antioxidant activities in the irradiated groups were enhancement by low dose rate irradiation, however the dependence of the dose rates were not clearly difference. These results suggest that the antioxidant activities in this model mouse were enhanced by the low dose rate irradiation, and may make it possible to prolong the life span of this mouse. (author)

Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome

Directory of Open Access Journals (Sweden)

A. James Mamary

2011-01-01

Full Text Available Background Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize patients admitted to a Ventilator Rehabilitation Unit (VRU for weaning and identify characteristics associated with survival. Methods 182 consecutive patients over 3.5 years admitted to Temple University Hospital (TUH VRU were characterized. Data were derived from comprehensive chart review and a prospectively collected computerized database. Survival was determined by hospital records and social security death index and mailed questionnaires. Results Upon admission to the VRU, patients were hypoalbuminemic (albumin 2.3 ± 0.6 g/dL, anemic (hemoglobin 9.6 ± 1.4 g/dL, with moderate severity of illness (APACHE II score 10.7 + 4.1, and multiple comorbidities (Charlson index 4.3 + 2.3. In-hospital mortality (19% was related to a higher Charlson Index score ( P = 0.006; OR 1.08-1.6, and APACHE II score ( P = 0.016; OR 1.03-1.29. In-hospital mortality was inversely related to admission albumin levels ( P = 0.023; OR 0.17-0.9. The presence of COPD as a comorbid illness or primary determinant of respiratory failure and higher VRU admission APACHE II score predicted higher long-term mortality. Conversely, higher VRU admission hemoglobin was associated with better long term survival (OR 0.57-0.90; P = 0.0006. Conclusion Patients receiving prolonged ventilation are hypoalbuminemic, anemic, have moderate severity of illness, and multiple comorbidities. Survival relates to these factors and the underlying illness precipitating respiratory failure, especially COPD.

Disseminated Mycobacterium celatum disease with prolonged pulmonary involvement

DEFF Research Database (Denmark)

Patsche, Cecilie Blenstrup; Svensson, Erik; Wejse, Christian

2014-01-01

Mycobacterium celatum is a rare cause of human infection, causing disseminated disease in immunosuppressed individuals. Infections localized to the lungs and the lymph nodes have also been reported in immunocompetent individuals. The existing literature on the subject is limited as are experiences...... with treatment regimens and durations. In the case presented herein, two different treatment regimens were applied to an immunocompromised HIV-negative patient with primary skin involvement and extensive pulmonary involvement due to suspected relapse on isoniazid, ethambutol, and clarithromycin treatment....... The treatment regimen was changed to azithromycin, ciprofloxacin, and pyrazinamide and the treatment duration was prolonged to a total of 24 months, with good effect....

"Tampering to Death": A Fatal Codeine Intoxication Due to a Homemade Purification of a Medical Formulation.

Science.gov (United States)

Fais, Paolo; Pigaiani, Nicola; Cecchetto, Giovanni; Montisci, Massimo; Gottardo, Rossella; Viel, Guido; Pascali, Jennifer Paola; Tagliaro, Franco

2017-11-01

Many homemade tamper processes of medical codeine formulations are available on selected "forums" on the Internet, where recreational codeine users claim to be able to purify codeine by removing additives, such as acetaminophen, to avoid or limit adverse effects. In this work, it is reported and discussed a fatal case of codeine intoxication. The findings of objects such as jars, filters, and tablets, and amounts of unknown liquid material at the death scene investigation suggested a fatal codeine intoxication after the tampering procedure called "cold water extraction." Toxicological results obtained from the analysis of both the nonbiological material and the body fluids of the decedent integrated with the information collected at the death scene investigation confirmed the above-mentioned hypothesis. This report underlines the importance of a tight interconnection between criminalistics and legal medicine to strengthen the identification of the cause of death and the reconstruction of the event. © 2017 American Academy of Forensic Sciences.

How many deaths will it take? A death from asthma associated with work-related environmental tobacco smoke.

Science.gov (United States)

Stanbury, Martha; Chester, Debra; Hanna, Elizabeth A; Rosenman, Kenneth D

2008-02-01

Despite epidemiologic, experimental and observational data on the association of environmental tobacco smoke (ETS) and adverse health effects, bar and restaurant workers remain exposed to ETS in the majority of states and countries. Three public health surveillance systems were used to identify and conduct a follow-up investigation of a reported acute asthma death of a young waitress in a bar. The waitress collapsed at the bar where she worked and was declared dead shortly thereafter. Evaluation of the circumstances of her death and her medical history concluded that her death was from acute asthma due to environmental tobacco smoke at work. This is the first reported acute asthma death associated with work-related ETS. Recent studies of asthma among bar and restaurant workers before and after smoking bans support this association. This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke.

New Heterogeneous Clustering Protocol for Prolonging Wireless Sensor Networks Lifetime

Directory of Open Access Journals (Sweden)

Md. Golam Rashed

2014-06-01

Full Text Available Clustering in wireless sensor networks is one of the crucial methods for increasing of network lifetime. The network characteristics of existing classical clustering protocols for wireless sensor network are homogeneous. Clustering protocols fail to maintain the stability of the system, especially when nodes are heterogeneous. We have seen that the behavior of Heterogeneous-Hierarchical Energy Aware Routing Protocol (H-HEARP becomes very unstable once the first node dies, especially in the presence of node heterogeneity. In this paper we assume a new clustering protocol whose network characteristics is heterogeneous for prolonging of network lifetime. The computer simulation results demonstrate that the proposed clustering algorithm outperforms than other clustering algorithms in terms of the time interval before the death of the first node (we refer to as stability period. The simulation results also show the high performance of the proposed clustering algorithm for higher values of extra energy brought by more powerful nodes.

Prolonged labour as indication for emergency caesarean section

DEFF Research Database (Denmark)

Maaløe, Nanna; Sorensen, B L; Onesmo, R

2012-01-01

To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.......To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour....

Differential cellular responses to prolonged LDR-IR in MLH1-proficient and MLH1-deficient colorectal cancer HCT116 cells.

Science.gov (United States)

Yan, Tao; Seo, Yuji; Kinsella, Timothy J

2009-11-15

MLH1 is a key DNA mismatch repair (MMR) protein involved in maintaining genomic stability by participating in the repair of endogenous and exogenous mispairs in the daughter strands during S phase. Exogenous mispairs can result following treatment with several classes of chemotherapeutic drugs, as well as with ionizing radiation. In this study, we investigated the role of the MLH1 protein in determining the cellular and molecular responses to prolonged low-dose rate ionizing radiation (LDR-IR), which is similar to the clinical use of cancer brachytherapy. An isogenic pair of MMR(+) (MLH1(+)) and MMR(-) (MLH1(-)) human colorectal cancer HCT116 cells was exposed to prolonged LDR-IR (1.3-17 cGy/h x 24-96 h). The clonogenic survival and gene mutation rates were examined. Cell cycle distribution was analyzed with flow cytometry. Changes in selected DNA damage repair proteins, DNA damage response proteins, and cell death marker proteins were examined with Western blotting. MLH1(+) HCT116 cells showed greater radiosensitivity with enhanced expression of apoptotic and autophagic markers, a reduced HPRT gene mutation rate, and more pronounced cell cycle alterations (increased late-S population and a G(2)/M arrest) following LDR-IR compared with MLH1(-) HCT116 cells. Importantly, a progressive increase in MLH1 protein levels was found in MLH1(+) cells during prolonged LDR-IR, which was temporally correlated with a progressive decrease in Rad51 protein (involved in homologous recombination) levels. MLH1 status significantly affects cellular responses to prolonged LDR-IR. MLH1 may enhance cell radiosensitivity to prolonged LDR-IR through inhibition of homologous recombination (through inhibition of Rad51).

The effect of prolonged of warm ischaemic injury on renal function in an experimental ex vivo normothermic perfusion system.

Science.gov (United States)

Hosgood, Sarah A; Shah, K; Patel, M; Nicholson, M L

2015-06-30

Donation after circulatory death (DCD) kidney transplants inevitably sustain a degree of warm ischaemic injury, which is manifested clinically as delayed graft function. The aim of this study was to define the effects of prolonged periods of warm ischaemic injury on renal function in a normothermic haemoperfused kidney model. Porcine kidneys were subjected to 15, 60, 90 (n = 6 per group) and 120 min (n = 4) of in situ warm ischaemia (WI) and then retrieved, flushed with cold preservation fluid and stored in ice for 2 h. Kidneys then underwent 3 h of normothermic reperfusion with a whole blood-based perfusate using an ex vivo circuit developed from clinical grade cardiopulmonary bypass technology. Creatinine clearance, urine output and fractional excretion of sodium deteriorated sequentially with increasing warm time. Renal function was severely compromised after 90 or 120 min of WI but haemodynamic, metabolic and histological parameters demonstrated the viability of kidneys subjected to prolonged warm ischaemia. Isolated kidney perfusion using a warm, oxygenated, red cell-based perfusate allows an accurate ex vivo assessment of the potential for recovery from warm ischaemic injury. Prolonged renal warm ischaemic injury caused a severe decrement in renal function but was not associated with tissue necrosis.

Fournier gangrene and unexpected death.

Science.gov (United States)

Bury, Danielle; Byard, Roger W

2012-11-01

Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case. © 2012 American Academy of Forensic Sciences.

Suicidal Deaths an a Water Environment

Directory of Open Access Journals (Sweden)

Michniewicz Iwona

2017-03-01

Full Text Available Unexpected, abrupt death is always a great tragedy, both for a victim, as well as, for their family, friends, society or even country. However, death as a result of a suicide always seems to be unnecessary and difficult to accept by relatives. Every 40 seconds someone dies on the globe due to a kind of an auto-destruction act. Out of all suicides, the biggest group are adult men, frequently with mental disorders, who commit suicide by hanging themselves. The only suicide method where women are almost on the par with men is drowning (by many authors referred to as death by drowning.

Stochastic health effects assessment due to short-term external exposure

International Nuclear Information System (INIS)

Raicevic, J.J.; Raskob, W.; Merkle, M.; Ninkovic, M.M.

2001-01-01

The new model for calculation of stochastic health effects is presented in this paper. The exposure pathways which are briefly considered are the short-term external exposure due to passage of the radioactive cloud (cloudshine) and the short-term external exposure due to radioactive material deposited on skin and clothes (skin contamination). The quantitative assessment of stochastic effects is expressed in numbers of deaths, which are given as a functions of the time at the accident, and age at death, what on the other side enables estimation of the number of deaths within the specified range of the time/age parameters. That means the model calculates the number of deaths within one particular year, summed up over all ages at deaths, or vice versa, it finds the number of deaths within the specified range of ages at death, summed up over all observation times. Results presented in this paper are implemented in the module LATEHEAL, which is incorporated in RODOS, a new European system for decision support for nuclear emergencies. (author)

Prolonged QRS Widening After Aripiprazole Overdose.

Science.gov (United States)

Mazer-Amirshahi, Maryann; Porter, Robert; Dewey, Kayla

2018-05-05

Aripiprazole is an atypical antipsychotic with a long half-life. Overdose can result in protracted somnolence and cardiac disturbances, particularly QT interval prolongation. This is a single case report of a 14-year-old boy who took an overdose of aripiprazole and developed QRS widening. A 14-year-old boy intentionally ingested 20 tablets of aripiprazole (5 mg). He was brought to the emergency department when his ingestion was discovered. The patient's vital signs were as follows: temperature, 37.7°C; heart rate, 108 beats/min; blood pressure, 138/98 mm Hg; and respirations, 16 breaths/min. Activated charcoal was administered within 90 minutes of ingestion. Initial electrocardiogram (EKG) showed sinus tachycardia, with a QRS of 138 ms and QT interval of 444 ms. QRS duration was 90 ms on an EKG performed 3 months earlier. A bolus of sodium bicarbonate was administered, and the patient was transferred to the pediatric intensive care unit. Repeat EKG demonstrated a QRS of 156 ms, and a sodium bicarbonate infusion was initiated. The patient continued to have QRS prolongation for the next 8 days, reaching a peak of 172 ms 3 days postingestion. Despite aggressive treatment with sodium bicarbonate, there was persistent QRS prolongation; however, the patient did not have any dysrhythmias and remained hemodynamically stable. The patient was discharged 9 days postingestion when the QRS duration normalized to 82 ms. Genetic testing revealed that the patient was a CYP2D6 poor metabolizer. This case suggests that aripiprazole toxicity may possibly be associated with QRS prolongation without associated dysrhythmias or cardiovascular compromise. In addition, toxicity may be prolonged in patients who are CYP2D6 poor metabolizers.

UK asbestos imports and mortality due to idiopathic pulmonary fibrosis.

Science.gov (United States)

Barber, C M; Wiggans, R E; Young, C; Fishwick, D

2016-03-01

Previous studies have demonstrated that the rising mortality due to mesothelioma and asbestosis can be predicted from historic asbestos usage. Mortality due to idiopathic pulmonary fibrosis (IPF) is also rising, without any apparent explanation. To compare mortality due to these conditions and examine the relationship between mortality and national asbestos imports. Mortality data for IPF and asbestosis in England and Wales were available from the Office for National Statistics. Data for mesothelioma deaths in England and Wales and historic UK asbestos import data were available from the Health & Safety Executive. The numbers of annual deaths due to each condition were plotted separately by gender, against UK asbestos imports 48 years earlier. Linear regression models were constructed. For mesothelioma and IPF, there was a significant linear relationship between the number of male and female deaths each year and historic UK asbestos imports. For asbestosis mortality, a similar relationship was found for male but not female deaths. The annual numbers of deaths due to asbestosis in both sexes were lower than for IPF and mesothelioma. The strength of the association between IPF mortality and historic asbestos imports was similar to that seen in an established asbestos-related disease, i.e. mesothelioma. This finding could in part be explained by diagnostic difficulties in separating asbestosis from IPF and highlights the need for a more accurate method of assessing lifetime occupational asbestos exposure. © Crown copyright 2015.

Concanavalin A/IFN-gamma triggers autophagy-related necrotic hepatocyte death through IRGM1-mediated lysosomal membrane disruption.

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Chih-Peng Chang

Full Text Available Interferon-gamma (IFN-γ, a potent Th1 cytokine with multiple biological functions, can induce autophagy to enhance the clearance of the invading microorganism or cause cell death. We have reported that Concanavalin A (Con A can cause autophagic cell death in hepatocytes and induce both T cell-dependent and -independent acute hepatitis in immunocompetent and immunodeficient mice, respectively. Although IFN-γ is known to enhance liver injury in Con A-induced hepatitis, its role in autophagy-related hepatocyte death is not clear. In this study we report that IFN-γ can enhance Con A-induced autophagic flux and cell death in hepatoma cell lines. A necrotic cell death with increased lysosomal membrane permeabilization (LMP is observed in Con A-treated hepatoma cells in the presence of IFN-γ. Cathepsin B and L were released from lysosomes to cause cell death. Furthermore, IFN-γ induces immunity related GTPase family M member 1(IRGM1 translocation to lysosomes and prolongs its activity in Con A-treated hepatoma cells. Knockdown of IRGM1 inhibits the IFN-γ/Con A-induced LMP change and cell death. Furthermore, IFN-γ(-/- mice are resistant to Con A-induced autophagy-associated necrotic hepatocyte death. We conclude that IFN-γ enhances Con A-induced autophagic flux and causes an IRGM1-dependent lysosome-mediated necrotic cell death in hepatocytes.

Predictive value of long-term changes of growth differentiation factor-15 over a 27-year-period for heart failure and death due to coronary heart disease.

Science.gov (United States)

Fluschnik, Nina; Ojeda, Francisco; Zeller, Tanja; Jørgensen, Torben; Kuulasmaa, Kari; Becher, Peter Moritz; Sinning, Christoph; Blankenberg, Stefan; Westermann, Dirk

2018-01-01

Growth differentiation factor-15 (GDF-15), Cystatin C and C-reactive protein (CRP) have been discussed as biomarkers for prediction of cardiac diseases. The aim of this study was to investigate the predictive value of single and repeated measurements of GDF-15 compared to Cystatin C and CRP for incidence of heart failure (HF) and death due to coronary heart disease (CHD) in the general population. Levels of GDF-15, CRP and Cystatin C were determined in three repeated measurements collected 5 years apart in the DAN-MONICA (Danish-Multinational MONitoring of trends and determinants in Cardiovascular disease) cohort (participants at baseline n = 3785). Cox regression models adjusted for cardiovascular risk factors revealed significantly increased hazard ratios (HR) for GDF-15 for incident HF 1.36 (HR per interquartile range (IQR) increase, 95% confidence interval (CI): 1.16; 1.59) and for death from CHD 1.51 (HR per IQR increase, 95% CI: 1.31, 1.75) (both with p<0.001). Joint modeling of time-to-event and longitudinal GDF-15 over a median 27-year follow-up period showed that the marker evolution was positively associated with death of CHD (HR per IQR increase 3.02 95% CI: (2.26, 4.04), p < 0.001) and HF (HR per IQR increase 2.12 95% CI: (1.54, 2.92), p<0.001). However using Cox models with follow-up time starting at the time of the third examination, serial measurement of GDF-15, modeled as changes between the measurements, did not improve prediction over that of the most recent measurement. GDF-15 is a promising biomarker for prediction of HF and death due to CHD in the general population, which may provide prognostic information to already established clinical biomarkers. Repeated measurements of GDF-15 displayed only a slight improvement in the prediction of these endpoints compared to a single measurement.

An autopsy study of death due to Suicidal Hanging – 264 cases

Directory of Open Access Journals (Sweden)

Dinesh Rao

2016-09-01

Full Text Available The present study was carried out between 2010 and 2013, a total of 7968 Autopsies were conducted of which 3.31% (n – 264 cases were deaths due to hanging. The most preferred ligature materials were Stole (n – 79 and Bed spread/Sari (n – 68. In 88% of the cases, hanging was complete. Females (n – 136 and males (n – 128 were equally affected. The major age group involved in both the sexes was of 31–40 years, contributing to 50.76% (n – 136 of the self suspension. In 80.58% (n – 213 of the incidents, ligature mark showed discontinuity (incomplete. A Slip type of knot was used in majority of the noose, contributing to 97.73% (n – 258 of the suspensions. In 87.88% (n – 232 of hanging an oblique shaped ligature mark was noticed. The horizontal and near oblique ligature marks were seen only in cases of partial suspension. In 95.45% (n – 252 of the cases, the ligature mark showed blackening of the skin (friction burn. Only 4.54% (n – 12 showed intact skin. The outer layer of the skin over the ligature mark showed displacement in majority of the cases. Married victims contributed to 70.45% of cases. Domestic issues were the commonest reason (n – 82 for self suspension, of which female (n – 68 formed the majority of victims. In 70.83% (n – 187 of cases damage to neck muscle fibers and hemorrhage at the Sternal end of the Sternocleidomastoid muscle were present. In 85.61% (n – 226 of cases the cervical vertebra was intact. In 52.27% (n – 138 of the cases the internal carotid artery showed transverse tear. In 99.42% (n – 248 cases the thyroid cartilage was found intact. The hyoid bone was damaged in 6.06% (n – 16 of the victims. Majority of the victims, 59.09% (n – 156 belonged to low socioeconomic class.

A whiff of death: fatal volatile solvent inhalation abuse.

Science.gov (United States)

Steffee, C H; Davis, G J; Nicol, K K

1996-09-01

Inhalation abuse of volatile solvents, previously known generically as "glue sniffing," is typically pursued by adolescents. A wide range of legal, easily obtained products containing volatile substances are available for abuse. We report two illustrative cases of fatal volatile substance abuse: gasoline sniffing in a 20-year-old man and aerosol propellant gas inhalation (aerosol air freshener) in a 16-year-old girl with underlying reactive airway disease. Although the ratio of deaths to nonfatal inhalation escapades is extremely low, volatile solvent abuse carries the risk of sudden death due to cardiac arrest after a dysrhythmia or vasovagal event, central nervous system respiratory depression, hypoxia and hypercapnia due to the techniques of inhalation, and other mechanisms. Investigation of the patient's substance abuse history, examination of the scene of death, and special toxicologic analyses are critical to identifying volatile substance inhalation abuse as the cause of death because anatomic autopsy findings will typically be nonspecific. Above all, physicians must suspect the diagnosis of volatile substance inhalation abuse, especially in any case of sudden death involving an otherwise healthy young person.

Pedestrian deaths in children--potential for prevention.

LENUS (Irish Health Repository)

Hamilton, K

2015-01-01

The National Paediatric Mortality Database was reviewed for the six year period 1st January 2006 to 31st December 2011 and all pedestrian deaths extracted, after review of available data the deaths were categorized as either traffic or non-traffic related. There were 45 child pedestrian fatalities in the period examined. Traffic related deaths accounted for 26 (58%) vs. 19 (42%) non-traffic related. Analysis of the deaths showed there was a male preponderance 28 (62%), weekend trend 22 (49%) with an evening 16 (35%) and summer peak 20 (44%). The highest proportion of deaths occurred in the 1-4 year age group 24 (53%), with 13 (28%) due to low speed vehicle rollovers, mainly occurring in residential driveways 8 (61%). Child pedestrian fatalities are highly preventable through the modification of risk factors including behavioural, social and environmental. Preventative action needs to be addressed, particularly in relation to non-traffic related deaths i.e, low speed vehicle rollovers.

Cardiac symptoms before sudden cardiac death caused by coronary artery disease

DEFF Research Database (Denmark)

Jabbari, Reza; Risgaard, Bjarke; Holst, Anders G

2013-01-01

The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).......The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD)....

Assessment of risk for asthma initiation and cancer and heart disease deaths among patrons and servers due to secondhand smoke exposure in restaurants and bars

Science.gov (United States)

Liu, Ruiling; Bohac, David L; Gundel, Lara A; Hewett, Martha J; Apte, Michael G; Hammond, S Katharine

2014-01-01

Background Despite efforts to reduce exposure to secondhand smoke (SHS), only 5% of the world's population enjoy smoke-free restaurants and bars. Methods Lifetime excess risk (LER) of cancer death, ischaemic heart disease (IHD) death and asthma initiation among non-smoking restaurant and bar servers and patrons in Minnesota and the US were estimated using weighted field measurements of SHS constituents in Minnesota, existing data on tobacco use and multiple dose-response models. Results A continuous approach estimated a LER of lung cancer death (LCD) of 18×10−6(95% CI 13 to 23×10−6) for patrons visiting only designated non-smoking sections, 80×10−6(95% CI 66 to 95×10−6) for patrons visiting only smoking venues/sections and 802×10−6(95% CI 658 to 936×10−6) for servers in smoking-permitted venues. An attributable-risk (exposed/non-exposed) approach estimated a similar LER of LCD, a LER of IHD death about 10−2 for non-smokers with average SHS exposure from all sources and a LER of asthma initiation about 5% for servers with SHS exposure at work only. These risks correspond to 214 LCDs and 3001 IHD deaths among the general non-smoking population and 1420 new asthma cases among non-smoking servers in the US each year due to SHS exposure in restaurants and bars alone. Conclusions Health risks for patrons and servers from SHS exposure in restaurants and bars alone are well above the acceptable level. Restaurants and bars should be a priority for governments’ effort to create smoke-free environments and should not be exempt from smoking bans. PMID:23407112

Associations between intrapartum death and piglet, placental, and umbilical characteristics.

Science.gov (United States)

Rootwelt, V; Reksen, O; Farstad, W; Framstad, T

2012-12-01

Intrapartum death in multiparous gestations in sows (Sus scrofa) is often caused by hypoxia. There is little information in the literature on the assessment of the placenta in relation to intrapartum death in piglets. The aim of this study was to evaluate the impact of the placental area and weight upon piglet birth characteristics and intrapartum death. Litters from 26 Landrace-Yorkshire sows were monitored during farrowing and the status of each piglet was recorded, including blood parameters of piglets and their umbilical veins. Of 413 piglets born, 6.5% were stillborn. Blood concentrations of glucose, lactate, and CO(2) partial pressure were increased in the stillborn piglets (P birth was increased for piglets born dead vs. live (P birth weight for piglets born dead was not different from live-born piglets (P = 0.631), whereas mean body mass index was reduced (P 0.2). Piglet BW was positively correlated with placental area and placental weight (P birth order group, and broken umbilical cords explained 71% of the stillbirths (P = 0.001). We conclude that placental area and placental weight are both positively associated with piglet birth weight, but not with the probability of being born dead. Placental area was a better predictor of piglet vitality than placental weight. Because umbilical cord rupture and prolonged birth time were associated with being born dead, umbilical cord rupture and placental detachment seem to be probable causes of intrapartum death.

Psychic trauma as cause of death.

Science.gov (United States)

Terranova, C; Snenghi, R; Thiene, G; Ferrara, S D

2011-01-01

of study Psychic trauma is described as the action of 'an emotionally overwhelming factor' capable of causing neurovegetative alterations leading to transitory or persisting bodily changes. The medico-legal concept of psychic trauma and its definition as a cause in penal cases is debated. The authors present three cases of death after psychic trauma, and discuss the definition of cause within the penal ambit of identified 'emotionally overwhelming factors'. The methodological approach to ascertainment and criterion-based assessment in each case involved the following phases: (1) examination of circumstantial evidence, clinical records and documentation; (2) autopsy; (3) ascertainment of cause of death; and (4) ascertainment of psychic trauma, and its coexisting relationship with the cause of death. The results and assessment of each of the three cases are discussed from the viewpoint of the causal connotation of psychic trauma. In the cases presented, psychic trauma caused death, as deduced from assessment of the type of externally caused emotional insult, the subjects' personal characteristics and the circumstances of the event causing death. In cases of death due to psychic trauma, careful methodological ascertainment is essential, with the double aim of defining 'emotionally overwhelming factors' as a significant cause of death from the penal point of view, and of identifying the responsibility of third parties involved in the death event and associated dynamics of homicide.

Dummy (pacifier) use and sudden infant death syndrome: Potential advantages and disadvantages

NARCIS (Netherlands)

Horne, R.S.C.; Moon, R.Y; L'Hoir, M.P.; Blair, P.S.

2014-01-01

The large decline in deaths due to the sudden infant death syndrome (SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely

Can Tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation?

Science.gov (United States)

Yuan, Ciou-Rong; Lan, Tzuo-Yun; Tang, Gau-Jun

2015-01-01

Background: It is not clear whether the benefits of tracheostomy remain the same in the population. This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients. Methods: Data were from the medical claims data in Taiwan. A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified. Among them, 645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period, and successful weaning and medical utilization during hospitalization. Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes. Results: The tracheostomy rate was 30%, and 55% of tracheostomies were performed within 30 days of mechanical ventilation. After adjustments, patients with tracheostomy were at a lower risk of death during hospitalization (hazard ratio [HR] =0.51; 95% confidence interval [CI] =0.43–0.61) and 5-year observation (HR = 0.73; 95% CI = 0.66–0.81), and a lower probability of successful weaning (HR = 0.88; 95% CI = 0.79–0.99). Higher medical use was also observed in patients with tracheostomy. Conclusions: The beneficial effect for tracheostomy observed in our data was the reduction of death. However, patients with tracheostomy were less likely to wean and more likely to consume medical resources. PMID:26415799

HAMLET triggers apoptosis but tumor cell death is independent of caspases, Bcl-2 and p53.

Science.gov (United States)

Hallgren, O; Gustafsson, L; Irjala, H; Selivanova, G; Orrenius, S; Svanborg, C

2006-02-01

HAMLET (Human alpha-lactalbumin Made Lethal to Tumor cells) triggers selective tumor cell death in vitro and limits tumor progression in vivo. Dying cells show features of apoptosis but it is not clear if the apoptotic response explains tumor cell death. This study examined the contribution of apoptosis to cell death in response to HAMLET. Apoptotic changes like caspase activation, phosphatidyl serine externalization, chromatin condensation were detected in HAMLET-treated tumor cells, but caspase inhibition or Bcl-2 over-expression did not prolong cell survival and the caspase response was Bcl-2 independent. HAMLET translocates to the nuclei and binds directly to chromatin, but the death response was unrelated to the p53 status of the tumor cells. p53 deletions or gain of function mutations did not influence the HAMLET sensitivity of tumor cells. Chromatin condensation was partly caspase dependent, but apoptosis-like marginalization of chromatin was also observed. The results show that tumor cell death in response to HAMLET is independent of caspases, p53 and Bcl-2 even though HAMLET activates an apoptotic response. The use of other cell death pathways allows HAMLET to successfully circumvent fundamental anti-apoptotic strategies that are present in many tumor cells.

Death in hospital and at home: population and health policy influences in Londrina, State of Paraná, Brazil (1996-2010

Directory of Open Access Journals (Sweden)

Fernando Cesar Iwamoto Marcucci

2015-03-01

Full Text Available An aging population and epidemiological transition involves prolonged terminal illnesses and an increased demand for end-stage support in health services, mainly in hospitals. Changes in health care and government health policies may influence the death locations, making it possible to remain at home or in an institution. The scope of this article is to analyze death locations in the city of Londrina, State of Paraná, from 1996 to 2010, and to verify the influence of population and health policy changes on these statistics. An analysis was conducted into death locations in Londrina in Mortality Information System (SIM considering the main causes and locations of death. There was an increase of 28% in deaths among the population in general, though 48% for the population over 60 years of age. There was an increase of deaths in hospitals, which were responsible for 70% of the occurrences, though death frequencies in others locations did not increase, and deaths in the home remained at about 18%. The locations of death did not change during this period, even with health policies that broadened care in other locations, such as the patient´s home. The predominance of hospital deaths was similar to other Brazilian cities, albeit higher than in other countries.

Isosteviol prevents the prolongation of action potential in hypertrophied cardiomyoctyes by regulating transient outward potassium and L-type calcium channels.

Science.gov (United States)

Fan, Zhuo; Lv, Nanying; Luo, Xiao; Tan, Wen

2017-10-01

Cardiac hypertrophy is a thickening of the heart muscle that is associated with cardiovascular diseases such as hypertension and myocardial infarction. It occurs initially as an adaptive process against increased workloads and often leads to sudden arrhythmic deaths. Studies suggest that the lethal arrhythmia is attributed to hypertrophy-induced destabilization of cardiac electrical activity, especially the prolongation of the action potential. The reduced activity of I to is demonstrated to be responsible for the ionic mechanism of prolonged action potential duration and arrhythmogeneity. Isosteviol (STV), a derivative of stevioside, plays a protective role in a variety of stress-induced cardiac diseases. Here we report effects of STV on rat ISO-induced hypertrophic cardiomyocytes. STV alleviated ISO-induced hypertrophy of cardiomyocytes by decreasing cell area of hypertrophied cardiomyocytes. STV application prevented the prolongation of action potential which was prominent in hypertrophied cells. The decrease and increase of current densities for I to and I CaL observed in hypertrophied myocytes were both prevented by STV application. In addition, the results of qRT-PCR suggested that the changes of electrophysiological activity of I to and I CaL are correlated to the alterations of the mRNA transcription level. Copyright © 2017. Published by Elsevier B.V.

Return to work following sickness absence due to infectious mononucleosis

NARCIS (Netherlands)

Koopmans, P.C.; Bakhtali, R.; Katan, A.A.; Groothoff, J.W.; Roelen, C.A.

BACKGROUND: Epstein-Barr virus infectious mononucleosis among adults is notorious because of the prolonged incapacitating fatigue it causes. AIMS: To investigate the duration of sickness absence and return to work following infectious mononucleosis. METHODS: Episodes of sickness absence due to

High-Dose Citalopram and Escitalopram and the Risk of Out-of-Hospital Death.

Science.gov (United States)

Ray, Wayne A; Chung, Cecilia P; Murray, Katherine T; Hall, Kathi; Stein, C Michael

2017-02-01

Studies demonstrating that higher doses of citalopram (> 40 mg) and escitalopram (> 20 mg) prolong the corrected QT interval prompted regulatory agency warnings, which are controversial, given the absence of confirmatory clinical outcome studies. We compared the risk of potential arrhythmia-related deaths for high doses of these selective serotonin reuptake inhibitors (SSRIs) to that for equivalent doses of fluoxetine, paroxetine, and sertraline. The Tennessee Medicaid retrospective cohort study included 54,220 persons 30-74 years of age without cancer or other life-threatening illness who were prescribed high-dose SSRIs from 1998 through 2011. The mean age was 47 years, and 76% were female. Demographic characteristics and comorbidity for individual SSRIs were comparable. Because arrhythmia-related deaths are typically sudden and occur outside the hospital, we analyzed out-of-hospital sudden unexpected death as well as sudden cardiac deaths, a more specific indicator of proarrhythmic effects. The adjusted risk of sudden unexpected death for citalopram did not differ significantly from that for the other SSRIs. The respective hazard ratios (HRs) for citalopram versus escitalopram, fluoxetine, paroxetine, and sertraline were 0.84 (95% CI, 0.40-1.75), 1.24 (95% CI, 0.75-2.05), 0.75 (95% CI, 0.45-1.24), and 1.53 (95% CI, 0.91-2.55). There were no significant differences for sudden cardiac death or all study deaths, nor were there significant differences among high-risk patients (≥ 60 years of age, upper quartile baseline cardiovascular risk). Escitalopram users had no significantly increased risk for any study end point. We found no evidence that risk of sudden unexpected death, sudden cardiac death, or total mortality for high-dose citalopram and escitalopram differed significantly from that for comparable doses of fluoxetine, paroxetine, and sertraline. © Copyright 2016 Physicians Postgraduate Press, Inc.

Radiation, nitric oxide and cellular death

International Nuclear Information System (INIS)

Dubner, D.; Perez, M.R. Del; Michelin, S.C.; Gisone, P.A.

1997-01-01

The mechanisms of radiation induced cellular death constitute an objective of research ever since the first biological effects of radiation were first observed. The explosion of information produced in the last 20 years calls for a careful analysis due to the apparent contradictory data related to the cellular system studied and the range of doses used. This review focuses on the role of the active oxygen species, in particular the nitric oxides, in its relevance as potential mediator of radiation induced cellular death

Sudden unexpected death in infancy: place and time of death.

Science.gov (United States)

Glasgow, J F T; Thompson, A J; Ingram, P J

2006-01-01

In recent years, many babies who die of Sudden Unexpected Death in Infancy (SUDI) in Northern Ireland are found dead in bed--i.e. co-sleeping--with an adult. In order to assess its frequency autopsy reports between April 1996 and August 2001 were reviewed and linked to temporal factors. The day and month of death, and the place where the baby was found were compared to a reference population of infant deaths between one week of age and the second birthday. Although the rate of SUDI was lower than the UK average, 43 cases of SUDI were identified, and two additional deaths with virtually identical autopsy findings that were attributed to asphyxia caused by suffocation due to overlaying. Thirty-two of the 45 (71%) were less than four months of age. In 30 of the 45 cases (67%) the history stated that the baby was bed sharing with others; 19 died sleeping in an adult bed, and 11 on a sofa or armchair. In 16 of the 30 (53%) there were at least two other people sharing the sleeping surface, and in one case, three. SUDI was twice as frequent at weekends (found dead Saturday-Monday mornings) compared to weekdays (psharing a place of sleep per se may not increase the risk of death, our findings may be linked to factors such as habitual smoking, consumption of alcohol or illicit drugs as reported in case-control studies. In advising parents on safer childcare practices, health professionals must be knowledgeable of current research and when, for example, giving advice on co-sleeping this needs to be person-specific cognisant of the risks within a household. New and better means of targeting such information needs to be researched if those with higher risk life-styles are to be positively influenced.

Comparison between worker-deaths in modern industries and in nuclear activities

International Nuclear Information System (INIS)

Failla, L.

1977-01-01

The statistical data related to the deaths of workers in modern industries, are examined. This analysis regards deaths by accident. It regards some particular countries in the world; these particular countries have been selected because their data are comparable. The analysis in modern industry regards different years. For the worker deaths caused by professional diseases, some particular considerations are made. Due to the fact that international statistics for worker deaths due to professional diseases don't exist, it was necessary to resort to the existing corollation between professional diseases and accidents in industry, to extrapolate, with some approximation, the number of deaths due to professional disease. Using these considerations it is possible to find some interesting data. The statistics are examined in order to compare them with those pertinent to nuclear energy. With regard to this topic, the mortal-risks from radiation exposures are considered. The philosophies used in modern industry and in the nuclear energy field, are compared. A special discussion is carried on about ICRP conception, expressed in Publication 22: 'Implications of Commission Recommendations that Doses be kept as Low as Readily Achievable'

Comparison between worker-deaths in modern industries and in nuclear activities

International Nuclear Information System (INIS)

Failla, L.

1977-01-01

The author examines the statistical data related to the deaths of workers in modern industries. This analysis regards deaths by accident. It regards some particular countries in the world; these particular countries have been selected because their data are comparable. The analysis in modern industry regards different years (1965 - 1974). For the worker deaths caused by professional diseases, some particular considerations are made in this paper. Due to the fact that international statistics for worker deaths due to professional diseases don't exist, it was necessary to resort to the existing correllation between professional diseases and accidents in industry, to extrapolate, with some approximation, the number of deaths due to professional disease. Using these considerations it is possible to find some interesting data. Then the author examines the statistics in order to compare them with those pertinent to nuclear energy. With regard to this topic, the author considers the mortal-risks from radiation exposures. Then the author compares the philosophy that is used in modern industry and in the nuclear energy field. A special discussion is carried on about ICRP conception, expressed in Publication 22; ''Implications of Commission Recommendations that Doses be kept as Low as Readily Achievable''

Death from a driverless vehicle.

Science.gov (United States)

Das, Siddhartha; Menezes, Ritesh G

2018-03-01

Road traffic accidents are a major cause of fatalities around the world, and a number of deaths are caused by moving traffic on public roads. Deaths from vehicles that are off the highway may be called non-traffic fatalities which can be due to a vehicle reversing, carbon monoxide poisoning, weather-induced over-heating inside the vehicle and electric windows. Children (and animals) are the usual victims. We report a case from India where a man was found lying dead by the roadside with a lorry nearby. The autopsy findings indicated that he had been run over, but as there was no history of a vehicular collision and with no eyewitnesses, the investigators were unsure of the probable sequence of events that led to his death. The autopsy findings, history, circumstantial evidence and chemical analysis enabled us to work out what had happened.

Prolonged reorganization of thiol-capped Au nanoparticles layered structures

Directory of Open Access Journals (Sweden)

Sarathi Kundu

2013-09-01

Full Text Available Prolonged reorganization behaviour of mono-, di-, tri- and multi-layer films of Au nanoparticles prepared by Langmuir-Blodgett method on hydrophobic Si(001 substrates have been studied by using X-ray scattering techniques. Out-of-plane study shows that although at the initial stage the reorganization occurs through the compaction of the films keeping the layered structure unchanged but finally all layered structures modify to monolayer structure. Due to this reorganization the Au density increases within the nanometer thick films. In-plane study shows that inside the reorganized films Au nanoparticles are distributed randomly and the particle size modifies as the metallic core of Au nanoparticles coalesces.

The bereavement experience of adolescents and early young adults with cancer: Peer and parental loss due to death is associated with increased risk of adverse psychological outcomes.

Directory of Open Access Journals (Sweden)

Liza-Marie Johnson

Full Text Available Adolescents commonly experience loss due to death, and perceived closeness to the deceased can often increase the intensity of bereavement. Adolescents and early young adult (AeYA oncology patients may recall previous losses or experience new losses, possibly of other children with cancer, while coping with their own increased risk of mortality. The bereavement experiences of AeYA patients are not well described in the literature.This analysis of bereavement sought to describe the prevalence and types of losses, the support following a death, and the impact of loss on AeYAs aged 13-21 years with malignant disease (or a hematologic disorder requiring allogeneic transplant. Participants were receiving active oncologic therapy or had completed therapy within the past 3 years. Participants completed a bereavement questionnaire and inventories on depression, anxiety, and somatization. The cross-sectional study enrolled 153 AeYAs (95% participation, most (88% of whom had experienced a loss due to death. The most commonly reported losses were of a grandparent (58% or friend (37%. Peer deaths were predominantly cancer related (66%. Many participants (39% self-identified a loss as "very significant." As loss significance increased, AeYAs were more likely to report that it had changed their life "a lot/enormously" (P<0.0001, that they were grieving "slowly or never got over it" (P<0.0001, and that they felt a need for more professional help (P = 0.026. Peer loss was associated with increased risk of adverse psychological outcomes (P = 0.029, as was parental loss (P = 0.018.Most AeYAs with serious illness experience the grief process as slow or ongoing. Peer or parental loss was associated with increased risk of negative mental health outcomes. Given the high prevalence of peer loss, screening for bereavement problems is warranted in AeYAs with cancer, and further research on grief and bereavement is needed in AeYAs with serious illness.

Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation.

Science.gov (United States)

Oliveira, Ana Carolina Martins de; Friche, Amélia Augusta de Lima; Salomão, Marina Silva; Bougo, Graziela Chamarelli; Vicente, Laélia Cristina Caseiro

2017-09-13

Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia. To verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit. This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the Speech Therapist assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval. The prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence of dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold. Patients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients. Copyright © 2017. Published by Elsevier Editora Ltda.

Inducible cell death in plant immunity

DEFF Research Database (Denmark)

Hofius, Daniel; Tsitsigiannis, Dimitrios I; Jones, Jonathan D G

2006-01-01

Programmed cell death (PCD) occurs during vegetative and reproductive plant growth, as typified by autumnal leaf senescence and the terminal differentiation of the endosperm of cereals which provide our major source of food. PCD also occurs in response to environmental stress and pathogen attack......, and these inducible PCD forms are intensively studied due their experimental tractability. In general, evidence exists for plant cell death pathways which have similarities to the apoptotic, autophagic and necrotic forms described in yeast and metazoans. Recent research aiming to understand these pathways...

Assessment of Muscle Fatigue Associated with Prolonged Standing in the Workplace

Science.gov (United States)

Omar, Abdul Rahman; Saman, Alias Mohd; Othman, Ibrahim

2012-01-01

Objectives The objectives of this study were to determine the psychological fatigue and analyze muscle activity of production workers who are performing processes jobs while standing for prolonged time periods. Methods The psychological fatigue experienced by the workers was obtained through questionnaire surveys. Meanwhile, muscle activity has been analyzed using surface electromyography (sEMG) measurement. Lower extremities muscles include: erector spinae, tibialis anterior, and gastrocnemius were concurrently measured for more than five hours of standing. Twenty male production workers in a metal stamping company participated as subjects in this study. The subjects were required to undergo questionnaire surveys and sEMG measurement. Results Results of the questionnaire surveys found that all subjects experienced psychological fatigue due to prolonged standing jobs. Similarly, muscle fatigue has been identified through sEMG measurement. Based on the non-parametric statistical test using the Spearman's rank order correlation, the left erector spinae obtained a moderate positive correlation and statistically significant (rs = 0.552, p fatigue and to muscle fatigue among the production workers. PMID:22953228

Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

Directory of Open Access Journals (Sweden)

Chung-Lan Kao

2006-11-01

Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

Pharmacometabolomic approach to predict QT prolongation in guinea pigs.

Directory of Open Access Journals (Sweden)

Jeonghyeon Park

Full Text Available Drug-induced torsades de pointes (TdP, a life-threatening arrhythmia associated with prolongation of the QT interval, has been a significant reason for withdrawal of several medicines from the market. Prolongation of the QT interval is considered as the best biomarker for predicting the torsadogenic risk of a new chemical entity. Because of the difficulty assessing the risk for TdP during drug development, we evaluated the metabolic phenotype for predicting QT prolongation induced by sparfloxacin, and elucidated the metabolic pathway related to the QT prolongation. We performed electrocardiography analysis and liquid chromatography-mass spectroscopy-based metabolic profiling of plasma samples obtained from 15 guinea pigs after administration of sparfloxacin at doses of 33.3, 100, and 300 mg/kg. Principal component analysis and partial least squares modelling were conducted to select the metabolites that substantially contributed to the prediction of QT prolongation. QTc increased significantly with increasing dose (r = 0.93. From the PLS analysis, the key metabolites that showed the highest variable importance in the projection values (>1.5 were selected, identified, and used to determine the metabolic network. In particular, cytidine-5'-diphosphate (CDP, deoxycorticosterone, L-aspartic acid and stearic acid were found to be final metabolomic phenotypes for the prediction of QT prolongation. Metabolomic phenotypes for predicting drug-induced QT prolongation of sparfloxacin were developed and can be applied to cardiac toxicity screening of other drugs. In addition, this integrative pharmacometabolomic approach would serve as a good tool for predicting pharmacodynamic or toxicological effects caused by changes in dose.

Births and deaths including fetal deaths

Data.gov (United States)

U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

Sport and sudden death in children

Directory of Open Access Journals (Sweden)

L. M. Makarov

2017-01-01

Full Text Available The article presents data on contemporary views of the prevalence, causes, circumstances of sudden cardiac death, and its prevention measures in children and adolescents during sports activity. It notes a difficulty in defining the epidemiology of the above condition because the data are primarily based upon mass media news coverage. The incidence of sudden cardiac death is approximately 1 per 100,000 young athletes; more than 90% boys die. The sports, during which sudden cardiac death often occurs, include (both American and European football, basketball, and hockey. Sudden cardiac death due to cоmmоtio cordis (life-threatening cardiac arrhythmias resulting from a blow with a blunt instrument to the area of the heart during the vulnerable phase of the cardiac cycle is considered separately. Children who die suddenly during sports are frequently detected to have hypertrophic cardiomyopathy or myocarditis; but no changes are found in more than 50% of cases at autopsy, which is suggestive of primary arrhythmogenic death. The basis for prevention is the early detection of diseases that can cause sudden death during sports, regular examination, knowledge of ECG characteristics in athletes, and first aid techniques, including the use of automated external defibrillators.

Staging Death, Translating Death, Rehearsing Death: A Photographer’s Apprenticeship in Dying

Directory of Open Access Journals (Sweden)

Daniela Fargione

2010-10-01

Full Text Available The preponderance of death imagery in the mass media and a recent interest of photography in the practice of death suggest the need to reevaluate our approach to death and dying, especially when violence is involved. This essay is a case study of History of Violence, Claudio Cravero's last photographic project. His collection of "portraits" reproduce apparent dead bodies, mostly attacked in their own domestic spheres, but neither the perpetrator of death (a mysterious murderer?, nor the weapon used (an omnipresent knife, should be considered as main focal points of the artist's inquiry. The undoubtful protagonist of these photographs, instead, is the light, that illuminates fear: not of death itself, rather of the obnoxious indifference to it, as the result of generalized death imagery saturation.     The staged apparent death displayed in Cravero's photographs serve both as a memento mori and as a strategy to come to terms with the idea of death. In short, it is an apprentship in dying through a domesticating translation practice. Eventually, Cravero's History of Violence offers a complex reflection on the interplay between each individual story and macrolevel social History, thus providing some hypotheses of where violence and death fit in that odd geometry of time and space that we call life.

Optimal foetal growth in the reduction of learning and behaviour disorder and prevention of sudden infant death (SIDS) after the first month.

Science.gov (United States)

Saugstad, L F

1997-09-01

A theory is presented that a diet low in polyunsaturated fatty acids (PUFA) in the third trimester of pregnancy may delay myelination and brain maturation. This may underpin learning and behaviour disorders and sudden infant death (SIDS) after the first month, conditions that are associated with lower than average birthweight. Epidemiological evidence is reviewed showing an inverse relation between the proportion of heavy newborns (> 3500 g) and infant mortality rate. Some countries with a lower proportion of heavy newborns despite equally high standards of living and medical care have higher post-neonatal death rates. The higher rates are solely due to SIDS which has a peak mortality within 80-100 days. It is hypothesised that as this is a time when myelination peaks, SIDS may be due to maturational delay. Evidence of subtle CNS changes in brainstem structures and in the neuromuscular system supports an instability in brainstem control systems. Moderate iatrogenic dietary restriction predominates today, but a rising number of women favour a low-caloric low-fat diet especially in the third trimester when the foetus is most susceptible. This may lead to a depressed birthweight, delayed somatic growth and neuronal maturation, such as is observed in SIDS victims. The majority exposed to suboptimal conditions survive, but a few suffer SIDS; confirming post-neonatal susceptibility. Many, especially males, present minor CNS signs and learning/behaviour disorders that could be the sequelae of repeated hypoxic episodes, such as recorded in more than 80% of SIDS victims. To reduce learning/behaviour disorders and prevent death from SIDS after the first month, it is necessary to ensure optimal development by promoting foetal growth. It is advised to avoid unnecessary dieting and to favour a diet high in PUFAs, thus prolonging pregnancy and so increasing birthweight.

Factors that prolong the 'postmortem interval until finding' (PMI-f) among community-dwelling elderly individuals in Japan: analysis of registration data.

Science.gov (United States)

Ito, Tomoko; Tamiya, Nanako; Takahashi, Hideto; Yamazaki, Kentaro; Yamamoto, Hideki; Sakano, Shoji; Kashiwagi, Masayo; Miyaishi, Satoru

2012-01-01

To clarify the factors affecting 'postmortem interval until finding' (PMI-f) among elderly unexpected death cases. Cross-sectional study. All area of Yamagata prefecture in Japan. Entering subjects were 5675 elderly cases with age of ≥65 years selected from all 9002 cases of unexpected death from 2002 to 2007 in Yamagata prefecture between 2002 and 2007. Our final study subjects consisted of 3387 cases sampled with several criteria to assess the factors to prolong PMI-f. The outcome was the postmortem interval until finding (PMI-f) as the time from death until finding the body which we defined in this study. 'Living alone' showed the highest adjusted HR (3.73, 95% CI 3.37 to 4.13), also 'unnatural death' (1.50, 1.28 to 1.75), 'found at own home' (1.37, 1.22 to 1.55) and 'younger subjects' (0.99, 0.98 to 0.99). In the model including interactions with the household situation, we found 'male subjects living alone' and 'female subjects living with family' tended to be found later. PMI-f is an effective outcome for quantitative analyses of risk of bodies left. To prevent the elderly dead bodies left for long time, it is necessary to keep regular home-based contact with elderly individuals living alone.

RD50 Prolongation Request 2018

CERN Document Server

Casse, Gianluigi

2018-01-01

With this document, we request the prolongation of the CERN RD50 research program for 5 years. A very brief historical review of the RD50 research program since the RD50 project approval by the Research Board in the year 2002 is presented and the biggest RD50 achievements are highlighted. The present composition of the collaboration, its organizational structure, and the research methodology are described. The role of RD50 in the present various upgrade and research programs of the LHC Experiments community is given and the overall work plan explained. Finally, a detailed 5-years work program with precise milestones and deliverables for the various research activities is presented. We conclude with our prolongation request towards the LHCC.

Cardiovascular death and manic-depressive psychosis

DEFF Research Database (Denmark)

Weeke, A; Juel, K; Vaeth, M

2013-01-01

In order to study if tricyclic antidepressant drugs (TCA) in therapeutic doses increase the risk of death due to cardiovascular causes, the relative mortality from cardiovascular diseases was studied in two large groups of first hospitalized manic-depressive patients, one from the TCA era...... to the general population. Among 1133 such cases admitted between 1950 and 1956, the rate was 1.87. Our findings do not support the hypothesis that TCA contribute to the cardiovascular mortality in manic-depressives and even support suggestions that TCA treatment may lower the risk of death by cardiovascular...

[Death of Napoleon Bonaparte].

Science.gov (United States)

Camici, M

2003-06-01

The causa mortis of Napoleon Bonaparte has been vexata quaestio for a long time. The author tries to outline a picture of Napoleon from a sanitary point of view. From the report of doctor Francesco Antonmarchi who performed the autopsy, the author tries to understans the cause of death: gastric perforation due to malignant ulcer and subsequent peritonitis with pulmonary tubercolosis.

Protection of the public in situations of prolonged radiation exposure. The application of the Commission's system of radiological protection to controllable radiation exposure due to natural sources and long-lived radioactive residues.

Science.gov (United States)

1999-01-01

This report provides guidance on the application of the ICRP system of radiological protection to prolonged exposure situations affecting members of the public. It addresses the general application of the Commission's system to the control of prolonged exposures resulting from practices and to the undertaking of interventions in prolonged exposure situations. Additionally, it provides recommendations on generic reference levels for such interventions. The report also considers some specific situations and discusses a number of issues that have been of concern, namely: natural radiation sources that may give rise to high doses; the restoration and rehabilitation of sites where human activities involving radioactive substances have been carried out; the return to 'normality' following an accident that has released radioactive substances to the environment; and the global marketing of commodities for public consumption that contain radioactive substances. Annexes provide some examples of prolonged exposure situations and discuss the radiological protection quantities, radiation-induced health effects and aspects of the Commission's system of radiological protection relevant to prolonged exposure. Quantitative recommendations for prolonged exposures are provided in the report. They must be interpreted with extreme caution; Chapters 4 and 5 stress the upper bound nature of the following values: Generic reference levels for intervention, in terms of existing total annual doses, are given as < approximately 100 mSv, above which intervention is almost always justifiable (situations for which the annual dose threshold for deterministic effects in relevant organs is exceeded will almost always require intervention), and < approximately 10 mSv, below which intervention is not likely to be justifiable (and above which it may be necessary). Intervention exemption levels for commodities, especially building materials, are expressed as an additional annual dose of approximately 1

Fermionic covariant prolongation structure theory for supernonlinear evolution equation

International Nuclear Information System (INIS)

Cheng Jipeng; Wang Shikun; Wu Ke; Zhao Weizhong

2010-01-01

We investigate the superprincipal bundle and its associated superbundle. The super(nonlinear)connection on the superfiber bundle is constructed. Then by means of the connection theory, we establish the fermionic covariant prolongation structure theory of the supernonlinear evolution equation. In this geometry theory, the fermionic covariant fundamental equations determining the prolongation structure are presented. As an example, the supernonlinear Schroedinger equation is analyzed in the framework of this fermionic covariant prolongation structure theory. We obtain its Lax pairs and Baecklund transformation.

Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan.

Science.gov (United States)

Katsuragi, Shinji; Tanaka, Hiroaki; Hasegawa, Junichi; Nakamura, Masamitsu; Kanayama, Naohiro; Nakata, Masahiko; Murakoshi, Takeshi; Yoshimatsu, Jun; Osato, Kazuhiro; Tanaka, Kayo; Sekizawa, Akihiko; Ishiwata, Isamu; Ikeda, Tomoaki

2018-04-26

Hypertensive disorder of pregnancy (HDP) is a major cause of maternal death. The goal of this study was to investigate factors associated with maternal death due to HDP. HDP-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor and Welfare from 2010 to 2015 were examined. Out of 47 cases of HDP, 30 were identified as the major cause of maternal death. The median maternal age was 34 years (range 24-45) and the mortality in women aged ≥40 years was seven times higher that than in women aged deaths in Japan. Mothers aged ≥40 years are most at risk for HDP-related maternal death. Major concerns for preventabilities were late hospitalization, maternal transportation, and termination of pregnancy for term or near-term HDP. Regular vital checks and prompt lowering of BP were lacked during labor in most cases. HELLP syndrome should be managed at a general hospital with sufficient medical resources.

Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins.

Science.gov (United States)

Arora, Satyam; Doda, Veena; Maria, Arti; Kotwal, Urvershi; Goyal, Saurabh

2015-01-01

Allo-anti-M often has an immunoglobulin G (IgG) component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN) due to maternal alloimmunization. Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2) had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia) due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.

Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins

Directory of Open Access Journals (Sweden)

Satyam Arora

2015-01-01

Full Text Available Allo-anti-M often has an immunoglobulin G (IgG component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN due to maternal alloimmunization. Direct antiglobulin test (DAT, antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2 had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.

[Causes of death of German refugee children in 1945].

Science.gov (United States)

Lylloff, K

2000-02-28

In the last months of the second World War, 250,000 German refugees landed in Denmark. A third of them were children under the age of 15. Seven thousand German refugee children under the age of five died in Denmark in 1945. Using birth certificates and death certificates from the Danish national archives and burial lists from the German refugee cemetaries I have collected data to reveal causes of death, age distributions and time of the deaths of the 7000 fatal cases among children under the age of five. Three thousand children under the age of one, 2000 children one year old and 2000 children 2-4 years old died. Most of them died just before and after the German surrender, but many died in the months following the German surrender. The infant mortality was extremely high all during 1945. The infants died from diseases due to malnutrition, but the older the children the more likely the causes of death were due to infectious diseases such as pneumonia, measles, diphtheria and gastroenteritis.

[Brain death in children--how to deal with the parents?].

Science.gov (United States)

Schindler, Nicola; Vagts, Dierk

2008-07-01

For parents the death of children is hard to bear and to accept. In situations where a brain death needs to be diagnosed, the psychological stress for parents who lose their child is aggravated due to a mostly sudden and unprepared confrontation with this situation. The rationality to accept the death of a their child is opposed by the hope for recovery as long as the children are "warm and dead" instead of "cold and dead" due to the maintenance of cardiac circulation. In Germany in this situation, after diagnosing the brain death, doctors are forced by legislation to ask the parents to agree for organ donation. However, to our knowledge, no literature is available how doctors should conduct such an important conversation to the parents. This manuscript tries to give some hints for conducting a conversation from the psychological background of mourning and from our own experience gained during the last 5 years.

Correlation between relative rates of hospital treatment or death due to ischaemic heart disease (IHD) and of IHD-related medication among socio-occupational and economic activities groups in Denmark, 1996-2005

DEFF Research Database (Denmark)

Hannerz, Harald; Dalhoff, Kim; Burr, Hermann

2014-01-01

Standardised Hazard Ratios (SHR) for hospital treatment or death due to IHD and SHR for purchase of prescriptions for medicine that may prevent IHD from (re)occurring, among socio-occupational and economic activities groups in Denmark. The SHR were based on a 10-year prospective follow-up of 2 million people.......74 for the economic activities groups). We observed, however, one markedly contradictive result; the industrial group entitled 'general practitioner, dentists etc.' was associated both with significantly high rates of medicine usage (SHR = 1.15, 95% CI: 1.12-1.19) and significantly low rates of hospital treatment...... or death due to IHD (SHR = 0.80, 95% CI: 0.71-0.91). CONCLUSION: Apart from a few caveats, the strong correlations obtained in the present study signify that purchase of a prescription for IHD-related medication is a usable risk indicator for IHD in the working population of Denmark. The usage of medicine...

Association of green tea consumption with mortality due to all causes and major causes of death in a Japanese population: the Japan Public Health Center-based Prospective Study (JPHC Study).

Science.gov (United States)

Saito, Eiko; Inoue, Manami; Sawada, Norie; Shimazu, Taichi; Yamaji, Taiki; Iwasaki, Motoki; Sasazuki, Shizuka; Noda, Mitsuhiko; Iso, Hiroyasu; Tsugane, Shoichiro

2015-07-01

We examined the association between green tea consumption and mortality due to all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale population-based cohort study in Japan. We studied 90,914 Japanese (aged between 40 and 69 years) recruited between 1990 and 1994. After 18.7 years of follow-up, 12,874 deaths were reported. The association between green tea consumption and risk of all causes and major causes of mortality was assessed using the Cox proportional hazards regression model with adjustment for potential confounders. Hazard ratios for all-cause mortality among men who consumed green tea compared with those who drank less than 1 cup/day were 0.96 (0.89-1.03) for 1-2 cups/day, 0.88 (0.82-0.95) for 3-4 cups/day, and 0.87 (0.81-0.94) for more than 5 cups/day (P for trend death in Japan. Copyright © 2015 Elsevier Inc. All rights reserved.

Profile of sudden death in an adult population (1999-2008).

LENUS (Irish Health Repository)

Downes, M R

2010-06-01

Sudden death is the sudden and unexpected death of an individual within 24 hours of symptom onset. The vast majority of these cases are found, at autopsy, to be due to underlying ischaemic cardiac disease. We retrospectively reviewed all adult post mortems performed at Beaumont Hospital over a decade (1999-2008). Our aim was to identify all sudden death cases (natural and accidental) and subclassify them according to age profile and organ system involved. We identified 1230 sudden death cases in the review period with 775 (63%) deaths attributable to ischaemic heart disease. The rate of sudden death remained constant over the decade with 663 (54%) deaths occurring in the first five years. Our negative autopsy rate was 2.8% corresponding to 35 cases. This is the first Irish study to retrospectively review all adult sudden deaths within a defined catchment area and analyse them as outlined above.

In vitro chemo-sensitivity assay guided chemotherapy is associated with prolonged overall survival in cancer patients.

Science.gov (United States)

Udelnow, Andrej; Schönfęlder, Manfred; Würl, Peter; Halloul, Zuhir; Meyer, Frank; Lippert, Hans; Mroczkowski, Paweł

2013-06-01

The overall survival (OS) of patients suffering From various tumour entities was correlated with the results of in vitro-chemosensitivity assay (CSA) of the in vivo applied drugs. Tumour specimen (n=611) were dissected in 514 patients and incubated for primary tumour cell culture. The histocytological regression assay was performed 5 days after adding chemotherapeutic substances to the cell cultures. n=329 patients undergoing chemotherapy were included in the in vitro/in vivo associations. OS was assessed and in vitro response groups compared using survival analysis. Furthermore Cox-regression analysis was performed on OS including CSA, age, TNM classification and treatment course. The growth rate of the primary was 73-96% depending on tumour entity. The in-vitro response rate varied with histology and drugs (e.g. 8-18% for methotrexate and 33-83% for epirubicine). OS was significantly prolonged for patients treated with in vitro effective drugs compared to empiric therapy (log-rank-test, p=0.0435). Cox-regression revealed that application of in vitro effective drugs, residual tumour and postoperative radiotherapy determined the death risk independently. When patients were treated with drugs effective in our CSA, OS was significantly prolonged compared to empiric therapy. CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.

Neonatal Death

Science.gov (United States)

... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...

Death rattle: prevalence, prevention and treatment.

Science.gov (United States)

Wildiers, Hans; Menten, Johan

2002-04-01

A retrospective analysis was performed to study the occurrence and treatment of death rattle (DR) in 107 consecutive dying patients on the palliative care unit of the University Hospital Leuven. The incidence of DR (23%) is lower than reported in literature, possibly due to low hydration. We found 2 types of rattle: "Real DR" responds generally very well to anticholinergic therapy, and is probably caused by non-expectorated secretions. "Pseudo DR" is poorly responsive to therapy and is probably caused by bronchial secretions due to pulmonary pathology, such as infection, tumor, fluid retention, or aspiration. Rattle disappeared in >90% for the patients with real DR. Real DR is a strong predictor for death, and 76% (19/25) died within 48h after onset. Administration of subcutaneous hyoscine hydrobromide, as a bolus or continuous infusion, is effective therapy for real DR and is comfortable for the patient and caregivers.

Torsades de Pointes associated with QT prolongation after catheter ablation of paroxysmal atrial fibrillation

Directory of Open Access Journals (Sweden)

Yae Min Park

2017-09-01

Full Text Available A 79-year-old woman who underwent catheter ablation for paroxysmal atrial fibrillation presented with Torsades de Pointes (TdP. Aggravation of prolonged QT interval which is most likely due to neural modulation by catheter ablation, played major role in the initiation of TdP. The patient was successfully treated with isoproterenol during acute stage and discharged after stabilization without implantation of permanent pacemaker or implantable cardioverter defibrillator.

Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome.

Science.gov (United States)

Sugaya, Nagisa; Izawa, Shuhei; Saito, Keisuke; Shirotsuki, Kentaro; Nomura, Shinobu; Shimada, Hironori

2015-01-01

The purpose of this study was to investigate the effect of prolonged stress on the salivary adrenal hormones (cortisol, dehydroepiandrosterone [DHEA], DHEA-sulfate [DHEA-S]) of individuals with irritable bowel syndrome (IBS). The participants were female college students, including 10 with IBS and 16 without IBS (control group), who were scheduled for a 2-week teaching practice at a kindergarten. Participants were asked to collect saliva for determining adrenal hormones immediately and 30 min after awakening and before sleep, 2 weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice. Regarding cortisol/DHEA ratio, significantly increased levels were found during the first week of the practice, and a significant interaction between group and time was found; the ratio at 30 min after awakening in the IBS group was higher than that in the control group. For the other adrenal hormone indexes, no significant differences due to the presence of IBS were found. Individuals with IBS showed an elevated cortisol/DHEA ratio after awakening compared with individuals without IBS, and the elevated ratio peaked under the prolonged stress. The present study suggests that the cortisol effect is dominant in individuals with IBS under prolonged stress.

Death Cafe.

Science.gov (United States)

Miles, Lizzy; Corr, Charles A

2017-06-01

This article explains the meaning of the phrase Death Cafe and describes what typically occurs at a Death Cafe gathering. The article traces the history of the Death Cafe movement, explores some reasons why people take part in a Death Cafe gathering, and gives examples of what individuals think they might derive from their participation. In addition, this article notes similarities between the Death Cafe movement and three other developments in the field of death, dying, and bereavement. Finally, this article identifies two provisional lessons that can be drawn from Death Cafe gatherings and the Death Cafe movement itself.

Necrotizing pneumonia after pharyngitis due to fusobacterium necrophorum

Energy Technology Data Exchange (ETDEWEB)

Kleinman, P K; Flowers, R A

1984-01-01

A case of necrotizing pneumonia secordary to Fusobacterium necrophorum is reported. This anaerobic infection commonly originates in the upper respiratory tract and is often accompanied by multiple system disease due to hematogeneous seeding. When the lungs are involved, diffuse necrotizing pneumonia with pleural effusions and cavitation result. The course is prolonged, and the diagnosis is frequently delayed. With appropriate antibiotics, the prognosis is good.

Effects of specific and prolonged expression of zebrafish growth factors, Fgf2 and Lif in primordial germ cells in vivo

Energy Technology Data Exchange (ETDEWEB)

Wong, Ten-Tsao, E-mail: wong20@purdue.edu [Department of Animal Sciences, Purdue University, 901 W. State Street, West Lafayette, IN 47907 (United States); Collodi, Paul [Department of Animal Sciences, Purdue University, 901 W. State Street, West Lafayette, IN 47907 (United States)

2013-01-04

Highlights: Black-Right-Pointing-Pointer We discovered that nanos3 3 Prime UTR prolonged PGC-specific protein expression up to 26 days. Black-Right-Pointing-Pointer Expression of Fgf2 in PGCs significantly increased PGC number at later developmental stages. Black-Right-Pointing-Pointer Expression of Lif in PGCs resulted in a significant disruption of PGC migration. Black-Right-Pointing-Pointer Lif illicited its effect on PGC migration through Lif receptor a. Black-Right-Pointing-Pointer Our approach could be used to achieve prolonged PGC-specific expression of other proteins. -- Abstract: Primordial germ cells (PGCs), specified early in development, proliferate and migrate to the developing gonad before sexual differentiation occurs in the embryo and eventually give rise to spermatogonia or oogonia. In this study, we discovered that nanos3 3 Prime UTR, a common method used to label PGCs, not only directed PGC-specific expression of DsRed but also prolonged this expression up to 26 days post fertilization (dpf) when DsRed-nanos3 3 Prime UTR hybrid mRNAs were introduced into 1- to 2-cell-stage embryos. As such, we employed this knowledge to express zebrafish leukemia inhibitory factor (Lif), basic fibroblast growth factor (Fgf2) and bone morphogenetic protein 4 (Bmp4) in the PGCs and evaluate their effects on PGC development in vivo for over a period of 3 weeks. The results show that expression of Fgf2 significantly increased PGC number at 14- and 21-dpf while Bmp4 resulted in severe ventralization and death of the embryos by 3 days. Expression of Lif resulted in a significant disruption of PGC migration. Mopholino knockdown experiments indicated that Lif illicited its effect on PGC migration through Lif receptor a (Lifra) but not Lifrb. The general approach described in this study could be used to achieve prolonged PGC-specific expression of other proteins to investigate their roles in germ cell and gonad development. The results also indicate that zebrafish PGCs

Detecting drug-induced prolongation of the QRS complex: New insights for cardiac safety assessment

Energy Technology Data Exchange (ETDEWEB)

Cros, C., E-mail: caroline.cros@hotmail.co.uk [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Skinner, M., E-mail: Matthew.Skinner@astrazeneca.com [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Moors, J. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Lainee, P. [Sanofi-Aventis R and D, 371, rue du Pr Joseph Blayac, 34184 Montpellier Cedex 04 (France); Valentin, J.P. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom)

2012-12-01

Background: Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I{sub Na}) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I{sub Na}, this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. Methods: Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1 h period from 1 h pre-dose to 5 h post-dose. Results: Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E{sub max} 13% and 20% respectively, P < 0.01–0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of + 0.7 ± 0.5 ms (quinidine, NS), + 1.8 ± 0.8 ms (mexiletine, P < 0.05) and + 2.8 ± 0.8 ms (flecainide, P < 0.01) (calculated as QRS at basal HR-QRS at high HR). Conclusion: Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function. -- Highlights: ► We aimed to improve detection of drug-induced QRS prolongation in safety screening. ► We used telemetered dogs to test class I antiarrhythmics at low and high heart rate. ► At low heart rate only quinidine and flecainide induced an increase in QRS duration. ► At high heart rate the effects of two

Detecting drug-induced prolongation of the QRS complex: New insights for cardiac safety assessment

International Nuclear Information System (INIS)

Cros, C.; Skinner, M.; Moors, J.; Lainee, P.; Valentin, J.P.

2012-01-01

Background: Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I Na ) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I Na , this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. Methods: Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1 h period from 1 h pre-dose to 5 h post-dose. Results: Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E max 13% and 20% respectively, P < 0.01–0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of + 0.7 ± 0.5 ms (quinidine, NS), + 1.8 ± 0.8 ms (mexiletine, P < 0.05) and + 2.8 ± 0.8 ms (flecainide, P < 0.01) (calculated as QRS at basal HR-QRS at high HR). Conclusion: Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function. -- Highlights: ► We aimed to improve detection of drug-induced QRS prolongation in safety screening. ► We used telemetered dogs to test class I antiarrhythmics at low and high heart rate. ► At low heart rate only quinidine and flecainide induced an increase in QRS duration. ► At high heart rate the effects of two out of three

Gastrointestinal causes of sudden unexpected death: A review.

Science.gov (United States)

Menezes, Ritesh G; Ahmed, Saba; Pasha, Syed Bilal; Hussain, Syed Ather; Fatima, Huda; Kharoshah, Magdy A; Madadin, Mohammed

2018-01-01

Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.

Histone Deacetylase Inhibitors Prolong Cardiac Repolarization through Transcriptional Mechanisms.

Science.gov (United States)

Spence, Stan; Deurinck, Mark; Ju, Haisong; Traebert, Martin; McLean, LeeAnne; Marlowe, Jennifer; Emotte, Corinne; Tritto, Elaine; Tseng, Min; Shultz, Michael; Friedrichs, Gregory S

2016-09-01

Histone deacetylase (HDAC) inhibitors are an emerging class of anticancer agents that modify gene expression by altering the acetylation status of lysine residues of histone proteins, thereby inducing transcription, cell cycle arrest, differentiation, and cell death or apoptosis of cancer cells. In the clinical setting, treatment with HDAC inhibitors has been associated with delayed cardiac repolarization and in rare instances a lethal ventricular tachyarrhythmia known as torsades de pointes. The mechanism(s) of HDAC inhibitor-induced effects on cardiac repolarization is unknown. We demonstrate that administration of structurally diverse HDAC inhibitors to dogs causes delayed but persistent increases in the heart rate corrected QT interval (QTc), an in vivo measure of cardiac repolarization, at timepoints far removed from the Tmax for parent drug and metabolites. Transcriptional profiling of ventricular myocardium from dogs treated with various HDAC inhibitors demonstrated effects on genes involved in protein trafficking, scaffolding and insertion of various ion channels into the cell membrane as well as genes for specific ion channel subunits involved in cardiac repolarization. Extensive in vitro ion channel profiling of various structural classes of HDAC inhibitors (and their major metabolites) by binding and acute patch clamp assays failed to show any consistent correlations with direct ion channel blockade. Drug-induced rescue of an intracellular trafficking-deficient mutant potassium ion channel, hERG (G601S), and decreased maturation (glycosylation) of wild-type hERG expressed by CHO cells in vitro correlated with prolongation of QTc intervals observed in vivo The results suggest that HDAC inhibitor-induced prolongation of cardiac repolarization may be mediated in part by transcriptional changes of genes required for ion channel trafficking and localization to the sarcolemma. These data have broad implications for the development of these drug classes and

Ionizing radiation-induced cell death

International Nuclear Information System (INIS)

Szumiel, I.

1994-01-01

Selected aspects of radiation-induced cell death, connected with signal transduction pathways are reviewed. Cell death is defined as insufficiency of the cellular signal transducing system to maintain the cell's physiological functions. The insufficiency may be due to impaired signal reception and/or transduction, lack or erroneous transcription activation, and eventual cellular ''misexpression'' of the signal. The molecular basis of this insufficiency would be damage to genomic (but also other cellular) structures and closing of specific signalling pathways or opening of others (like those leading to apoptosis). I describe experimental data that suggest an important role of RAS/NFI and p53/p105 Rb proteins in cell cycle control-coupled responses to DNA damage. (Author)

A computer case definition for sudden cardiac death.

Science.gov (United States)

Chung, Cecilia P; Murray, Katherine T; Stein, C Michael; Hall, Kathi; Ray, Wayne A

2010-06-01

To facilitate studies of medications and sudden cardiac death, we developed and validated a computer case definition for these deaths. The study of community dwelling Tennessee Medicaid enrollees 30-74 years of age utilized a linked database with Medicaid inpatient/outpatient files, state death certificate files, and a state 'all-payers' hospital discharge file. The computerized case definition was developed from a retrospective cohort study of sudden cardiac deaths occurring between 1990 and 1993. Medical records for 926 potential cases had been adjudicated for this study to determine if they met the clinical definition for sudden cardiac death occurring in the community and were likely to be due to ventricular tachyarrhythmias. The computerized case definition included deaths with (1) no evidence of a terminal hospital admission/nursing home stay in any of the data sources; (2) an underlying cause of death code consistent with sudden cardiac death; and (3) no terminal procedures inconsistent with unresuscitated cardiac arrest. This definition was validated in an independent sample of 174 adjudicated deaths occurring between 1994 and 2005. The positive predictive value of the computer case definition was 86.0% in the development sample and 86.8% in the validation sample. The positive predictive value did not vary materially for deaths coded according to the ICO-9 (1994-1998, positive predictive value = 85.1%) or ICD-10 (1999-2005, 87.4%) systems. A computerized Medicaid database, linked with death certificate files and a state hospital discharge database, can be used for a computer case definition of sudden cardiac death. Copyright (c) 2009 John Wiley & Sons, Ltd.

Years of Life Lost (YLL in Colombia 1998-2011: Overall and Avoidable Causes of Death Analysis.

Directory of Open Access Journals (Sweden)

Liliana Castillo-Rodríguez

Full Text Available Estimate the Years of Life Lost (YLL for overall and avoidable causes of death (CoD in Colombia for the period 1998-2011.From the reported deaths to the Colombian mortality database during 1998-2011, we classified deaths from avoidable causes. With the reference life table of the Global Burden of Disease (GBD 2010 study, we estimated the overall YLL and YLL due to avoidable causes. Calculations were performed with the difference between life expectancy and the age of death. Results are reported by group of cause of death, events, sex, year and department. Comparative analysis between number of deaths and YLL was carried out.A total of 83,856,080 YLL were calculated in Colombia during period 1998-2011, 75.9% of them due to avoidable CoD. The year 2000 reported the highest number of missed YLL by both overall and avoidable CoD. The departments with the highest YLL rates were Caquetá, Guaviare, Arauca, Meta, and Risaralda. In men, intentional injuries and cardiovascular and circulatory diseases had the higher losses, while in women YLL were mainly due to cardiovascular and circulatory diseases.The public health priorities should focus on preventing the loss of YLL due to premature death and differentiated interventions by sex.

Early death after feline infectious peritonitis virus challenge due to recombinant vaccinia virus immunization.

Science.gov (United States)

Vennema, H; de Groot, R J; Harbour, D A; Dalderup, M; Gruffydd-Jones, T; Horzinek, M C; Spaan, W J

1990-01-01

The gene encoding the fusogenic spike protein of the coronavirus causing feline infectious peritonitis was recombined into the genome of vaccinia virus. The recombinant induced spike-protein-specific, in vitro neutralizing antibodies in mice. When kittens were immunized with the recombinant, low titers of neutralizing antibodies were obtained. After challenge with feline infectious peritonitis virus, these animals succumbed earlier than did the control group immunized with wild-type vaccinia virus (early death syndrome). Images PMID:2154621

Drug-related celebrity deaths: A cross-sectional study.

Science.gov (United States)

Just, Johannes M; Bleckwenn, Markus; Schnakenberg, Rieke; Skatulla, Philipp; Weckbecker, Klaus

2016-12-09

Celebrities are at risk for premature mortality as well as drug-related death. Despite being a vulnerable patient group, celebrities influence people's health behaviours through biological, psychological and social processes. Therefore, celebrity endorsement of the topic could be one way to challenge the current "opioid endemic". Our aim was to better understand the factors surrounding drug-related celebrity deaths by investigating the incidence as well as substances used between 1970 and 2015 using a cross-sectional study design. We searched public databases for drug-related celebrity deaths between 1970 and 2015. They were categorized for sex, profession, age at death, year of death and substances involved. The main outcome measures are descriptive values including number of drug deaths per year and substances involved. Secondary outcome measures are analytical questions to examine whether and which factors influence age at death and year of death (e.g. type of substance use disorder). We identified 220 celebrities who died a drug-related death with a clear indication of involved substances between 1970 and 2015. The average age at death was 38.6 years; 75% were male. Most celebrities died between the age of 25 and 40. The number of drug-related deaths increased in the 21st century, with a significant increase in the use of prescription opioids. Deaths involving prescription opioids and heroin were associated with a significantly lower mean age at death compared to deaths where these substances were not involved. Compared to the 20th century, the total number of celebrities who died from a drug-related death in the 21st century increased, possibly due to an increased involvement of prescription opioids. Negative effects on individual health decisions of celebrity's followers could be the result.

Competing causes of death: a death certificate study

NARCIS (Netherlands)

Mackenbach, J. P.; Kunst, A. E.; Lautenbach, H.; Oei, Y. B.; Bijlsma, F.

1997-01-01

BACKGROUND: Despite the widespread interest in competing causes of death, empirical information on interrelationships between causes of death is scarce. We have used death certificate information to estimate the prevalence of competing causes of death at the moment of dying from specific underlying

The history of life and death: a 'spiritual' history from invisible matter to prolongation of life.

Science.gov (United States)

Gemelli, Benedino

2012-01-01

Over a long period of time, particularly from the nineteenth century on, Francis Bacon's philosophy has been interpreted as centred on the Novum organum and focused on the role that a well-organized method may play in securing a reliable knowledge of nature. In fact, if we examine Bacon's oeuvre as a whole, including some recent manuscript findings (De vijs mortis), we can safely argue that the issues addressed in the Novum organum represent only a part of Bacon's agenda, and not even the most important ones. By contrast, it is apparent that, from the very beginning of his investigations, he emphasized the central role of medicine, the need to establish new approaches in the study of the vital functions and the importance of promoting new discoveries in the medical field, not so much to find a cure for the many illnesses that plagued mankind as to prolong human life. In this sense, Historia vitae et mortis plays a central role in Bacon's programme to extend human knowledge and power, for, in his opinion, human beings could recover their lost ability to live a long and healthy life by embarking on careful investigations of nature. Far from being a purely descriptive or abstract exercise, Bacon's historia can therefore be seen as an operative tool to attain some of mankind's basic aims.

A case of sudden cardiac death following Domperidone self-medication.

Science.gov (United States)

Fais, Paolo; Vermiglio, Elisa; Laposata, Chiara; Lockwood, Robert; Gottardo, Rossella; De Leo, Domenico

2015-09-01

The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Death and digital photography

Directory of Open Access Journals (Sweden)

Ennis, Helen

2011-01-01

Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy.Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death.In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections.Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.

Death and Digital Photography

Directory of Open Access Journals (Sweden)

Helen Ennis

2011-03-01

Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy. Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death. In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections. Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.

Effect of prolonged photopeiod on morphology, biomass accumulation and nutrient utilazation and nutrient utilization in post-transplant taxus cuspidata seedlings

International Nuclear Information System (INIS)

Zhao, Y.; Wang, Zi.; Wei, H.; Bao, Y.; Guo, P.

2017-01-01

Both threats and interest are the reasons for studying conservation and restoration programs of yew species. The seedling growth rate of slowly-growing species has been found to accelerate under prolonged photoperiod relative to that under the natural one, but the illumination effect has rarely been identified on yew species especially at their post-transplant stage. In the present study, one-year-old Taxus cuspidata seedlings were fed with exponential fertilization at the rate of 80 mg N/seedling under the prolonged photoperiod (18 h per day) with natural photoperiod (10.5 h per day) as the control in Northeast China. In the subsequent spring, seedlings were sampled to identify their post-transplant responses. Compared to the natural photoperiod, prolonged photoperiod increased seedling height, RCD, root length, and number of FOLR by 70 percent (p<0.0001), 30 percent (p=0.0037), 31 percent (p=0.0128), and 76 percent (P=0.0002), respectively. In addition, prolonged photoperiod increased dry mass in new shoot, old shoot, and root by 140 percent, 200 percent, and 153 percent (all P values <0.0001), respectively. In response to prolonged photoperiod, whole-plant nitrogen (N) and phosphorus (P) contents and utilizaitons decreased with the decline of N concentration in new shoot and P concentration in annual organ, respectively. Our results indicated that prolonged photoperiod did not promote, but stimulated, growth and biomass accumulation of transplanted T. cuspidata seedlings due to inherent decline of nutrient utilization for new growth. (author)

Dengue Deaths in Puerto Rico: Lessons Learned from the 2007 Epidemic

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Tomashek, Kay M.; Gregory, Christopher J.; Rivera Sánchez, Aidsa; Bartek, Matthew A.; Garcia Rivera, Enid J.; Hunsperger, Elizabeth; Muñoz-Jordán, Jorge L.; Sun, Wellington

2012-01-01

Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. PMID:22530072

Sudden infant death syndrome (SIDS, substance misuse, and smoking in pregnancy

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Ali K

2012-10-01

Full Text Available Kamal Ali, Na’eem Ahmed, Anne GreenoughDivision of Asthma, Allergy, and Lung Biology, Medical Research Council and Asthma UK Center in Allergic Mechanisms of Asthma, King’s College Hospital, London, United KingdomAbstract: In the developed world, sudden infant death syndrome (SIDS remains the leading cause of death in the post neonatal period. This review highlights the association between maternal substance misuse and SIDS, and discusses whether the increased risk is explained by abnormalities of respiratory control. Substance misuse during pregnancy is common, and although the incidence of smoking has declined in recent years among pregnant women, an increasing proportion of mothers of infants who have died of SIDS smoke. The risk of SIDS is increased in women who take opiates, but not cocaine or marijuana, although infants exposed to either of these drugs suffer morbidity, including reduced birth weight. Nicotine exposure increases the risk of SIDS, particularly if both parents smoke, and there is a dose-dependent effect. A variety of respiratory abnormalities have been described in the infants of substance abuse mothers, which may increase their risk of SIDS. These abnormalities include a reduced ability to recover from prolonged apnea and a blunted response to hypoxia and hypercarbia. These results are consistent with postmortem brainstem abnormalities reported among SIDS victims.Keywords: sudden infant death syndrome, nicotine, opiates

Branched-chain amino acid supplementation reduces oxidative stress and prolongs survival in rats with advanced liver cirrhosis.

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Motoh Iwasa

Full Text Available Long-term supplementation with branched-chain amino acids (BCAA is associated with prolonged survival and decreased frequency of development of hepatocellular carcinoma (HCC in patients with liver cirrhosis. However, the pharmaceutical mechanism underlying this association is still unclear. We investigated whether continuous BCAA supplementation increases survival rate of rats exposed to a fibrogenic agent and influences the iron accumulation, oxidative stress, fibrosis, and gluconeogenesis in the liver. Further, the effects of BCAA on gluconeogenesis in cultured cells were also investigated. A significant improvement in cumulative survival was observed in BCAA-supplemented rats with advanced cirrhosis compared to untreated rats with cirrhosis (P<0.05. The prolonged survival due to BCAA supplementation was associated with reduction of iron contents, reactive oxygen species production and attenuated fibrosis in the liver. In addition, BCAA ameliorated glucose metabolism by forkhead box protein O1 pathway in the liver. BCAA prolongs survival in cirrhotic rats and this was likely the consequences of reduced iron accumulation, oxidative stress and fibrosis and improved glucose metabolism in the liver.

SALIVARY ANTIMICROBIAL PROTEIN RESPONSE TO PROLONGED RUNNING

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Suzanne Schneider

2013-01-01

Full Text Available Prolonged exercise may compromise immunity through a reduction of salivary antimicrobial proteins (AMPs. Salivary IgA (IgA has been extensively studied, but little is known about the effect of acute, prolonged exercise on AMPs including lysozyme (Lys and lactoferrin (Lac. Objective: To determine the effect of a 50-km trail race on salivary cortisol (Cort, IgA, Lys, and Lac. Methods: 14 subjects: (6 females, 8 males completed a 50km ultramarathon. Saliva was collected pre, immediately after (post and 1.5 hrs post race ( 1.5. Results: Lac concentration was higher at 1.5 hrs post race compared to post exercise (p0.05. IgA concentration, secretion rate, and IgA/Osm were lower 1.5 hrs post compared to pre race (p<0.05. Cort concentration was higher at post compared to 1.5 (p<0.05, but was unaltered from pre race levels. Subjects finished in 7.81 ± 1.2 hrs. Saliva flow rate did not differ between time points. Saliva Osm increased at post (p<0.05 compared to pre race. Conclusions: The intensity could have been too low to alter Lys and Lac secretion rates and thus, may not be as sensitive as IgA to changes in response to prolonged running. Results expand our understanding of the mucosal immune system and may have implications for predicting illness after prolonged running.

Presence or Absence of QTc Prolongation in Buprenorphine-Naloxone Among Youth With Opioid Dependence.

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Poole, Sabrina A; Pecoraro, Anna; Subramaniam, Geetha; Woody, George; Vetter, Victoria L

2016-01-01

The aim of the study was to evaluate buprenorphine-naloxone effects on the QTc in youth with opioid dependence. Buprenorphine is a partial agonist that is an effective treatment for opioid dependence. Compared with methadone, it has a lower risk of QTc prolongation in adults, but is less studied in the youth. It may also reduce the risk of torsades de pointes (TdP)--an uncommon variant of polymorphic ventricular tachycardia--that can result in syncope, ventricular fibrillation, and sudden death. Secondary analysis of the electrocardiogram data from 95 individuals who participated in a multisite trial for youth with opioid dependence. The participants were randomized to a 2-week (DETOX) or a 12-week course of buprenorphine-naloxone (BUP). At baseline, 12-lead electrocardiograms were done at weeks 4 and 12, and QTc intervals were hand-measured and calculated using Bazett formula. Increases above 60 milliseconds were considered clinically significant, and readings above 450 milliseconds (in men) and 470 milliseconds (in women) indicated a prolonged QTc. Mean QTc intervals were higher for BUP than for DETOX participants at baseline, week 4, and week 12 (P = 0.045), and women had longer mean QTc intervals than men (P DETOX patients. Minimal changes in the QTc were seen at 4 and 12 weeks in a few patients in both groups. There was no evidence that buprenorphine-naloxone alone increased the QTc to a level that increased the risk for TdP.

Brain donation procedures in the Sudden Death Brain Bank in Edinburgh.

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Smith, Colin; Millar, Tracey

2018-01-01

Brain banks typically receive donations through premortem consent procedures, often through disease-specific patient cohorts, such as dementia. While some control cases can be obtained through this route, access to age-matched control tissues, and some chronic neurologic conditions, particularly psychiatric disorders, can be challenging. The Edinburgh Sudden Death Brain Bank was established to try and increase access to control cases across all ages, and also access to psychiatric disorders through suicides. This chapter outlines the processes for establishing donations through medicolegal postmortems, which, although often with a prolonged postmortem interval, can provide high-quality well-characterized postmortem brain tissue to the neuroscience research community. Copyright © 2018 Elsevier B.V. All rights reserved.

Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

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Sorin Giusca

2017-01-01

Full Text Available Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

Sudden or unnatural deaths involving anabolic-androgenic steroids.

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Darke, Shane; Torok, Michelle; Duflou, Johan

2014-07-01

Anabolic-androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995-2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable. © 2014 American Academy of Forensic Sciences.

Persistent ER stress induces the spliced leader RNA silencing pathway (SLS, leading to programmed cell death in Trypanosoma brucei.

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Hanoch Goldshmidt

2010-01-01

Full Text Available Trypanosomes are parasites that cycle between the insect host (procyclic form and mammalian host (bloodstream form. These parasites lack conventional transcription regulation, including factors that induce the unfolded protein response (UPR. However, they possess a stress response mechanism, the spliced leader RNA silencing (SLS pathway. SLS elicits shut-off of spliced leader RNA (SL RNA transcription by perturbing the binding of the transcription factor tSNAP42 to its cognate promoter, thus eliminating trans-splicing of all mRNAs. Induction of endoplasmic reticulum (ER stress in procyclic trypanosomes elicits changes in the transcriptome similar to those induced by conventional UPR found in other eukaryotes. The mechanism of up-regulation under ER stress is dependent on differential stabilization of mRNAs. The transcriptome changes are accompanied by ER dilation and elevation in the ER chaperone, BiP. Prolonged ER stress induces SLS pathway. RNAi silencing of SEC63, a factor that participates in protein translocation across the ER membrane, or SEC61, the translocation channel, also induces SLS. Silencing of these genes or prolonged ER stress led to programmed cell death (PCD, evident by exposure of phosphatidyl serine, DNA laddering, increase in reactive oxygen species (ROS production, increase in cytoplasmic Ca(2+, and decrease in mitochondrial membrane potential, as well as typical morphological changes observed by transmission electron microscopy (TEM. ER stress response is also induced in the bloodstream form and if the stress persists it leads to SLS. We propose that prolonged ER stress induces SLS, which serves as a unique death pathway, replacing the conventional caspase-mediated PCD observed in higher eukaryotes.

A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature

International Nuclear Information System (INIS)

Wongworawat, M.D.; Holtom, P.; Learch, T.J.; Fedenko, A.; Stevanovic, M.V.

2003-01-01

We report on a 30-year-old man with prolonged Mycobacterium marinum flexor tenosynovitis. Due to low clinical suspicion, diagnosis was not made until 8 years after initial presentation. The history and magnetic resonance and tissue examination findings are consistent with mycobacterial tenosynovitis. These findings are presented, together with a review of the literature. (orig.)

A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Wongworawat, M.D. [Dept. of Orthopaedic Surgery, Loma Linda Univ. Medical Center, Loma Linda, CA (United States); USC Univ. Hospital, Los Angeles, CA (United States); Holtom, P.; Learch, T.J.; Fedenko, A.; Stevanovic, M.V. [USC Univ. Hospital, Los Angeles, CA (United States)

2003-09-01

We report on a 30-year-old man with prolonged Mycobacterium marinum flexor tenosynovitis. Due to low clinical suspicion, diagnosis was not made until 8 years after initial presentation. The history and magnetic resonance and tissue examination findings are consistent with mycobacterial tenosynovitis. These findings are presented, together with a review of the literature. (orig.)

Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001-2010: Report of the Committee on Causes of Death in Diabetes Mellitus.

Science.gov (United States)

Nakamura, Jiro; Kamiya, Hideki; Haneda, Masakazu; Inagaki, Nobuya; Tanizawa, Yukio; Araki, Eiichi; Ueki, Kohjiro; Nakayama, Takeo

2017-05-01

The principal causes of death among 45,708 patients with diabetes (29,801 men and 15,907 women) who died in 241 hospitals throughout Japan during 2001-2010 were determined based on a survey of the hospital records. Autopsy had been conducted in 978 of the 45,708 cases. The most frequent cause of death was malignant neoplasia (38.3%), followed by, in order of descending frequency: infections (17.0%); and then vascular diseases (14.9%), including renal failure (3.5%), ischemic heart diseases (4.8%) and cerebrovascular diseases (6.6%). Diabetic coma associated with hyperglycemia with or without ketoacidosis accounted for only 0.6% of the deaths. In regard to the relationship between the age and cause of death in patients with diabetes, the incidence of death due to vascular diseases was higher in patients over the age of 30 or 40 years, and the 97.0% of the total death due to vascular diseases was observed in patients over the age of 50 years. The incidence of death due to infectious diseases, especially pneumonia, increased in an age-dependent fashion, and the 80.7% of the total death due to pneumonia was observed in patients over the age of 70 years. 'Poorer' glycemic control was associated with the reduced lifespan of patients with diabetes, especially of those with nephropathy. The average age at death in the survey population was 72.6 years. The lifespan was 1.6 years shorter in patients with 'poorer' glycemic control than in those with 'better' glycemic control. In patients with diabetes of less than 10 years' duration, the incidence of death due to macroangiopathy was higher than that due to nephropathy. Of the 45,708 patients with diabetes, 33.9% were on oral medication, 41.9% received insulin therapy and 18.8% were treated by diet alone. Among the patients in whom the cause of death was diabetic nephropathy, a high percentage, 53.7%, was on insulin therapy. The average age at death of the 45,708 patients with diabetes was 71.4 years in men and 75.1�

Inference in randomized trials with death and missingness.

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Wang, Chenguang; Scharfstein, Daniel O; Colantuoni, Elizabeth; Girard, Timothy D; Yan, Ying

2017-06-01

In randomized studies involving severely ill patients, functional outcomes are often unobserved due to missed clinic visits, premature withdrawal, or death. It is well known that if these unobserved functional outcomes are not handled properly, biased treatment comparisons can be produced. In this article, we propose a procedure for comparing treatments that is based on a composite endpoint that combines information on both the functional outcome and survival. We further propose a missing data imputation scheme and sensitivity analysis strategy to handle the unobserved functional outcomes not due to death. Illustrations of the proposed method are given by analyzing data from a recent non-small cell lung cancer clinical trial and a recent trial of sedation interruption among mechanically ventilated patients. © 2016, The International Biometric Society.

When the Simulator Dies: Experiential Education about Death Designed for Undergraduate Nursing Students

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Foltz-Ramos, Kelly

2017-01-01

Background and Objectives: Graduates from undergraduate nursing programs report inadequate death education. Most death education is focused on end-of-life care and taught by lecture. Students are not provided opportunities to reflect on their own feelings about death. Due to lack of clinical nursing faculty and shortage of clinical sites, students…

Optimized Model of Cerebral Ischemia In situ for the Long-Lasting Assessment of Hippocampal Cell Death

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Oksana Rybachuk

2017-07-01

Full Text Available Among all the brain, the hippocampus is the most susceptible region to ischemic lesion, with the highest vulnerability of CA1 pyramidal neurons to ischemic damage. This damage may cause either prompt neuronal death (within hours or with a delayed appearance (over days, providing a window for applying potential therapies to reduce or prevent ischemic impairments. However, the time course when ischemic damage turns to neuronal death strictly depends on experimental modeling of cerebral ischemia and, up to now, studies were predominantly focused on a short time-window—from hours to up to a few days post-lesion. Using different schemes of oxygen-glucose deprivation (OGD, the conditions taking place upon cerebral ischemia, we optimized a model of mimicking ischemic conditions in organotypical hippocampal slices for the long-lasting assessment of CA1 neuronal death (at least 3 weeks. By combining morphology and electrophysiology, we show that prolonged (30-min duration OGD results in a massive neuronal death and overwhelmed astrogliosis within a week post-OGD whereas OGD of a shorter duration (10-min triggered programmed CA1 neuronal death with a significant delay—within 2 weeks—accompanied with drastically impaired CA1 neuron functions. Our results provide a rationale toward optimized modeling of cerebral ischemia for reliable examination of potential treatments for brain neuroprotection, neuro-regeneration, or testing neuroprotective compounds in situ.

Drug of the year: programmed death-1 receptor/programmed death-1 ligand-1 receptor monoclonal antibodies.

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Robert, Caroline; Soria, Jean-Charles; Eggermont, Alexander M M

2013-09-01

Programmed death-1 receptor (PD-1)/its ligand (PD-L1) antibodies have changed the landscape in oncology in 2013. The most mature results have been obtained in advanced melanoma patients. They indicate important response rates and high quality responses or prolonged duration. Also in renal cancer and in lung cancer remarkable activity has been demonstrated. Thus it is clear that these antibodies have a very broad potential and trials in many tumour types are being initiated. Breaking tolerance at the tumour site is a potent phenomenon and the potential for synergy with other checkpoint inhibitors such as ipilimumab have also been demonstrated in 2013. Long term tumour control now seems achievable and thus the concept of a clinical cure is emerging by modulation of the immune system. These antibodies bring immunotherapy to the forefront and indicate that immune-modulation will be a key component of therapeutic strategies from now on. Because of all these reasons PD-1/PD-L1 antibodies are considered 'drug of the year'. Copyright © 2013 Elsevier Ltd. All rights reserved.

53BP1 and USP28 mediate p53-dependent cell cycle arrest in response to centrosome loss and prolonged mitosis.

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Fong, Chii Shyang; Mazo, Gregory; Das, Tuhin; Goodman, Joshua; Kim, Minhee; O'Rourke, Brian P; Izquierdo, Denisse; Tsou, Meng-Fu Bryan

2016-07-02

Mitosis occurs efficiently, but when it is disturbed or delayed, p53-dependent cell death or senescence is often triggered after mitotic exit. To characterize this process, we conducted CRISPR-mediated loss-of-function screens using a cell-based assay in which mitosis is consistently disturbed by centrosome loss. We identified 53BP1 and USP28 as essential components acting upstream of p53, evoking p21-dependent cell cycle arrest in response not only to centrosome loss, but also to other distinct defects causing prolonged mitosis. Intriguingly, 53BP1 mediates p53 activation independently of its DNA repair activity, but requiring its interacting protein USP28 that can directly deubiquitinate p53 in vitro and ectopically stabilize p53 in vivo. Moreover, 53BP1 can transduce prolonged mitosis to cell cycle arrest independently of the spindle assembly checkpoint (SAC), suggesting that while SAC protects mitotic accuracy by slowing down mitosis, 53BP1 and USP28 function in parallel to select against disturbed or delayed mitosis, promoting mitotic efficiency.

CPP2-p16MIS treatment–induced colon carcinoma cell death in vitro and prolonged lifespan of tumor-bearing mice

International Nuclear Information System (INIS)

Wang, Lifeng; Chen, Haijin; Yu, Jinlong; Lin, Xiaohua; Qi, Jia; Cui, Chunhui; Xie, Lang; Huang, Shuxin

2016-01-01

Cell-penetrating peptides (CPPs) are a research hotspot due to their noninvasive delivery ability. Among the identified CPPs, the TAT and R8 peptides have been preferentially applied to transduction into different cells. However, this process is nonselective among various cells. Recent research suggested that CPP2 could selectively penetrate human colorectal cancer (CRC) cells. Using in vitro experiments, the mean fluorescence intensity of fluorescein isothiocyanate–labeled CPPs (CPPs-FITC) incubated with different cell lines was compared to corroborate the colon tumor targeting ability of CPP2. The targeting ability of CPP2 was determined in the same way in tumor-bearing mice. We synthesized antitumor peptides by fusing CPP2 to the minimal inhibitory sequence of p16 (p16MIS), which had the ability to restore the function of lost p16, the expression of which was absent in tumor cell lines of various origins. The antitumor effect of the combined peptide was tested in both CRC cell lines and tumor-bearing mice. In each CRC cell line, the mean fluorescence intensity of CPP2-FITC was higher than that of the TAT-FITC (p < 0.001) and R8-FITC (p < 0.001) groups. CPP2-p16MIS, the targeting carrier, showed a higher antitumor response in the in vitro cell research. CPP2-p16MIS showed a prolonged mean lifespan of tumor-bearing mice, further characterizing its role in specific tumor-targeting ability in vivo. Survival analysis showed that the mice treated with CPP2-p16MIS had significantly longer survival than the mice treated with phosphate-buffered saline (p < 0.05) or those treated with control peptides, including the CPP2 (p < 0.05) and p16MIS (p < 0.05) groups. CPP2 could more selectively penetrate CRC cells than TAT or R8 as well as effectively deliver the p16MIS to the tumor

Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography

DEFF Research Database (Denmark)

Madsen, B K; Rasmussen, Verner; Hansen, J F

1997-01-01

Association class II and 44% in III. Total mortality after 1 year was 21%, after 2 years 32%. Of 60 deaths, 33% were sudden and 49% due to pump failure. Multivariate analyses identified totally different risk factors for sudden death: ventricular tachycardia, s-sodium ....6 mmol/l, s-potassium sudden death and for death from progressive pump failure........80 mmol/l, s-creatinine > 121 mumol/l, and maximal change in heart rate during exercise death from progressive pump failure: New York Heart Association class III + IV, delta heart rate over 24 h 7...

Changes in tumor cell response due to prolonged dose delivery times in fractionated radiation therapy

International Nuclear Information System (INIS)

Paganetti, Harald

2005-01-01

Purpose: Dynamic radiation therapy, such as intensity-modulated radiation therapy, delivers more complex treatment fields than conventional techniques. The increased complexity causes longer dose delivery times for each fraction. The cellular damage after a full treatment may depend on the dose rate, because sublethal radiation damage can be repaired more efficiently during prolonged dose delivery. The goal of this study was to investigate the significance of this effect in fractionated radiation therapy. Methods and Materials: The lethal/potentially lethal model was used to calculate lesion induction rates for repairable and nonrepairable lesions. Dose rate effects were analyzed for 9 different cell lines (8 human tumor xenografts and a C3H10T1/2 cell line). The effects of single-fraction as well as fractionated irradiation for different dose rates were studied. Results: Significant differences can be seen for dose rates lower than about 0.1 Gy/min for all cell lines considered. For 60 Gy delivered in 30 fractions, the equivalent dose is reduced by between 1.3% and 12% comparing 2 Gy delivery over 30 min per fraction with 2 Gy delivery over 1 min per fraction. The effect is higher for higher doses per fraction. Furthermore, the results show that dose rate effects do not show a simple correlation with the α/β ratio for ratios between 3 Gy and 31 Gy. Conclusions: If the total dose delivery time for a treatment fraction in radiation therapy increases to about 20 min, a correction for dose rate effects may have to be considered in treatment planning. Adjustments in effective dose may be necessary when comparing intensity-modulated radiation therapy with conventional treatment plans

(+)-Grandifloracin, an antiausterity agent, induces autophagic PANC-1 pancreatic cancer cell death.

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Ueda, Jun-ya; Athikomkulchai, Sirivan; Miyatake, Ryuta; Saiki, Ikuo; Esumi, Hiroyasu; Awale, Suresh

2014-01-01

Human pancreatic tumors are known to be highly resistant to nutrient starvation, and this prolongs their survival in the hypovascular (austere) tumor microenvironment. Agents that retard this tolerance to nutrient starvation represent a novel antiausterity strategy in anticancer drug discovery. (+)-Grandifloracin (GF), isolated from Uvaria dac, has shown preferential toxicity to PANC-1 human pancreatic cancer cells under nutrient starvation, with a PC50 value of 14.5 μM. However, the underlying mechanism is not clear. In this study, GF was found to preferentially induce PANC-1 cell death in a nutrient-deprived medium via hyperactivation of autophagy, as evidenced by a dramatic upregulation of microtubule-associated protein 1 light chain 3. No change was observed in expression of the caspase-3 and Bcl-2 apoptosis marker proteins. GF was also found to strongly inhibit the activation of Akt, a key regulator of cancer cell survival and proliferation. Because pancreatic tumors are highly resistant to current therapies that induce apoptosis, the alternative cell death mechanism exhibited by GF provides a novel therapeutic insight into antiausterity drug candidates.

What is the risk of death or severe harm due to bone cement implantation syndrome among patients undergoing hip hemiarthroplasty for fractured neck of femur? A patient safety surveillance study

Science.gov (United States)

Rutter, Paul D; Panesar, Sukhmeet S; Darzi, Ara; Donaldson, Liam J

2014-01-01

Objective To estimate the risk of death or severe harm due to bone cement implantation syndrome (BCIS) among patients undergoing hip hemiarthroplasty for fractured neck of femur. Setting Hospitals providing secondary and tertiary care throughout the National Health Service (NHS) in England and Wales. Participants Cases reported to the National Reporting and Learning System (NRLS) in which the reporter clearly describes severe acute patient deterioration associated with cement use in hip hemiarthroplasty for fractured neck of femur (assessed independently by two reviewers). Outcome measures Primary—number of reported deaths, cardiac arrests and periarrests per year. Secondary—timing of deterioration and outcome in relation to cement insertion. Results Between 2005 and 2012, the NRLS received 62 reports that clearly describe death or severe harm associated with the use of cement in hip hemiarthroplasty for fractured neck of femur. There was one such incident for every 2900 hemiarthroplasties for fractured neck of femur during the period. Of the 62 reports, 41 patients died, 14 were resuscitated from cardiac arrest and 7 from periarrest. Most reports (55/62, 89%) describe acute deterioration occurring during or within a few minutes of cement insertion. The vast majority of deaths (33/41, 80%) occurred on the operating table. Conclusions These reports provide narrative evidence from England and Wales that cement use in hip hemiarthroplasty for fractured neck of femur is associated with instances of perioperative death or severe harm consistent with BCIS. In 2009, the National Patient Safety Agency publicised this issue and encouraged the use of mitigation measures. Three-quarters of the deaths in this study have occurred since that alert, suggesting incomplete implementation or effectiveness of those mitigation measures. There is a need for stronger evidence that weighs the risks and benefits of cement in hip hemiarthroplasty for fractured neck of femur. PMID

Deliberating death.

Science.gov (United States)

Landes, Scott D

2010-01-01

Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

Pathological prolongation of action potential duration as a cause of the reduced alpha-adrenoceptor-mediated negative inotropy in streptozotocin-induced diabetic mice myocardium.

Science.gov (United States)

Kanae, Haruna; Hamaguchi, Shogo; Wakasugi, Yumi; Kusakabe, Taichi; Kato, Keisuke; Namekata, Iyuki; Tanaka, Hikaru

2017-11-01

Effect of pathological prolongation of action potential duration on the α-adrenoceptor-mediated negative inotropy was studied in streptozotocin-induced diabetic mice myocardium. In streptozotocin-treated mouse ventricular myocardium, which had longer duration of action potential than that in control mice, the negative inotropic response induced by phenylephrine was smaller than that in control mice. 4-Aminopyridine prolonged the action potential duration and decreased the negative inotropy in control mice. Cromakalim shortened the action potential duration and increased the negative inotropy in streptozotocin-treated mice. These results suggest that the reduced α-adrenoceptor-mediated inotropy in the diabetic mouse myocardium is partly due to its prolonged action potential. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

One Decade of Unnatural Deaths in Yazd Province: 2003-2013

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mohamad hassan lotfi

2016-02-01

Full Text Available Abstract Introduction: Death is defined as the permanent loss of all signs of life at any time after birth (Irrevocable disappearance of all vital signs after birth. Unnatural deaths seem to be either suspicious or  unexpected. Deaths that occur suddenly and their causes need to be investigated, are termed unnatural deaths. According to the death certificate contents of Ministry of Health and Forensics, if the cause of death is unnatural, the corpse will be submitted to the forensic medicine departments in 19 cases in order to determine the death cause and to issue the burial permit.   Material & Methods: In this descriptive study, the data were extracted from unnatural death cases in the province of Yazd during 2003 to 2013 recorded by Yazd Forensic Medicine. Results: During 2003 -2013, 5552 cases of unnatural deaths were recorded by the Forensic Medicine of Yazd, out of which 4373 cases of unnatural deaths were caused by road traffic accidents (outside and inside the city, 89 deaths from electrocution, 439 deaths from poisoning, 72 deaths from drowning, 129 deaths from asphyxia (by carbon monoxide, 56 deaths from work incidents, and 394 deaths from burns. The group of males aged 20-29 years allocated the highest number of unnatural deaths to themselves. Conclusion: Road traffic accidents are the second leading cause of unnatural deaths in Iran. The number of unnatural death incidents in men is more than women indicating that men are more exposed to risk factors than women, though regarding the deaths due to the burns, women are exposed to the high risk factors.

The Significance of Prolonged and Saddleback Fever in Hospitalised Adult Dengue.

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Deborah Hl Ng

Full Text Available Dengue fever is gaining importance in Singapore with an increase in the number of cases and mortality in recent years. Although prolonged and saddleback fever have been reported in dengue fever, there are no specific studies on their significance in dengue. This study aims to examine the prevalence of prolonged and saddleback fever in dengue as well as their associations with dengue severity. A total of 2843 polymerase-chain reaction (PCR confirmed dengue patients admitted to Tan Tock Seng Hospital from 2004 to 2008 were included in the study. Sixty-nine percent of them were male with a median age of 34 years. Prolonged fever (fever > 7 days duration was present in 572 (20.1% of patients. Dengue hemorrhagic fever (DHF, dengue shock syndrome (DSS and severe dengue (SD were significantly more likely to occur in patients with prolonged fever. Mucosal bleeding, anorexia, diarrhea, abdominal pain, nausea or vomiting, lethargy, rash, clinical fluid accumulation, hepatomegaly, nosocomial infection, leukopenia, higher neutrophil count, higher hematocrit, higher alanine transaminase (ALT and aspartate transaminase (AST, higher creatinine, lower protein and prolonged activated partial thromboplastin time (APTT were significantly associated with prolonged fever but not platelet count or prothrombin time (PT. Saddleback fever was present in 165 (5.8%. Although DHF and SD were more likely to occur in patients in those with saddleback fever, DSS was not. Compared with prolonged fever, saddleback fever did not show many significant associations except for diarrhea, abdominal pain, clinical fluid accumulation, hematocrit and platelet change, and lower systolic blood pressure. This study demonstrates that prolonged fever may be associated with various warning signs and more severe forms of dengue (SD, DSS, DHF, while saddleback fever showed associations with DHF and SD but not DSS. The presence of prolonged or saddleback fever in dengue patients should therefore

Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011-16.

Science.gov (United States)

Guha-Sapir, Debarati; Schlüter, Benjamin; Rodriguez-Llanes, Jose Manuel; Lillywhite, Louis; Hicks, Madelyn Hsiao-Rei

2018-01-01

Since March, 2011, the Syrian civil war has lowered life expectancy by as much as 20 years. We describe demographic, spatial, and temporal patterns of direct deaths of civilians and opposition combatants from conflict-related violence in 6 years of war. We analysed conflict-related violent deaths with complete information on date, place, and cause of death and demographic group occurring from March 18, 2011, to Dec 31, 2016, recorded by the Violation Documentation Center (VDC). We included civilian and combatant deaths in all Syrian governorates, excluding government-controlled areas. We did not include detainees and missing persons, nor deaths from siege conditions or insufficient medical care. We categorised deaths based on VDC weapon type. We used χ 2 testing to compare deaths from different weapons in civilian men, women, boys, and girls and adult and child combatants. We analysed deaths by governorate and over time. The VDC recorded 143 630 conflict-related violent deaths with complete information between March 18, 2011, and Dec 31, 2016. Syrian civilians constituted 101 453 (70·6%) of the deaths compared with 42 177 (29·4%) opposition combatants. Direct deaths were caused by wide-area weapons of shelling and air bombardments in 58 099 (57·3%) civilians, including 8285 (74·6%) civilian women and 13 810 (79·4%) civilian children, and in 4058 (9·6%) opposition combatants. Proportions of children among civilian deaths increased from 8·9% (388 of 4254 civilian deaths) in 2011 to 19·0% (4927 of 25 972) in 2013 and to 23·3% (2662 of 11 444) in 2016. Of 7566 deaths from barrel bombs, 7351 (97·2%) were civilians, of whom 2007 (27·3%) were children. Of 20 281 deaths by execution, 18 747 (92·4%) were civilians and 1534 (7·6%) were opposition combatants. Compared with opposition child soldiers who were male (n=333), deaths of civilian male children (n=11 730) were caused more often by air bombardments (39·2% vs 5·4%, pwar crime. None

[Human mortality due to invertebrate and vertebrate envenomation in Monagas State, Venezuela].

Science.gov (United States)

De Sousa, Leonardo; Vásquez, Dioniris; Salazar, Doyra; Valecillos, Rigoberto; Vásquez, Dionisio; Rojas, María; Parrila-Alvarez, Pedro; Quiroga, Mercedes

2005-09-01

Human mortality due to envenomation by animals in Monagas state, Venezuela was evaluated. In this state 47 deaths due to envenomations produced by vertebrates and invertebrates (scorpions = 21, snakes = 20, bees = 6) during the period 1980-2000 were registered. The mountainous area, at the north of the state (Turimiquire sub-region) and its piedmonts reported most of the mortality by scorpionism (57.2%) and ophidism (70.0%). The age group of the patients was related with the sort of envenomation causing the death. During the period of dry season the highest percentage of deaths by scorpions and bees occurred; and the deaths produced by snakes were more frequent in the median raining season. The most frequent causes of death (61.9%) by scorpionism were the acute lung edema and congestive heart failure. In 40% of the deaths caused by snakes, alterations of the blood coagulability were observed. Bee envenomation was responsible of 50% of the deaths produced by anaphylactic shock. In none of the deaths, the species responsible of the accident was identified. The annual mean mortality rate/100,000 inhabitants, in the 21 years registered was 0.20 for the scorpion envenomation, 0.19 for ophidism and 0.06 for bee envenomation. The data suggest the importance of the mortality produced by scorpions and snakes, particularly at the north of the state.

Parents' Death and its Implications for Child Survival

OpenAIRE

Atrash, Hani K.

2011-01-01

Reduction of child mortality is a global public health priority. Parents can play an important role in reducing child mortality. The inability of one or both parents to care for their children due to death, illness, divorce or separation increases the risk of death of their children. There is increasing evidence that the health, education, and socioeconomic status of mothers and fathers have significant impact on the health and survival of their children. We conducted a literature review to e...

Prolonged social withdrawal disorder: a hikikomori case in Spain.

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Ovejero, Santiago; Caro-Cañizares, Irene; de León-Martínez, Victoria; Baca-Garcia, Enrique

2014-09-01

The Japanese term hikikomori means literally 'to be confined'. Social withdrawal can be present in severe psychiatric disorders; however, in Japan, hikikomori is a defined nosologic entity. There have been only a few reported cases in occidental culture. We present a case report of a Spanish man with prolonged social withdrawal lasting for 4 years. This is a case of prolonged social withdrawal not bound to culture, as well as the second case of hikikomori reported in Spain. We propose prolonged social withdrawal disorder as a disorder not linked to culture, in contrast to hikikomori. Further documentation of this disorder is still needed to encompass all cases reported in Japan and around the world. © The Author(s) 2013.

38 CFR 38.618 - Findings concerning commission of a capital crime where a person has not been convicted due to...

Science.gov (United States)

2010-07-01

... commission of a capital crime where a person has not been convicted due to death or flight to avoid... of a capital crime where a person has not been convicted due to death or flight to avoid prosecution... committed a Federal or State capital crime of which he or she was not convicted due to death or flight to...

Prognostic Factors of Organophosphate Poisoning Between the Death and Survival Groups

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Tzeng-Jih Lin

2007-04-01

duration of PAM use was shorter than the maximum duration of urine organophosphate, although the medians of duration of PAM use were more than the medians of duration of urine organophosphate in both the survival and death groups. Prolonged coma duration, lower level of acetylcholinesterase and lower level of plasma cholinesterase were related to the poor prognosis of the patients.

Ventricular Cycle Length Characteristics Estimative of Prolonged RR Interval during Atrial Fibrillation

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CIACCIO, EDWARD J.; BIVIANO, ANGELO B.; GAMBHIR, ALOK; EINSTEIN, ANDREW J.; GARAN, HASAN

2014-01-01

Background When atrial fibrillation (AF) is incessant, imaging during a prolonged ventricular RR interval may improve image quality. It was hypothesized that long RR intervals could be predicted from preceding RR values. Methods From the PhysioNet database, electrocardiogram RR intervals were obtained from 74 persistent AF patients. An RR interval lengthened by at least 250 ms beyond the immediately preceding RR interval (termed T0 and T1, respectively) was considered prolonged. A two-parameter scatterplot was used to predict the occurrence of a prolonged interval T0. The scatterplot parameters were: (1) RR variability (RRv) estimated as the average second derivative from 10 previous pairs of RR differences, T13–T2, and (2) Tm–T1, the difference between Tm, the mean from T13 to T2, and T1. For each patient, scatterplots were constructed using preliminary data from the first hour. The ranges of parameters 1 and 2 were adjusted to maximize the proportion of prolonged RR intervals within range. These constraints were used for prediction of prolonged RR in test data collected during the second hour. Results The mean prolonged event was 1.0 seconds in duration. Actual prolonged events were identified with a mean positive predictive value (PPV) of 80% in the test set. PPV was >80% in 36 of 74 patients. An average of 10.8 prolonged RR intervals per 60 minutes was correctly identified. Conclusions A method was developed to predict prolonged RR intervals using two parameters and prior statistical sampling for each patient. This or similar methodology may help improve cardiac imaging in many longstanding persistent AF patients. PMID:23998759

TRAIL death receptors and cancer therapeutics

International Nuclear Information System (INIS)

Huang Ying; Sheikh, M. Saeed

2007-01-01

Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) also known as Apo2L is an apoptotic molecule that belongs to the tumor necrosis factor superfamily of cytokines. It mediates its apoptotic effects via its cognate death receptors including DR4 and DR5. Agonistic monoclonal antibodies have also been developed that selectively activate TRAIL death receptors to mediate apoptosis. Multiple clinically relevant agents also upregulate the expression of TRAIL death receptors, and cooperate with TRAIL as well as DR4 and DR5-specific agonistic antibodies to exhibit tumor cell killing. TRAIL is currently in phase I clinical trials, whereas DR4 and DR5-specific agonistic antibodies have been tested in phase I and II studies. Thus, TRAIL has clearly distinguished itself from the other family members including TNF-alpha and FasL both of which could not make it to the clinic due to their toxic nature. It is therefore, evident that the future of TRAIL-based therapeutic approaches looks brighter

Women's experiences of becoming a mother after prolonged labour.

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Nystedt, Astrid; Högberg, Ulf; Lundman, Berit

2008-08-01

This paper is a report of a study to explore women's experiences of becoming a mother after prolonged labour. The negativity associated with a complicated labour such as prolonged labour can lead to a struggle to become a healthy mother and could restrict the process of becoming a mother. Interviews were conducted in 2004 with 10 mothers who had been through a prolonged labour with assisted vaginal or caesarean delivery 1-3 months previously. Thematic content analysis was used. Three themes were formulated, describing women's experiences as fumbling in the dark, struggling for motherhood and achieving confidence in being a mother. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like 'fumbling in the dark'. Women experienced bodily fatigue, accompanied by feelings of illness and detachment from the child. Having the child when in this condition entailed a struggle to become a mother. In spite of these experiences and the desire to achieve confidence in being a mother, the reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged interaction and relationship with the child, and contributed to their adaptation to motherhood. Women experiencing prolonged labour may be comparable with the experience of and recovery from illness, which could contribute to difficulties transitioning to motherhood and limit a woman's ability to be emotionally available for the child.

Prolonged unexplained fatigue in paediatrics

NARCIS (Netherlands)

Bakker, R.J.

2010-01-01

Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of

Prolonged cardiac effects of momentary assessed stressful events and worry episodes.

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Pieper, Suzanne; Brosschot, Jos F; van der Leeden, Rien; Thayer, Julian F

2010-07-01

To test the hypothesize that increased heart rate (HR) and decreased heart rate variability (HRV) are not only due to concurrent stressful events and worries but also to stressors and worries occurring in the preceding hours or stressors anticipated to occur in the next hour. Worry was expected to mediate at least part of the prolonged effects of stressors. Ambulatory HR and HRV of 73 teachers were recorded for 4 days, during which the participants reported occurrence and duration of worry episodes and stressful events on an hourly basis, using computerized diaries. Multilevel regression models were used, accounting for effects of several biobehavioral variables. Stressful events were not associated with changes in HR or HRV. However, worry episodes had effects on concurrent HR and HRV (2.55 beats/minute; -5.76 milliseconds) and HR and HRV in the succeeding hour (3.05 beats/minute; -5.80 milliseconds) and 2 hours later (1.52 beats/minute; -3.14 milliseconds). These findings were independent of emotions, physical activity, posture, and other biobehavioral factors. Worry has effects on cardiac activity, and these effects were still visible after 2 hours. The latter finding suggests that a considerable part of prolonged activation may be induced by unconscious stress-related cognition.

Using poison center exposure calls to predict methadone poisoning deaths.

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Nabarun Dasgupta

Full Text Available PURPOSE: There are more drug overdose deaths in the Untied States than motor vehicle fatalities. Yet the US vital statistics reporting system is of limited value because the data are delayed by four years. Poison centers report data within an hour of the event, but previous studies suggested a small proportion of poisoning deaths are reported to poison centers (PC. In an era of improved electronic surveillance capabilities, exposure calls to PCs may be an alternate indicator of trends in overdose mortality. METHODS: We used PC call counts for methadone that were reported to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS® System in 2006 and 2007. US death certificate data were used to identify deaths due to methadone. Linear regression was used to quantify the relationship of deaths and poison center calls. RESULTS: Compared to decedents, poison center callers tended to be younger, more often female, at home and less likely to require medical attention. A strong association was found with PC calls and methadone mortality (b=0.88, se=0.42, t=9.5, df=1, p<0.0001, R(2 =0.77. These findings were robust to large changes in a sensitivity analysis assessing the impact of underreporting of methadone overdose deaths. CONCLUSIONS: Our results suggest that calls to poison centers for methadone are correlated with poisoning mortality as identified on death certificates. Calls received by poison centers may be used for timely surveillance of mortality due to methadone. In the midst of the prescription opioid overdose epidemic, electronic surveillance tools that report in real-time are powerful public health tools.

Cause-specific mortality among children and young adults with epilepsy: Results from the U.S. National Child Death Review Case Reporting System.

Science.gov (United States)

Tian, Niu; Shaw, Esther C; Zack, Matthew; Kobau, Rosemarie; Dykstra, Heather; Covington, Theresa M

2015-04-01

We investigated causes of death in children and young adults with epilepsy by using data from the U.S. National Child Death Review Case Reporting System (NCDR-CRS), a passive surveillance system composed of comprehensive information related to deaths reviewed by local child death review teams. Information on a total of 48,697 deaths in children and young adults 28days to 24years of age, including 551 deaths with epilepsy and 48,146 deaths without epilepsy, was collected from 2004 through 2012 in 32 states. In a proportionate mortality analysis by official manner of death, decedents with epilepsy had a significantly higher percentage of natural deaths but significantly lower percentages of deaths due to accidents, homicide, and undetermined causes compared with persons without epilepsy. With respect to underlying causes of death, decedents with epilepsy had significantly higher percentages of deaths due to drowning and most medical conditions including pneumonia and congenital anomalies but lower percentages of deaths due to asphyxia, weapon use, and unknown causes compared with decedents without epilepsy. The increased percentages of deaths due to pneumonia and drowning in children and young adults with epilepsy suggest preventive interventions including immunization and better instruction and monitoring before or during swimming. State-specific and national population-based mortality studies of children and young adults with epilepsy are recommended. Published by Elsevier Inc.

Death by suicide in Graves' disease and Graves' orbitopathy

DEFF Research Database (Denmark)

Ferløv-Schwensen, Charlotte; Brix, Thomas Heiberg; Hegedus, Laszlo

2017-01-01

BACKGROUND: Graves' disease is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves' orbitopathy. Here we investigate the risk of unnatural death in Graves' patients with orbitopathy (GO) and without (GD), comp...... in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures....... with GD, and 3,965 with GO were identified and matched for age and gender with four subjects from the background population. Manner of death was identified and hazard ratios (HR) for mortality due to unnatural deaths (accident, suicide, violence/homicide, and unknown) were calculated using Cox regression...... analyses, adjusted for pre-existing somatic and psychiatric morbidity. RESULTS: In Graves' disease overall there was an increased risk of death from unknown unnatural manners [HR: 2.01 (95% confidence interval: 1.17-3.45); P=0.012] and of suicide, although the latter difference was not with certainty...

Romeo and Juliet: Play about love and death

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Andrejević Ana M.

2015-01-01

Full Text Available In the play Romeo and Juliet, which has become the synonym for the love tragedy, death is represented as the ultimate, all-consuming, and almost nihilistic power that cannot be conquered even by the most pure and passionate love. But, its devastating effect is reduced by the strong, transcendent, and the idealistic vision of love of the two young creatures who became immortal as the materialistic golden monuments, due to the power of the eternal art and the word of Shakespeare. Presenting it in the traditional frame of the Dance of Death and memento mori iconography, Shakespeare is showing us the different aspects of the Renaissance thought of death. The older generation sees it as the natural progression of life that cannot and must not stop everyday activities, but the younger hopes to find in death the salvation and escape from the insupportable and pragmatic world. Although there are religiously guided thoughts about life after death in the play, secular statements about death as a flight from the unbearable reality and the cure for the impossible love are more present. Even suicide is not conventionally represented as the sinful and devilish enterprise that must be condemned, but as the sacrifice and radical attempt to protect and preserve love. Shakespeare makes his lovers the owners of death, despite the rigid patriarchal effort to control both life and its opposite force. Love of Romeo and Juliet thus becomes victorious in death.

Does a 'tight' hamstring predict low back pain reporting during prolonged standing?

Science.gov (United States)

Raftry, Sean M; Marshall, Paul W M

2012-06-01

The purpose of this study was to investigate the relationship between hamstring passive stiffness and extensibility in asymptomatic individuals with the reporting of low back pain during 2-h prolonged standing. Twenty healthy participants with no history of low back pain (mean±SD, age 22.6±2.7 years, height 1.74±0.09 m, weight 76.2±14.8 kg). Low back pain (VAS score; mm) was continuously monitored during 2-h prolonged standing. Hamstring extensibility, passive stiffness, and stretch tolerance were measured before and after prolonged standing using an instrumented straight leg raise (iSLR). Ten participants reported a clinically relevant increase (Δ VAS>10mm) in low back pain during prolonged standing. Hamstring extensiblity (leg°(max)), passive stiffness (Nm.°(-1)), and stretch tolerance (VAS; mm) were no different between pain developers and non-pain developers. No changes in hamstring measures were observed following 2-h prolonged standing. No relationship was observed in this study between measures of hamstring extensibility and the reporting of low back pain during prolonged standing. There is no evidence to recommend hamstring extensibility interventions (i.e. passive stretching) as a means of reducing pain reporting in occupations requiring prolonged standing. Copyright © 2012 Elsevier Ltd. All rights reserved.

Death following intravascular administration of contrast media

International Nuclear Information System (INIS)

Shehadi, W.H.

1985-01-01

Adverse reactions to intravascularly administered contrast media preceding death and the autopsy findings in 44 patients are presented. There is a wide scatter of the age distribution of fatal reactions. The highest incidence is in the 50-70 year age group. Similar observations were obtained from the 405 deaths due to contrast media reported to the Food and Drug Administration of the United States. In the same age group the number of reactions is highest, likewise the autopsy findings. The predominant autopsy findings are pulmonary edema, congestion and hemorrhage; arteriosclerosis, both general and coronary. In the younger age group the autopsy findings are limited mostly to the respiratory tract. Fatal reactions to contrast media occur often without warning and most deaths occur within 15 min to 6 hours. Reactions to contrast media occur without relation to sex or age. (orig.)

The Presence or Absence of QTc Prolongation in Buprenorphine-Naloxone Among Youth with Opioid Dependence

Science.gov (United States)

Poole, Sabrina A.; Pecoraro, Anna; Subramaniam, Geetha; Woody, George; Vetter, Victoria L

2015-01-01

Objective To evaluate buprenorphine-naloxone effects on the QTc in youth with opioid dependence. Buprenorphine is a partial agonist that is an effective treatment for opioid dependence. Compared to methadone it has a lower risk of QTc prolongation in adults but is less well studied in youth. It may also reduce the risk for torsades de pointes (TdP) an uncommon variant of polymorphic ventricular tachycardia, that can result in syncope, ventricular fibrillation, and sudden death. Methods Secondary analysis of ECG data from 95 subjects who participated in a multi-site trial for youth with opioid dependence. Subjects were randomized to a 2-week (DETOX), or a 12-week course of buprenorphine-naloxone (BUP). 12-lead ECGs were done at baseline, weeks 4 and 12, and QTc intervals were hand measured and calculated using Bazett's formula. Increases > 60 milliseconds (ms) were considered clinically significant, and readings > 450 ms (males) and 470 ms (females) indicated a prolonged QTc. Results Mean QTc intervals were higher for BUP than DETOX participants at baseline, week 4, and week 12 (p = 0.045), and females had longer mean QTc intervals than males (p DETOX patients. Minimal changes in the QTc were seen at 4 and 12-weeks in a few patients in both groups. There was no evidence that buprenorphine-naloxone alone increased the QTc to a level that increased the risk for TdP. PMID:26690291

Childhood deaths from external causes in Estonia, 2001-2005.

Science.gov (United States)

Väli, Marika; Lang, Katrin; Soonets, Ruth; Talumäe, Marika; Grjibovski, Andrej M

2007-07-17

In 2000, the overall rate of injury deaths in children aged 0-14 was 28.7 per 100000 in Estonia, which is more than 5 times higher than the corresponding rate in neighbouring Finland. This paper describes childhood injury mortality in Estonia by cause and age groups, and validates registration of these deaths in the Statistical Office of Estonia against the autopsy data. The data on causes of all child deaths in Estonia in 2001-2005 were abstracted from the autopsy protocols at the Estonian Bureau of Forensic Medicine. Average annual mortality rates per 100,000 were calculated. Coverage (proportion of the reported injury deaths from the total number of injury deaths) and accuracy (proportion of correctly classified injury deaths) of the registration of causes of death in Statistical Office of Estonia were assessed by comparing the Statistical Office of Estonia data with the data from Estonian Bureau of Forensic Medicine. Average annual mortality from external causes in 0-14 years-old children in Estonia was 19.1 per 100,000. Asphyxia and transport accidents were the major killers followed by poisoning and suicides. Relative contribution of these causes varied greatly between age groups. Intent of death was unknown for more than 10% of injury deaths. Coverage and accuracy of registration of injury deaths by Statistical Office of Estonia were 91.5% and 95.3%, respectively. Childhood mortality from injuries in Estonia is among the highest in the EU. The number of injury deaths in Statistical Office of Estonia is slightly underestimated mostly due to misclassification for deaths from diseases. Accuracy of the Statistical Office of Estonia data was high with some underestimation of intentional deaths. Moreover, high proportion of death with unknown intent suggests underestimation of intentional deaths. Reduction of injury deaths should be given a high priority in Estonia. More information on circumstances around death is needed to enable establishing the intent of death.

A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work.

Science.gov (United States)

Baker, Richelle; Coenen, Pieter; Howie, Erin; Lee, Jeremy; Williamson, Ann; Straker, Leon

2018-07-01

Due to concerns about excessive sedentary exposure for office workers, alternate work positions such as standing are being trialled. However, prolonged standing may have health and productivity impacts, which this study assessed. Twenty adult participants undertook two hours of laboratory-based standing computer work to investigate changes in discomfort and cognitive function, along with muscle fatigue, movement, lower limb swelling and mental state. Over time, discomfort increased in all body areas (total body IRR [95% confidence interval]: 1.47[1.36-1.59]). Sustained attention reaction time (β = 18.25[8.00-28.51]) deteriorated, while creative problem solving improved (β = 0.89[0.29-1.49]). There was no change in erector spinae, rectus femoris, biceps femoris or tibialis anterior muscle fatigue; low back angle changed towards less  lordosis, pelvis movement increased, lower limb swelling increased and mental state decreased. Body discomfort was positively correlated with mental state. The observed changes suggest replacing office work sitting with standing should be done with caution. Practitioner Summary: Standing is being used to replace sitting by office workers; however, there are health risks associated with prolonged standing. In a laboratory study involving 2 h prolonged standing discomfort increased (all body areas), reaction time and mental state deteriorated while creative problem-solving improved. Prolonged standing should be undertaken with caution.

[Maternal death: unequal risks].

Science.gov (United States)

Defossez, A C; Fassin, D

1989-01-01

Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality

Temperature-Related Death and Illness. Chapter 2

Science.gov (United States)

Sarofim, Marcus C.; Saha, Shubhayu; Hawkins, Michelle D.; Mills, David M.; Hess, Jeremy; Horton, Radley; Kinney, Patrick; Schwartz, Joel; St. Juliana, Alexis

2016-01-01

Based on present-day sensitivity to heat, an increase of thousands to tens of thousands of premature heat-related deaths in the summer and a decrease of premature cold-related deaths in the winter are projected each year as a result of climate change by the end of the century. Future adaptation will very likely reduce these impacts (see Changing Tolerance to Extreme Heat Finding). The reduction in cold-related deaths is projected to be smaller than the increase in heat-related deaths in most regions. Days that are hotter than usual in the summer or colder than usual in the winter are both associated with increased illness and death. Mortality effects are observed even for small differences from seasonal average temperatures. Because small temperature differences occur much more frequently than large temperature differences, not accounting for the effect of these small differences would lead to underestimating the future impact of climate change. An increase in population tolerance to extreme heat has been observed over time. Changes in this tolerance have been associated with increased use of air conditioning, improved social responses, and or physiological acclimatization, among other factors. Expected future increases in this tolerance will reduce the projected increase in deaths from heat. Older adults and children have a higher risk of dying or becoming ill due to extreme heat. People working outdoors, the socially isolated and economically disadvantaged, those with chronic illnesses, as well as some communities of color, are also especially vulnerable to death or illness.

75 deaths in asthmatics prescribed home nebulisers.

Science.gov (United States)

Sears, M R; Rea, H H; Fenwick, J; Gillies, A J; Holst, P E; O'Donnell, T V; Rothwell, R P

1987-02-21

The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.

Geographical diversity of cause-of-death patterns and trends in Russia

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Vladimir Shkolnikov

2005-06-01

Full Text Available This paper performs a systematic analysis of all currently available Russian data on mortality by region, census year (1970, 1979, 1989, and 1994 and cause of death. It investigates what links may be found between these geographical variations in cause-specific mortality, the negative general trends observed since 1965, and the wide fluctuations of the last two decades. For that, four two-year periods of observation were selected where it was possible to calculate fairly reliable mortality indicators by geographic units using census data for 1970, 1979, 1989, and micro-census data for 1994, and used a clustering model. Behind the complexity of the studied universe, three main conclusions appeared. Firstly, in European Russia, there is a stark contrast between south-west and north-east, both in terms of total mortality and of cause-of-death patterns. Secondly, analysis of overall cause-of-death patterns for all periods combined clearly confirms that contrast at the whole country level by the prolongation of the southern part of European Russia through the continuation of the black soil ("chernoziom" belt along the Kazakhstan border, while the rest of Siberia presents a radically different picture to European Russia. Thirdly, while it is difficult to infer any permanent geographical pattern of mortality from that very fluctuating piece of history, 1988-89 appears to be a base period for at least the entire period from 1969-1994.

Representations of Death in a Changing World: An Anthropological Perusal of Death Rites of Gurungs in Nepal

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Prakash Upadhyay

2015-12-01

Full Text Available People have developed ceremonies and rituals to help make sense or celebrate an alteration in position, circumstance or relationship. However, over time some have become diluted or rejected for whom they are intended. In majority of cultures, the greatest effort is given to the death rite of passage– and yet paradoxically it is the one that is now most often distorted or lost. This study attempted to describe the multiple aspects of changes that are occurring in Gurung death rite. Gurungs are followers of ‘Bonism’ but they are under the profound influence of Tibetan Mahayani Lamaism. Gurung community is changing from Mechanical to Organic Solidarity in which the Mechanical Unity of their traditional culture is transforming to loosely united Organic Solidarity of body. Gurung death rites have been influenced by many rudiments--migration, urbanization and modernization due to which there has been the emergence of deformed usages and behaviors in death rite. Urbanization impact on death rite is closely linked to modernization and the sociological process of rationalization, a speedy and historic transformation of Gurung social roots whereby predominantly rural Gurung culture is being rapidly modified by urban ostentatious culture. However, there is very vital element of unity, cooperation, sympathy and we feeling among the Gurungs owing to death rite that has tied all Gurungs under a shared and endorsed bond. It has created a reciprocal relationship between the living and dead-- both depending upon each other. Death rituals have been a means of co-ordination creating solidarity through ‘Syaisyai’ which is a social institution for uniting the Gurungs. This bond between giver and gift, the act of giving creates a social bond in Gurung community with an obligation to reciprocate on part of the recipient.

Life Experience with Death: Relation to Death Attitudes and to the Use of Death-Related Memories

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Bluck, Susan; Dirk, Judith; Mackay, Michael M.; Hux, Ashley

2008-01-01

The study examines the relation of death experience to death attitudes and to autobiographical memory use. Participants (N = 52) completed standard death attitude measures and wrote narratives about a death-related autobiographical memory and (for comparison) a memory of a low point. Self-ratings of the memory narratives were used to assess their…

Incidence of death from congenital toxoplasmosis in 0-4-year-old children in Japan.

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Hoshino, Tatsuji; Kita, Masato; Imai, Yukihiro; Yamakawa, Masaru

2014-08-01

Congenital toxoplasmosis is caused by Toxoplasma gondii. The incidence of death due to congenital toxoplasmosis in Japan from 1974 to 2007 was calculated using the autopsy database of the Japanese Society of Pathology and vital statistics from the Ministry of Health, Labour and Welfare. Two neonatal deaths due to congenital toxoplasmosis were reported during that time. As there were 161,195 neonatal deaths during this period and 32,465 autopsies were performed, the yearly neonatal death from congenital toxoplasmosis was calculated as 2 × 161,195/32,465/34 = 0.29 and the autopsy rate as 32,465/161,195 = 0.2014 (20.14%). The calculated number of annual deaths in infants was 0.82 and in children aged 1-4 years it was 2.09; thus, although few, deaths from congenital toxoplasmosis do still occur in neonates, infants, and young children. Therefore, obstetricians and pediatricians should be aware of the potential for congenital toxoplasmosis, and pregnant women should make every effort to avoid T. gondii infection. © 2014 Japan Pediatric Society.

The unfolding counter-transition in rural South Africa: mortality and cause of death, 1994-2009.

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Brian Houle

Full Text Available The HIV pandemic has led to dramatic increases and inequalities in adult mortality, and the diffusion of antiretroviral treatment, together with demographic and socioeconomic shifts in sub-Saharan Africa, has further changed mortality patterns. We describe all-cause and cause-specific mortality patterns in rural South Africa, analyzing data from the Agincourt health and socio-demographic surveillance system from 1994 to 2009 for those aged 5 years and older. Mortality increased during that period, particularly after 2002 for ages 30-69. HIV/AIDS and TB deaths increased and recently plateaued at high levels in people under age 60. Noncommunicable disease deaths increased among those under 60, and recently also increased among those over 60. There was an inverse gradient between mortality and household SES, particularly for deaths due to HIV/AIDS and TB and noncommunicable diseases. A smaller and less consistent gradient emerged for deaths due to other communicable diseases. Deaths due to injuries remained an important mortality risk for males but did not vary by SES. Rural South Africa continues to have a high burden of HIV/AIDS and TB mortality while deaths from noncommunicable diseases have increased, and both of these cause-categories show social inequalities in mortality.

The Spectrum of Epidemiology Underlying Sudden Cardiac Death

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Hayashi, Meiso; Shimizu, Wataru; Albert, Christine M.

2015-01-01

Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15–20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who suffer a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly due to inherited disorders. Coronary heart disease (CHD) is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. Over the past three decades, declines in SCD rates have not been as steep as for other causes of CHD deaths, and there is a growing fraction of SCDs not due to CHD and/or ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition prior to death. Multifaceted preventative approaches, which address risk factors in seemingly low risk and known high-risk populations will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies. PMID:26044246

Death from Nitrous Oxide.

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Bäckström, Björn; Johansson, Bengt; Eriksson, Anders

2015-11-01

Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available. © 2015 American Academy of Forensic Sciences.

FEASIBILITY AND EFFECTIVENESS OF DYADIC PROLONGED EXPOSURE INTERVENTION FOR PREVENTING POSTTRAUMATIC GRIEF IN YOUNG CHILDREN: A CASE REPORT OF TWO SIBLINGS.

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Rachamim, Lilach

2017-09-01

This article highlights the feasibility of a dyadic prolonged exposure (DPE) intervention (L. Rachamim, I. Mirochnik, L. Helpman, N. Nacasch, & E. Yadin, ) in a 3-year-old preschooler and in a 6-year-old kindergartener immediately following the traumatic death of their younger sibling. It presents a detailed case description of the DPE treatment addressing traumatic grief and includes transcribed treatment dialogue. At the time of treatment termination, both children and caregivers resumed normal functioning. The results suggest that DPE intervention may ameliorate posttraumatic grief symptoms in young children. Controlled studies of preventive interventions for this population are clearly warranted. © 2017 Michigan Association for Infant Mental Health.

A case of death of the driver due to environmental asphyxia by liquid nitrogen leakage in the cabin of the car during a road accident

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Raczkowska, Zuzanna; Samojłowicz, Dorota

2013-01-01

Nitrogen causes environmental asphyxia by displacing oxygen in the air leading to death. The study presents a case of a death of a driver death who was transporting flasks with liquid nitrogen that depressurized during an accident. The mechanism and cause of death were determined based on the result of the autopsy and histopathologic examination. The authors emphasize the relevance of accident scene inspection during establishing the cause of death in similar cases.

Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment

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2014-01-01

Background Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women’s experiences of prolonged and normal labour. Method Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women’s feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours. Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement ‘My birth experience made me decide not to have any more children’ (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement ‘It was exiting to give birth’ (OR 0.13, 95% CI 0.34-0.5). Conclusions There is need for increased clinical skill in identification and classification

End of life care in chronic obstructive pulmonary disease: in search of a good death

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Anna Spathis

2008-03-01

Full Text Available Anna Spathis, Sara BoothPalliative Care Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UKAbstract: Chronic obstructive pulmonary disease (COPD is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation. There is increasing evidence that the end of life needs of those with advanced COPD are not being met by existing services. Many barriers hinder the provision of good end of life care in COPD, including the inherent difficulties in determining prognosis. This review provides an evidence-based approach to overcoming these barriers, summarising current evidence and highlighting areas for future research. Topics include end of life needs, symptom control, advance care planning, and service development to improve the quality of end of life care.Keywords: chronic obstructive pulmonary disease (MeSH, palliative care (MeSH, dyspnoea (MeSH, advance care planning (MeSH

Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study.

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Gatt, Moshe E; Paltiel, Ora; Bursztyn, Michael

2004-03-01

Prolonged immobilization and advanced age are considered to be important risk factors for venous thromboembolism (VTE). Nevertheless, the need for VTE prophylaxis in long-term bedridden patients is not known. To assess whether very prolonged immobilization (i.e. over three months) carries an increased risk for clinically apparent VTE, we performed a historical-cohort study of nursing home residents during a ten-year period. Data concerning patient's mobility and incidence of overt deep vein thrombosis or pulmonary embolism were registered. The mean resident age was 85+/-8.4 years. Eighteen mobile and eight immobile patients were diagnosed with clinically significant thromboembolic events, during 1137 and 573 patient-years of follow up, respectively. The incidence of venous thromboembolic events was similar in both chronically immobilized and mobile patient groups, 13.9 and 15.8 per thousand patient years, respectively (p=0.77). The rate ratio for having a VTE event in the immobilized patient group as compared with the mobile group was 0.88 (95% Confidence Interval (CI) 0.33 to 2.13). When taking into account baseline characteristics, risk factors and death rates by various causes, no differences were found between the two groups. In conclusion, chronically immobile bedridden patients are no more prone to clinically overt venous thromboembolic events than institutionalized mobile patients. Until further studies are performed concerning the impact of very prolonged immobilization on the risk of VTE, there is no evidence to support primary prevention after the first three months of immobilization. Evidence for efficacy or cost effectiveness beyond this early period is not available.

Quantitative risk assessment of listeriosis-associated deaths due to Listeria monocytogenes contamination of deli meats originating from manufacture and retail.

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Pradhan, Abani K; Ivanek, Renata; Gröhn, Yrjö T; Bukowski, Robert; Geornaras, Ifigenia; Sofos, John N; Wiedmann, Martin

2010-04-01

The objective of this study was to estimate the relative risk of listeriosis-associated deaths attributable to Listeria monocytogenes contamination in ham and turkey formulated without and with growth inhibitors (GIs). Two contamination scenarios were investigated: (i) prepackaged deli meats with contamination originating solely from manufacture at a frequency of 0.4% (based on reported data) and (ii) retail-sliced deli meats with contamination originating solely from retail at a frequency of 2.3% (based on reported data). Using a manufacture-to-consumption risk assessment with product-specific growth kinetic parameters (i.e., lag phase and exponential growth rate), reformulation with GIs was estimated to reduce human listeriosis deaths linked to ham and turkey by 2.8- and 9-fold, respectively, when contamination originated at manufacture and by 1.9- and 2.8-fold, respectively, for products contaminated at retail. Contamination originating at retail was estimated to account for 76 and 63% of listeriosis deaths caused by ham and turkey, respectively, when all products were formulated without GIs and for 83 and 84% of listeriosis deaths caused by ham and turkey, respectively, when all products were formulated with GIs. Sensitivity analyses indicated that storage temperature was the most important factor affecting the estimation of per annum relative risk. Scenario analyses suggested that reducing storage temperature in home refrigerators to consistently below 7 degrees C would greatly reduce the risk of human listeriosis deaths, whereas reducing storage time appeared to be less effective. Overall, our data indicate a critical need for further development and implementation of effective control strategies to reduce L. monocytogenes contamination at the retail level.

Cause-specific mortality among children and young adults with epilepsy: Results from the U.S. National Child Death Review Case Reporting System ☆

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Tian, Niu; Shaw, Esther C.; Zack, Matthew; Kobau, Rosemarie; Dykstra, Heather; Covington, Theresa M.

2015-01-01

We investigated causes of death in children and young adults with epilepsy by using data from the U.S. National Child Death Review Case Reporting System (NCDR-CRS), a passive surveillance system composed of comprehensive information related to deaths reviewed by local child death review teams. Information on a total of 48,697 deaths in children and young adults 28 days to 24 years of age, including 551 deaths with epilepsy and 48,146 deaths without epilepsy, was collected from 2004 through 2012 in 32 states. In a proportionate mortality analysis by official manner of death, decedents with epilepsy had a significantly higher percentage of natural deaths but significantly lower percentages of deaths due to accidents, homicide, and undetermined causes compared with persons without epilepsy. With respect to underlying causes of death, decedents with epilepsy had significantly higher percentages of deaths due to drowning and most medical conditions including pneumonia and congenital anomalies but lower percentages of deaths due to asphyxia, weapon use, and unknown causes compared with decedents without epilepsy. The increased percentages of deaths due to pneumonia and drowning in children and young adults with epilepsy suggest preventive interventions including immunization and better instruction and monitoring before or during swimming. State-specific and national population-based mortality studies of children and young adults with epilepsy are recommended. PMID:25794682

Prolonged particulate chromate exposure does not inhibit homologous recombination repair in North Atlantic right whale (Eubalaena glacialis) lung cells.

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Browning, Cynthia L; Wise, Catherine F; Wise, John Pierce

2017-09-15

Chromosome instability is a common feature of cancers that forms due to the misrepair of DNA double strand breaks. Homologous recombination (HR) repair is a high fidelity DNA repair pathway that utilizes a homologous DNA sequence to accurately repair such damage and protect the genome. Prolonged exposure (>72h) to the human lung carcinogen, particulate hexavalent chromium (Cr(VI)), inhibits HR repair, resulting in increased chromosome instability in human cells. Comparative studies have shown acute Cr(VI) exposure induces less chromosome damage in whale cells than human cells, suggesting investigating the effect of this carcinogen in other species may inform efforts to prevent Cr(VI)-induced chromosome instability. Thus, the goal of this study was to determine the effect of prolonged Cr(VI) exposure on HR repair and clastogenesis in North Atlantic right whale (Eubalaena glacialis) lung cells. We show particulate Cr(VI) induces HR repair activity after both acute (24h) and prolonged (120h) exposure in North Atlantic right whale cells. Although the RAD51 response was lower following prolonged Cr(VI) exposure compared to acute exposure, the response was sufficient for HR repair to occur. In accordance with active HR repair, no increase in Cr(VI)-induced clastogenesis was observed with increased exposure time. These results suggest prolonged Cr(VI) exposure affects HR repair and genomic stability differently in whale and human lung cells. Future investigation of the differences in how human and whale cells respond to chemical carcinogens may provide valuable insight into mechanisms of preventing chemical carcinogenesis. Copyright © 2017. Published by Elsevier Inc.

AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings.

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Hughes, Nancy L; Nelson, Audrey; Matz, Mary W; Lloyd, John

2011-06-01

Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology. Published by Elsevier Inc.

Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states

International Nuclear Information System (INIS)

Jaruskova, M.; Belohlavek, O.

2006-01-01

The role of FDG-PET and PET/CT in patients whose main symptom is prolonged fever has not yet been defined. We addressed this topic in a retrospective study. A total of 124 patients (referred between May 2001 and December 2004) with fever of unknown origin or prolonged fever due to a suspected infection of a joint or vascular prosthesis were included in the study. The patients underwent either FDG-PET or FDG-PET/CT scanning. Sixty-seven patients had a negative focal FDG-PET finding; in this group the method was regarded as unhelpful in determining a diagnosis, and no further investigation was pursued. We tried to obtain clinical confirmation for all patients with positive PET findings. Fifty-seven (46%) patients had positive FDG-PET findings. In six of them no further clinical information was available. Fifty-one patients with positive PET findings and 118 patients in total were subsequently evaluated. Systemic connective tissue disease was confirmed in 17 patients, lymphoma in three patients, inflammatory bowel disease in two patients, vascular prosthesis infection in seven patients, infection of a hip or knee replacement in seven patients, mycotic aneurysm in two patients, abscess in four patients and AIDS in one patient. In eight (16%) patients the finding was falsely positive. FDG-PET or PET/CT contributed to establishing a final diagnosis in 84% of the 51 patients with positive PET findings and in 36% of all 118 evaluated patients with prolonged fever. (orig.)

The difficulties of conducting maternal death reviews in Malawi

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van den Broek Nynke

2008-09-01

Full Text Available Abstract Background Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. Methods SWOT (strengths, weaknesses, opportunities and threats analysis of the process of maternal death review during a workshop in Malawi. Results Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Conclusion Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.

The difficulties of conducting maternal death reviews in Malawi.

Science.gov (United States)

Kongnyuy, Eugene J; van den Broek, Nynke

2008-09-11

Maternal death reviews is a tool widely recommended to improve the quality of obstetric care and reduce maternal mortality. Our aim was to explore the challenges encountered in the process of facility-based maternal death review in Malawi, and to suggest sustainable and logically sound solutions to these challenges. SWOT (strengths, weaknesses, opportunities and threats) analysis of the process of maternal death review during a workshop in Malawi. Strengths: Availability of data from case notes, support from hospital management, and having maternal death review forms. Weaknesses: fear of blame, lack of knowledge and skills to properly conduct death reviews, inadequate resources and missing documentation. Opportunities: technical assistance from expatriates, support from the Ministry of Health, national protocols and high maternal mortality which serves as motivation factor. Threats: Cultural practices, potential lawsuit, demotivation due to the high maternal mortality and poor planning at the district level. Solutions: proper documentation, conducting maternal death review in a blame-free manner, good leadership, motivation of staff, using guidelines, proper stock inventory and community involvement. Challenges encountered during facility-based maternal death review are provider-related, administrative, client related and community related. Countries with similar socioeconomic profiles to Malawi will have similar 'pull-and-push' factors on the process of facility-based maternal death reviews, and therefore we will expect these countries to have similar potential solutions.

Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

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Christina Bognet

2011-12-01

Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

Cell Death Conversion under Hypoxic Condition in Tumor Development and Therapy

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Yu Qiu

2015-10-01

Full Text Available Hypoxia, which is common during tumor progression, plays important roles in tumor biology. Failure in cell death in response to hypoxia contributes to progression and metastasis of tumors. On the one hand, the metabolic and oxidative stress following hypoxia could lead to cell death by triggering signal cascades, like LKB1/AMPK, PI3K/AKT/mTOR, and altering the levels of effective components, such as the Bcl-2 family, Atg and p62. On the other hand, hypoxia-induced autophagy can serve as a mechanism to turn over nutrients, so as to mitigate the adverse condition and then avoid cell death potentially. Due to the effective role of hypoxia, this review focuses on the crosstalk in cell death under hypoxia in tumor progression. Additionally, the illumination of cell death in hypoxia could shed light on the clinical applications of cell death targeted therapy.

Fire deaths in aircraft without the crashworthy fuel system.

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Springate, C S; McMeekin, R R; Ruehle, C J

1989-10-01

Cases reported to the Armed Forces Institute of Pathology were examined for occupants of helicopters without the crashworthy fuel system (CWFS) who survived crashes but died as a result of postcrash fires. There were 16 fire deaths in the 9 such accidents which occurred between January 1976 and April 1984. All of these victims would have survived if there had been no postcrash fire. Partial body destruction by fire probably prevented inclusion of many other cases. The dramatic reduction in fire deaths and injuries due to installation of the CWFS in Army helicopters is discussed. The author concludes that fire deaths and injuries in aircraft accidents could almost be eliminated by fitting current and future aircraft with the CWFS.

The death of Wolfgang Amadeus Mozart: an epidemiologic perspective.

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Zegers, Richard H C; Weigl, Andreas; Steptoe, Andrew

2009-08-18

The early death of the composer Wolfgang Amadeus Mozart on 5 December 1791 has fascinated the world for more than 2 centuries. It has been suggested that his final illness was caused by poisoning, renal failure, Henoch-Schönlein purpura, trichinosis, and many other conditions. The official daily register of deaths in Mozart's Vienna was evaluated to provide an epidemiologic framework into which the observations of contemporary witnesses of his death can be integrated. All recorded deaths in Vienna during November and December 1791 and January 1792 were analyzed, together with the corresponding periods in 1790 to 1791 and 1792 to 1793. The deaths of 5011 adults (3442 men, 1569 women) were recorded over these periods. The mean ages of death were 45.5 years (SD, 18.5) for men and 54.5 years (SD, 19.9) for women. Tuberculosis and related conditions accounted for the highest number of deaths; cachexia and malnutrition ranked second, and edema was the third most common cause. According to eyewitness accounts, the hallmark of Mozart's final disease was severe edema. Deaths from edema were markedly increased among younger men in the weeks surrounding Mozart's death compared with the previous and following years. This minor epidemic may have originated in the military hospital. Our analysis is consistent with Mozart's last illness and death being due to a streptococcal infection leading to an acute nephritic syndrome caused by poststreptococcal glomerulonephritis. Scarlet fever, which represents the same underlying disease from an etiologic perspective, is a less likely possibility.

Circadian Stress Regimes Affect the Circadian Clock and Cause Jasmonic Acid-Dependent Cell Death in Cytokinin-Deficient Arabidopsis Plants[OPEN

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Nitschke, Silvia; Cortleven, Anne; Iven, Tim; Havaux, Michel; Schmülling, Thomas

2016-01-01

The circadian clock helps plants measure daylength and adapt to changes in the day-night rhythm. We found that changes in the light-dark regime triggered stress responses, eventually leading to cell death, in leaves of Arabidopsis thaliana plants with reduced cytokinin levels or defective cytokinin signaling. Prolonged light treatment followed by a dark period induced stress and cell death marker genes while reducing photosynthetic efficiency. This response, called circadian stress, is also characterized by altered expression of clock and clock output genes. In particular, this treatment strongly reduced the expression of CIRCADIAN CLOCK ASSOCIATED1 (CCA1) and LATE ELONGATED HYPOCOTYL (LHY). Intriguingly, similar changes in gene expression and cell death were observed in clock mutants lacking proper CCA1 and LHY function. Circadian stress caused strong changes in reactive oxygen species- and jasmonic acid (JA)-related gene expression. The activation of the JA pathway, involving the accumulation of JA metabolites, was crucial for the induction of cell death, since the cell death phenotype was strongly reduced in the jasmonate resistant1 mutant background. We propose that adaptation to circadian stress regimes requires a normal cytokinin status which, acting primarily through the AHK3 receptor, supports circadian clock function to guard against the detrimental effects of circadian stress. PMID:27354555

Amplitude chimeras and chimera death in dynamical networks

International Nuclear Information System (INIS)

Zakharova, Anna; Kapeller, Marie; Schöll, Eckehard

2016-01-01

We find chimera states with respect to amplitude dynamics in a network of Stuart- Landau oscillators. These partially coherent and partially incoherent spatio-temporal patterns appear due to the interplay of nonlocal network topology and symmetry-breaking coupling. As the coupling range is increased, the oscillations are quenched, amplitude chimeras disappear and the network enters a symmetry-breaking stationary state. This particular regime is a novel pattern which we call chimera death. It is characterized by the coexistence of spatially coherent and incoherent inhomogeneous steady states and therefore combines the features of chimera state and oscillation death. Additionally, we show two different transition scenarios from amplitude chimera to chimera death. Moreover, for amplitude chimeras we uncover the mechanism of transition towards in-phase synchronized regime and discuss the role of initial conditions. (paper)

Physiology Of Prolonged Bed Rest

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Greenleaf, John E.

1991-01-01

Report describes physiological effects of prolonged bed rest. Rest for periods of 24 hours or longer deconditions body to some extent; healing proceeds simultaneously with deconditioning. Report provides details on shifts in fluid electrolytes and loss of lean body mass, which comprises everything in body besides fat - that is, water, muscle, and bone. Based on published research.

Rates of intentionally caused and road crash deaths of US citizens abroad.

Science.gov (United States)

Sherry, Melissa K; Mossallam, Mahmoud; Mulligan, Matthew; Hyder, Adnan A; Bishai, David

2015-04-01

Currently, little is known about rates of death by cause and country among US travellers. Understanding the risk by cause and country is imperative to risk communication and the development of risk reduction strategies. Publicly available data on non-natural deaths of US citizens abroad were gathered from January 2003 to December 2009 from the US Department of State's Department Bureau of Consular Affairs. Traveller information was gathered from the US Department of Commerce Office of Travel and Tourism for the same time period. Rates of death were calculated by dividing the number of non-natural deaths of US citizens abroad by the number of US outbound visits for each country. A total of 5417 non-natural death events were retrieved between 2003 and 2009 from the US State Department. Intentionally caused death rates ranged from 21.44 per 1 000 000 visits in the Philippines to 0 per 1 000 000 visits in several countries; the majority of countries had fewer than five intentionally caused deaths per 1 000 000 visits. Rates of road traffic crashes were higher than rates of intentionally caused deaths in almost every instance. Thailand had the highest rate of deaths due to road traffic crashes (16.49 per 1 000 000), followed by Vietnam, Morocco and South Africa (15.12 per 1 000 000, 11.96 per 1 000 000 and 10.90 per 1 000 000, respectively). Motorcycle deaths account for most of the heightened risk observed in Thailand and Vietnam. The leading cause of non-natural deaths in US travellers abroad was road crashes, which exceeds intentional injury as the leading cause of non-natural deaths in almost every country where US citizens travel. Southeast Asia had the highest unintentional injury death rates for US citizens abroad due to the high rates of deaths from motorcycle crashes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Quality insights of university teachers on dying, death, and death education.

Science.gov (United States)

Mak, Mui-Hing June

One of the main responsibilities of teachers is to help individual students cope with life difficulties such as grief following a death. However, very little research explores teachers' views on death, dying, and how they handle grief and loss in schools. This study aims to explore university teachers' knowledge and attitudes on dying, death, and death education. Fifteen university teachers were recruited using a qualitative method. This study reveals that most teachers' views on death and related issues are largely affected by their death experiences, religious beliefs, professional background, and the mass media. Although they have a general negative response toward death and dying, some teachers begin to affirm their meanings of life and death. Most teachers agree that they do not feel adequate about managing and teaching on life and death issues, so they strongly support including death education in the formal programs in Hong Kong.

The badness of death and priorities in health.

Science.gov (United States)

Solberg, Carl Tollef; Gamlund, Espen

2016-04-14

The state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities. Two questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, 'When is the worst time to die?' A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die. Deprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global

Unusual death due to a bleeding from a varicose vein: a case report

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Fragkouli Kleio

2012-09-01

Full Text Available Abstract Background Varicose veins are a common entity presenting a worldwide distribution. Although they are usually benign, sometimes are proved to be a threatening condition. Massive hemorrhage is an unusual complication of this common venous pathology that demands immediate medical intervention. Case presentation We present a case of a 66-year-old woman found dead in her house surrounded by a large quantity of blood. Autopsy revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein, signs of exsanguinations and liver cirrhosis. Toxicological analysis was negative. Conclusion Massive hemorrhage from a ruptured varicosity is a severe medical emergency. Awareness of the risk of massive hemorrhage may provoke preventive treatment to be undertaken so as terminal loss of consciousness and a subsequent unattended death to be averted.

Trends in fatalities due to poisoning at Umtata General Hospital, Mthatha (1993–2005

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Banwari L. Meel

2009-08-01

Full Text Available Poisoning is a common method of committing suicide in this region of South Africa. Females generally ingest poisons but it is increasingly becoming common in males too. This is a record review of autopsies carried out at the Umtata (Mthatha General Hospital mortuary, which forms part of the teaching hospital of the Walter Sisulu University Medical School. There were 10 230 unnatural deaths between 1993 and 2005. Of these deaths, 161 (1.6% were deaths due to poisoning. There was a marked increase in death by poisoning from 2.5% in 1993 to 13.7% in 2004. The highest percentage (17.4% of poison-related deaths was in 2001, and the lowest (2.5% was in 1993 and 1994. About two-thirds of victims (66% were males, and more than half of the victims (51.5% were in the 11 to 30 age group. There is an increasing trend in fatalities due to poisoning at Umtata General Hospital, Mthatha.

Lower air temperature is associated with ambulance transports and death in Takamatsu area, Japan.

Science.gov (United States)

Mochimasu, Kazumi Dokai; Miyatake, Nobuyuki; Tanaka, Naoko; Kinoshita, Hiroshi

2014-07-01

The aim of this study was to investigate the linkage among ambulance transports, the number of death and air temperature in Takamatsu area, Japan. Monthly data of ambulance transports (total and acute disease) and the number of death from 2004 to 2012 were obtained from Fire Department Service in Takamatsu and Takamatsu city official website, Japan. Climate parameters for required period were also obtained from Japan Meteorological Agency. Population data in Takamatsu area were also used to adjust ambulance transports and the number of death. The linkage among ambulance transports, the number of death and climate parameters was evaluated by ecological analysis. Total ambulance transports (/a hundred thousand people/day) and ambulance transports due to acute disease (/a hundred thousand people/day) were 12.3 ± 0.9 and 6.8 ± 0.7, respectively. The number of death (/a hundred thousand people/day) was 2.5 ± 0.4. By quadratic curve, ambulance transports due to acute disease and the number of death were significantly correlated with the parameters of air temperature. However, the number of death was the highest in January and the lowest in August. Although higher air temperature was only associated with higher ambulance transports, lower air temperature was associated with both higher ambulance transports and the number death in Takamatsu area, Japan.

[Secondary traumatization/trauma among employees in palliative care units--the products of prolonged repeated exposure to suffering and death].

Science.gov (United States)

Samson, Tali; Shvartzman, Pesach

2012-11-01

The palliative care philosophy accepts the dying process as a natural phase in the life cycle and provides quality end of life care for terminal patients and their family members. Prolonged exposure to the physical symptoms and pain, as well as the psychological, spiritual, and existential suffering of the dying patient, may be fertile ground for the development of post-traumatic stress symptoms among palliative care teams. Work-related positive outcomes (such as compassion, satisfaction and meaning) and work-related negative outcomes (such as compassion fatigue, secondary traumatization and burnout) can exist side by side, and the unique balance between them will determine the quality of life of the worker. This review presents the current knowledge about the prevalence and causes of work-related stress outcomes among palliative care teams and measurement tools that are available. The literature review discusses secondary traumatization in palliative care teams and relevant messages for the development of treatment options, burnout prevention programs and support interventions for professionals who lead the care for terminal patients in Israel.

Surveillance of maritime deaths on board Danish merchant ships, 1986-2009.

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Borch, Daniel F; Hansen, Henrik L; Burr, Hermann; Jepsen, Jørgen R

2012-01-01

A previous study demonstrated a high death rate among seafarers signed on Danish ships during the years 1986-1993. This study aimed to examine and analyse the subsequent development until 2009. A total of 356 fatalities were identified from data supplied from the Danish Maritime Authority, an insurance company, and other sources. Maritime deaths among seafarers signed on Danish ships comprise deaths from 1) accidents, suicides and homicides; and 2) disease on board. Deaths due to 2) occurring ashore within 30 days after signing off were included. The overall and mode-specific death rates were calculated for three eight-year observation periods. The rates for work-related fatal accidents were compared with the rates for land-based trades. All categories of maritime deaths were significantly reduced from 1986 to 2009 - in particular during the last eight-year period (Accidents 1986-1993: 66.6 per 100,000 person years, 2002-2009: 27.0 per 100,000 person years, diseases 49.5-26.1, suicides 14.4-7.8). In spite of the remarkable improvement since 1986, seafarers remain in 2002-2009 more than six times more likely to die from occupational accidents (including shipwrecks) than do workers ashore. The favourable trend of maritime deaths in the Danish merchant fleet may be due to 1) preventive measures - e.g. interventions relating to vessel safety, work environment, and improved medical care on board - and to 2) technological and organizational changes - e.g. newer and larger vessels in the Danish merchant fleet, changed composition of the workforce, and reduced shore leaves. The persisting excess risk warrants further preventive actions.

20 CFR 410.471 - Conclusion by physician regarding miner's disability or death.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Conclusion by physician regarding miner's disability or death. 410.471 Section 410.471 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Total Disability or Death Due to Pneumoconiosis § 410.471 Conclusion...

Observation of prolonged coherence time of the collective spin wave of an atomic ensemble in a paraffin-coated 87Rb vapor cell

International Nuclear Information System (INIS)

Jiang Shuo; Luo Xiaoming; Chen Liqing; Ning Bo; Chen Shuai; Wang Jingyang; Zhong Zhiping; Pan Jianwei

2009-01-01

We report a prolonged coherence time of the collective spin wave of a thermal 87 Rb atomic ensemble in a paraffin-coated cell. The spin wave is prepared through a stimulated Raman process. The long coherence time is achieved by prolonging the lifetime of the spins with paraffin coating and minimize dephasing with optimal experimental configuration. The observation of the long-time-delayed-stimulated Stokes signal in the writing process suggests the prolonged lifetime of the prepared spins; a direct measurement of the decay of anti-Stokes signal in the reading process shows the coherence time is up to 300 μs after minimizing dephasing. This is 100 times longer than the reported coherence time in the similar experiments in thermal atomic ensembles based on the Duan-Lukin-Cirac-Zoller and its improved protocols. This prolonged coherence time sets the upper limit of the memory time in quantum repeaters based on such protocols, which is crucial for the realization of long-distance quantum communication. The previous reported fluorescence background in the writing process due to collision in a sample cell with buffer gas is also reduced in a cell without buffer gas.

Time course of cell death due to acoustic overstimulation in the mouse medial geniculate body and primary auditory cortex

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Felix Frohlich

2017-01-01

Full Text Available It has previously been shown that acoustic overstimulation induces cell death and extensive cell loss in key structures of the central auditory pathway. A correlation between noise-induced apoptosis and cell loss was hypothesized for the cochlear nucleus and colliculus inferior. To determine the role of cell death in noise-induced cell loss in thalamic and cortical structures, the present mouse study (NMRI strain describes the time course following noise exposure of cell death mechanisms for the ventral medial geniculate body (vMGB, medial MGB (mMGB, and dorsal MGB (dMGB and the six histological layers of the primary auditory cortex (AI 1–6. Therefore, a terminal deoxynucleotidyl transferase dioxyuridine triphosphate nick-end labeling assay (TUNEL was performed in these structures 24 h, 7 days, and 14 days after noise exposure (3 h, 115 dB sound pressure level, 5–20 kHz, as well as in unexposed controls. In the dMGB, TUNEL was statistically significant elevated 24 h postexposure. AI-1 showed a decrease in TUNEL after 14 days. There was no statistically significant difference between groups for the other brain areas investigated. dMGB’s widespread connection within the central auditory pathway and its nontonotopical organization might explain its prominent increase in TUNEL compared to the other MGB subdivisions and the AI. It is assumed that the onset and peak of noise-induced cell death is delayed in higher areas of the central auditory pathway and takes place between 24 h and 7 days postexposure in thalamic and cortical structures.

Causes of death among street-connected children and youth in Eldoret, Kenya.

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Embleton, Lonnie; Ayuku, David; Makori, Dominic; Kamanda, Allan; Braitstein, Paula

2018-05-15

Street-connected young people carry a disproportionate burden of morbidities, and engage in a variety of practices that may heighten their risk of premature mortality, yet there are currently no reports in the literature on the rates or risk factors for mortality among them, nor on their causes of death. In low- and middle-income countries they are frequently in situations that violate their human rights, likely contributing to their increased burden of morbidities and vulnerability to mortality. We thus sought to describe the number of deaths annually, causes of death, and determine the number of deaths attributable to HIV among street-connected young people aged 0 to 30 years in Eldoret, Kenya. Eldoret, Kenya has approximately 1900 street-connected young people. We collected data on deaths occurring from October 2009 to December 2016 from Moi Teaching and Referral Hospital records, Academic Model Providing Access to Healthcare HIV program records, and utilized verbal autopsies when no records were available. Descriptive analyses were conducted stratified by sex and age category, and frequencies and proportions were calculated to provide an overview of the decedents. We used logistic regression to assess the association between underlying cause of death and sex, while controlling for age and location of death. In total there were 100-recorded deaths, 66 among males and 34 among females; 37% of were among those aged ≤18 years. HIV/AIDS (37%) was the most common underlying cause of death, followed by assault (36%) and accidents (10%) for all decedents. Among males, the majority of deaths were attributable to assault (49%) and HIV/AIDS (26%), while females primarily died due to HIV/AIDS (59%). Our results demonstrate a high number of deaths due to assault among males and HIV/AIDS among males and females. Our findings demonstrate the need for studies of HIV prevalence and incidence among this population to characterize the burden of HIV, particularly among young

Prolonged exposure to particulate chromate inhibits RAD51 nuclear import mediator proteins.

Science.gov (United States)

Browning, Cynthia L; Wise, John Pierce

2017-09-15

Particulate hexavalent chromium (Cr(VI)) is a human lung carcinogen and a human health concern. The induction of structural chromosome instability is considered to be a driving mechanism of Cr(VI)-induced carcinogenesis. Homologous recombination repair protects against Cr(VI)-induced chromosome damage, due to its highly accurate repair of Cr(VI)-induced DNA double strand breaks. However, recent studies demonstrate Cr(VI) inhibits homologous recombination repair through the misregulation of RAD51. RAD51 is an essential protein in HR repair that facilitates the search for a homologous sequence. Recent studies show prolonged Cr(VI) exposure prevents proper RAD51 subcellular localization, causing it to accumulate in the cytoplasm. Since nuclear import of RAD51 is crucial to its function, this study investigated the effect of Cr(VI) on the RAD51 nuclear import mediators, RAD51C and BRCA2. We show acute (24h) Cr(VI) exposure induces the proper localization of RAD51C and BRCA2. In contrast, prolonged (120h) exposure increased the cytoplasmic localization of both proteins, although RAD51C localization was more severely impaired. These results correlate temporally with the previously reported Cr(VI)-induced RAD51 cytoplasmic accumulation. In addition, we found Cr(VI) does not inhibit interaction between RAD51 and its nuclear import mediators. Altogether, our results suggest prolonged Cr(VI) exposure inhibits the nuclear import of RAD51C, and to a lesser extent, BRCA2, which results in the cytoplasmic accumulation of RAD51. Cr(VI)-induced inhibition of nuclear import may play a key role in its carcinogenic mechanism since the nuclear import of many tumor suppressor proteins and DNA repair proteins is crucial to their function. Copyright © 2017 Elsevier Inc. All rights reserved.

The incidence of hyponatremia during prolonged ultraendurance exercise.

Science.gov (United States)

Noakes, T D; Norman, R J; Buck, R H; Godlonton, J; Stevenson, K; Pittaway, D

1990-04-01

Recent studies have shown that potentially fatal hyponatremia can develop during prolonged exercise. To determine the incidence of hyponatremia in athletes competing in ultradistance events, we measured serum sodium levels in 315 of 626 (50%) runners who were treated for collapse after two 90 km ultramarathon footraces (total starters 20,335; total finishers 18,031) and in 101 of 147 (69%) finishers in a 186 km ultratriathlon. In both races the athletes drank fluids with low sodium chloride content (less than 6.8 mmol.l-1). Hyponatremia (serum sodium level less than 130 mmol.l-1) was identified in 27 of 315 (9%) collapsed runners in the 90 km races and in none of the triathletes. In response to diuretic therapy, the runner with the most severe hyponatremia (serum sodium level = 112 mmol.l-1) excreted in excess of 7.5 l dilute urine during the first 17 h of hospitalization. These data suggest that, although symptomatic hyponatremia occurs in less than 0.3% of competitors during prolonged exercise even when they ingest little sodium chloride, it is found in a significant proportion (9%) of collapsed runners. A regulated contraction of the extracellular fluid volume would explain why the majority of athletes maintain normal serum sodium levels even though they develop a significant sodium chloride deficit during prolonged exercise. Alternatively, sodium chloride losses during prolonged exercise may be substantially less than are currently believed. Physicians treating collapsed ultradistance athletes need to be aware that as many as 10% or more of such patients may be hyponatremic.

Death: a foe to be conquered? Questioning the paradigm.

Science.gov (United States)

Gellie, Anthea; Mills, Amber; Levinson, Michele; Stephenson, Gemma; Flynn, Eleanor

2015-01-01

There are few certainties in life-death is one of them. Yet death is often thought of today as the 'loss of the battle' against illness, where in traditional societies it was the natural, meaningful, end to life. Medical knowledge and technologies have extended the possibilities of medical care and increased our life span. People living in most developed countries today can expect to survive to an advanced age and die in hospital rather than at home as in the past. Owing to these and other historical, cultural and social factors, our views on death have been skewed. Medical technology provides an arsenal of weapons to launch against death and the 'war against disease' has entrenched itself in medical philosophy. We now primarily experience death through the lens of a camera. Representations of 'death as spectacle' distort our perceptions and leave us ill-prepared for the reality. Additionally, death as a natural consequence of life has become much less visible than it was in the past due to our longer life expectancies and lack of infectious disease. The continued thrust for treatment, wedded with a failure to recognise the dying process, can rob individuals of a peaceful, dignified death. Progress being made in Advance Care Planning and palliative care is limited by the existing paradigm of death as a 'foe to be conquered'. It is time for a shift in this paradigm. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Comparing Outcomes of Donation After Cardiac Death Versus Donation After Brain Death in Liver Transplant Recipients with Hepatitis C: A Systematic Review and Meta-Analysis

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Malcolm Wells

2014-01-01

Full Text Available BACKGROUND: Liver transplantation (LT using organs donated after cardiac death (DCD is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV infection remains unclear due to the limited experience and number of publications addressing this issue.

Prolonged sitting in cars: prevalence, socio-demographic variations, and trends.

Science.gov (United States)

Sugiyama, Takemi; Merom, Dafna; van der Ploeg, Hidde P; Corpuz, Grace; Bauman, Adrian; Owen, Neville

2012-10-01

Prolonged sitting is detrimentally associated with health outcomes. However, the prevalence and characteristics of those who sit in cars for long periods are not well understood. This study examined the population prevalence, socio-demographic variations, and trends for prolonged sitting in cars among adults. Using the Sydney Greater Metropolitan Area Household Travel Survey, the prevalence of prolonged sitting time in cars (≥2 h/day) was calculated for four 3-year periods (1997-99, 2000-02, 2003-05, and 2006-08) for each population subgroup. Trends were calculated as the mean change in prevalence between adjacent survey periods. Cars were used for 66% of the total trips recorded (n=336,505). The prevalence of prolonged sitting time in cars was 16-18% in men, and 10-12% in women. Relatively higher prevalence rates were found among middle-age groups (men: 20-22%, women: 12-15%), full-time workers (men: 21-24%, women: 14-15%), those with higher income (men: 21-25%, women: 14-16%), couples with children (men: 20-21%, women: 12-14%), and those living in outer suburbs (men: 20-23%, women: 12-13%). Trends were stable in men, but increasing in women. Several subgroups (older age; living in regional suburbs) also showed increasing trends. These findings provide evidence to inform integrated approaches to measurement and policy development on prolonged car use among the public health, urban planning, and transport sectors. Copyright © 2012 Elsevier Inc. All rights reserved.

Exploring children's understanding of death: through drawings and the Death Concept Questionnaire.

Science.gov (United States)

Bonoti, Fotini; Leondari, Angeliki; Mastora, Adelais

2013-01-01

To investigate whether children's understanding of the concept of death varies as a function of death experience and age, 52 children aged 7, 9, and 11 years (26 had a personal death experience), drew a picture reflecting the meaning of the word death and completed the Death Concept Questionnaire for examination of Human and Animal Death. The results showed that the 2 methodological tools used offered complementary information and that children's understanding of death is related both to age and past experience. Children with death experience seem to have a more realistic understanding of death than their inexperienced age-mates. As regards to the effect of age, our findings support the assumption that the different components of death develop through different processes.

Childhood deaths from external causes in Estonia, 2001–2005

Science.gov (United States)

Väli, Marika; Lang, Katrin; Soonets, Ruth; Talumäe, Marika; Grjibovski, Andrej M

2007-01-01

Background In 2000, the overall rate of injury deaths in children aged 0–14 was 28.7 per 100000 in Estonia, which is more than 5 times higher than the corresponding rate in neighbouring Finland. This paper describes childhood injury mortality in Estonia by cause and age groups, and validates registration of these deaths in the Statistical Office of Estonia against the autopsy data. Methods The data on causes of all child deaths in Estonia in 2001–2005 were abstracted from the autopsy protocols at the Estonian Bureau of Forensic Medicine. Average annual mortality rates per 100,000 were calculated. Coverage (proportion of the reported injury deaths from the total number of injury deaths) and accuracy (proportion of correctly classified injury deaths) of the registration of causes of death in Statistical Office of Estonia were assessed by comparing the Statistical Office of Estonia data with the data from Estonian Bureau of Forensic Medicine. Results Average annual mortality from external causes in 0–14 years-old children in Estonia was 19.1 per 100,000. Asphyxia and transport accidents were the major killers followed by poisoning and suicides. Relative contribution of these causes varied greatly between age groups. Intent of death was unknown for more than 10% of injury deaths. Coverage and accuracy of registration of injury deaths by Statistical Office of Estonia were 91.5% and 95.3%, respectively. Conclusion Childhood mortality from injuries in Estonia is among the highest in the EU. The number of injury deaths in Statistical Office of Estonia is slightly underestimated mostly due to misclassification for deaths from diseases. Accuracy of the Statistical Office of Estonia data was high with some underestimation of intentional deaths. Moreover, high proportion of death with unknown intent suggests underestimation of intentional deaths. Reduction of injury deaths should be given a high priority in Estonia. More information on circumstances around death is

Childhood deaths from external causes in Estonia, 2001–2005

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Soonets Ruth

2007-07-01

Full Text Available Abstract Background In 2000, the overall rate of injury deaths in children aged 0–14 was 28.7 per 100000 in Estonia, which is more than 5 times higher than the corresponding rate in neighbouring Finland. This paper describes childhood injury mortality in Estonia by cause and age groups, and validates registration of these deaths in the Statistical Office of Estonia against the autopsy data. Methods The data on causes of all child deaths in Estonia in 2001–2005 were abstracted from the autopsy protocols at the Estonian Bureau of Forensic Medicine. Average annual mortality rates per 100,000 were calculated. Coverage (proportion of the reported injury deaths from the total number of injury deaths and accuracy (proportion of correctly classified injury deaths of the registration of causes of death in Statistical Office of Estonia were assessed by comparing the Statistical Office of Estonia data with the data from Estonian Bureau of Forensic Medicine. Results Average annual mortality from external causes in 0–14 years-old children in Estonia was 19.1 per 100,000. Asphyxia and transport accidents were the major killers followed by poisoning and suicides. Relative contribution of these causes varied greatly between age groups. Intent of death was unknown for more than 10% of injury deaths. Coverage and accuracy of registration of injury deaths by Statistical Office of Estonia were 91.5% and 95.3%, respectively. Conclusion Childhood mortality from injuries in Estonia is among the highest in the EU. The number of injury deaths in Statistical Office of Estonia is slightly underestimated mostly due to misclassification for deaths from diseases. Accuracy of the Statistical Office of Estonia data was high with some underestimation of intentional deaths. Moreover, high proportion of death with unknown intent suggests underestimation of intentional deaths. Reduction of injury deaths should be given a high priority in Estonia. More information on

Deaths from abdominal trauma: analysis of 1888 forensic autopsies

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POLYANNA HELENA COELHO BORDONI

Full Text Available ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.

Years of life lost due to infectious diseases in Poland

Science.gov (United States)

Bryla, Marek; Dziankowska-Zaborszczyk, Elzbieta; Bryla, Pawel; Pikala, Malgorzata

2017-01-01

Purpose An evaluation of mortality due to infectious diseases in Poland in 1999–2012 and an analysis of standard expected years of life lost due to the above diseases. Methods The study material included a database created on the basis of 5,219,205 death certificates of Polish inhabitants, gathered between 1999 and 2012 and provided by the Central Statistical Office. Crude Death Rates (CDR), Standardized Death Rates (SDR) and Standard Expected Years of Life Lost (SEYLL) due to infectious and parasitic diseases were also evaluated in the study period as well as Standard Expected Years of Life Lost per living person (SEYLLp) and Standard Expected Years of Life Lost per dead person (SEYLLd). Time trends were evaluated with the application of joinpoint models and an annual percentage change in their values. Results Death certificates report that 38,261 people died due to infectious diseases in Poland in the period 1999–2012, which made up 0.73% of the total number of deaths. SDR caused by these diseases decreased, particularly in the male group: Annual Percentage Change (APC = -1.05; 95% CI:-2.0 to -0.2; p<0.05). The most positive trends were observed in mortality caused by tuberculosis (A15-A19) (APC = -5.40; 95% CI:-6.3 to -4.5; p<0.05) and also meningitis, encephalitis, myelitis and encephalomyelitis (G03-G04) (APC = -3.42; 95% CI:-4.7 to -2.1; p<0.05). The most negative mortality trends were observed for intestinal infectious diseases (A00-A09) Annual Average Percentage Change (AAPC = 7.3; 95% CI:3.1 to 11.7; p<0.05). SDR substantially decreased in the first half of the study period, but then significantly increased in the second half. Infectious and parasitic diseases contributed to a loss of around 37,000 standard expected years of life in 1999 and more than 28,000 in 2012. During the study period, the SEYLLp index decreased from 9.59 to 7.39 per 10,000 population and the SEYLLd index decreased from 14.26 to 10.34 years (AAPC = 2.3; 95% CI:-2,9 to -1.7; p<0

A Novel Initiation Mechanism of Death in Streptococcus pneumoniae Induced by the Human Milk Protein-Lipid Complex HAMLET and Activated during Physiological Death*

Science.gov (United States)

Clementi, Emily A.; Marks, Laura R.; Duffey, Michael E.; Hakansson, Anders P.

2012-01-01

To cause colonization or infection, most bacteria grow in biofilms where differentiation and death of subpopulations is critical for optimal survival of the whole population. However, little is known about initiation of bacterial death under physiological conditions. Membrane depolarization has been suggested, but never shown to be involved, due to the difficulty of performing such studies in bacteria and the paucity of information that exists regarding ion transport mechanisms in prokaryotes. In this study, we performed the first extensive investigation of ion transport and membrane depolarization in a bacterial system. We found that HAMLET, a human milk protein-lipid complex, kills Streptococcus pneumoniae (the pneumococcus) in a manner that shares features with activation of physiological death from starvation. Addition of HAMLET to pneumococci dissipated membrane polarity, but depolarization per se was not enough to trigger death. Rather, both HAMLET- and starvation-induced death of pneumococci specifically required a sodium-dependent calcium influx, as shown using calcium and sodium transport inhibitors. This mechanism was verified under low sodium conditions, and in the presence of ionomycin or monensin, which enhanced pneumococcal sensitivity to HAMLET- and starvation-induced death. Pneumococcal death was also inhibited by kinase inhibitors, and indicated the involvement of Ser/Thr kinases in these processes. The importance of this activation mechanism was made evident, as dysregulation and manipulation of physiological death was detrimental to biofilm formation, a hallmark of bacterial colonization. Overall, our findings provide novel information on the role of ion transport during bacterial death, with the potential to uncover future antimicrobial targets. PMID:22700972

A novel initiation mechanism of death in Streptococcus pneumoniae induced by the human milk protein-lipid complex HAMLET and activated during physiological death.

Science.gov (United States)

Clementi, Emily A; Marks, Laura R; Duffey, Michael E; Hakansson, Anders P

2012-08-03

To cause colonization or infection, most bacteria grow in biofilms where differentiation and death of subpopulations is critical for optimal survival of the whole population. However, little is known about initiation of bacterial death under physiological conditions. Membrane depolarization has been suggested, but never shown to be involved, due to the difficulty of performing such studies in bacteria and the paucity of information that exists regarding ion transport mechanisms in prokaryotes. In this study, we performed the first extensive investigation of ion transport and membrane depolarization in a bacterial system. We found that HAMLET, a human milk protein-lipid complex, kills Streptococcus pneumoniae (the pneumococcus) in a manner that shares features with activation of physiological death from starvation. Addition of HAMLET to pneumococci dissipated membrane polarity, but depolarization per se was not enough to trigger death. Rather, both HAMLET- and starvation-induced death of pneumococci specifically required a sodium-dependent calcium influx, as shown using calcium and sodium transport inhibitors. This mechanism was verified under low sodium conditions, and in the presence of ionomycin or monensin, which enhanced pneumococcal sensitivity to HAMLET- and starvation-induced death. Pneumococcal death was also inhibited by kinase inhibitors, and indicated the involvement of Ser/Thr kinases in these processes. The importance of this activation mechanism was made evident, as dysregulation and manipulation of physiological death was detrimental to biofilm formation, a hallmark of bacterial colonization. Overall, our findings provide novel information on the role of ion transport during bacterial death, with the potential to uncover future antimicrobial targets.

Mechanism of neem limonoids-induced cell death in cancer: Role of oxidative phosphorylation.

Science.gov (United States)

Yadav, Neelu; Kumar, Sandeep; Kumar, Rahul; Srivastava, Pragya; Sun, Leimin; Rapali, Peter; Marlowe, Timothy; Schneider, Andrea; Inigo, Joseph R; O'Malley, Jordan; Londonkar, Ramesh; Gogada, Raghu; Chaudhary, Ajay K; Yadava, Nagendra; Chandra, Dhyan

2016-01-01

We have previously reported that neem limonoids (neem) induce multiple cancer cell death pathways. Here we dissect the underlying mechanisms of neem-induced apoptotic cell death in cancer. We observed that neem-induced caspase activation does not require Bax/Bak channel-mediated mitochondrial outer membrane permeabilization, permeability transition pore, and mitochondrial fragmentation. Neem enhanced mitochondrial DNA and mitochondrial biomass. While oxidative phosphorylation (OXPHOS) Complex-I activity was decreased, the activities of other OXPHOS complexes including Complex-II and -IV were unaltered. Increased reactive oxygen species (ROS) levels were associated with an increase in mitochondrial biomass and apoptosis upon neem exposure. Complex-I deficiency due to the loss of Ndufa1-encoded MWFE protein inhibited neem-induced caspase activation and apoptosis, but cell death induction was enhanced. Complex II-deficiency due to the loss of succinate dehydrogenase complex subunit C (SDHC) robustly decreased caspase activation, apoptosis, and cell death. Additionally, the ablation of Complexes-I, -III, -IV, and -V together did not inhibit caspase activation. Together, we demonstrate that neem limonoids target OXPHOS system to induce cancer cell death, which does not require upregulation or activation of proapoptotic Bcl-2 family proteins. Copyright © 2015 Elsevier Inc. All rights reserved.

Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set.

Science.gov (United States)

Matthews, T J; MacDorman, Marian F; Thoma, Marie E

2015-08-06

This report presents 2013 period infant mortality statistics from the linked birth/infant death data set (linked file) by maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Descriptive tabulations of data are presented and interpreted. The U.S. infant mortality rate was 5.96 infant deaths per 1,000 live births in 2013, similar to the rate of 5.98 in 2012. The number of infant deaths was 23,446 in 2013, a decline of 208 infant deaths from 2012. From 2012 to 2013, infant mortality rates were stable for most race and Hispanic origin groups; declines were reported for two Hispanic subgroups: Cuban and Puerto Rican. Since 2005, the most recent high, the U.S. infant mortality rate has declined 13% (from 6.86), with declines in both neonatal and postneonatal mortality overall and for most groups. In 2013, infants born at 37–38 weeks of gestation (early term) had mortality rates that were 63% higher than for full-term (39–40 week) infants. For multiple births, the infant mortality rate was 25.84, 5 times the rate of 5.25 for singleton births. In 2013, 36% of infant deaths were due to preterm-related causes of death, and an additional 15% were due to causes grouped into the sudden unexpected infant death category. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Levofloxacin-Induced QTc Prolongation Depends on the Time of Drug Administration

NARCIS (Netherlands)

Kervezee, L; Gotta, V; Stevens, J; Birkhoff, W; Kamerling, Imc; Danhof, M; Meijer, J H; Burggraaf, J

2016-01-01

Understanding the factors influencing a drug's potential to prolong the QTc interval on an electrocardiogram is essential for the correct evaluation of its safety profile. To explore the effect of dosing time on drug-induced QTc prolongation, a randomized, crossover, clinical trial was conducted in

Redefining Death

Institute of Scientific and Technical Information of China (English)

2009-01-01

The results of 20 years of research on brain death will be released to the public, the Chinese Ministry of Health reported in early April. A special ministry team has drafted the criteria for brain death in Criteria for the Diagnosis of Brain Death in Adults (Revised Edition) and Technical Specifications for the Diagnosis

CT Angiography in the Diagnosis of Brain Death

International Nuclear Information System (INIS)

Sawicki, Marcin; Bohatyrewicz, Romuald; Walecka, Anna; Sołek-Pastuszka, Joanna; Rowiński, Olgierd; Walecki, Jerzy

2014-01-01

Summary Brain death is defined as the irreversible cessation of functioning of the entire brain, including the brainstem. Brain death is principally established using clinical criteria including coma, absence of brainstem reflexes and loss of central drive to breathe assessed with apnea test. In situations in which clinical testing cannot be performed or when uncertainty exists about the reliability of its parts due to confounding conditions ancillary tests (i.a. imaging studies) may be useful. The objective of ancillary tests in the diagnosis of brain death is to demonstrate the absence of cerebral electrical activity (EEG and evoked potentials) or cerebral circulatory arrest. In clinical practice catheter cerebral angiography, perfusion scintigraphy, transcranial Doppler sonography, CT angiography and MR angiography are used. Other methods, like perfusion CT, xenon CT, MR spectroscopy, diffusion weighted MRI and functional MRI are being studied as potentially useful in the diagnosis of brain death. CT angiography has recently attracted attention as a promising alternative to catheter angiography – a reference test in the diagnosis of brain death. Since 1998 several major studies were published and national guidelines were introduced in several countries (e.g. in France, Austria, Switzerland, the Netherlands and Canada). This paper reviews technique, characteristic findings and criteria for the diagnosis of cerebral circulatory arrest in CT angiography

Mcl-1 dynamics influence mitotic slippage and death in mitosis.

Science.gov (United States)

Sloss, Olivia; Topham, Caroline; Diez, Maria; Taylor, Stephen

2016-02-02

Microtubule-binding drugs such as taxol are frontline treatments for a variety of cancers but exactly how they yield patient benefit is unclear. In cell culture, inhibiting microtubule dynamics prevents spindle assembly, leading to mitotic arrest followed by either apoptosis in mitosis or slippage, whereby a cell returns to interphase without dividing. Myeloid cell leukaemia-1 (Mcl-1), a pro-survival member of the Bcl-2 family central to the intrinsic apoptosis pathway, is degraded during a prolonged mitotic arrest and may therefore act as a mitotic death timer. Consistently, we show that blocking proteasome-mediated degradation inhibits taxol-induced mitotic apoptosis in a Mcl-1-dependent manner. However, this degradation does not require the activity of either APC/C-Cdc20, FBW7 or MULE, three separate E3 ubiquitin ligases implicated in targeting Mcl-1 for degradation. This therefore challenges the notion that Mcl-1 undergoes regulated degradation during mitosis. We also show that Mcl-1 is continuously synthesized during mitosis and that blocking protein synthesis accelerates taxol induced death-in-mitosis. Modulating Mcl-1 levels also influences slippage; overexpressing Mcl-1 extends the time from mitotic entry to mitotic exit in the presence of taxol, while inhibiting Mcl-1 accelerates it. We suggest that Mcl-1 competes with Cyclin B1 for binding to components of the proteolysis machinery, thereby slowing down the slow degradation of Cyclin B1 responsible for slippage. Thus, modulating Mcl-1 dynamics influences both death-in-mitosis and slippage. However, because mitotic degradation of Mcl-1 appears not to be under the control of an E3 ligase, we suggest that the notion of network crosstalk is used with caution.

Mortality and causes of death among workers exposed to phosgene in 1943-45

International Nuclear Information System (INIS)

Polednak, A.P.; Hollis, D.R.

1985-01-01

Mortality and causes of death from death certificates were analyzed among workers exposed to phosgene while working at a uranium-processing plant in Tennessee in 1943-45. Standardized mortality ratios (SMRs) were calculated by using death rates for U.S. white males. As of 1979, SMRs for all causes and for various selected causes were similar in 694 male chemical workers chronically exposed to low levels of phosgene in 1943-45 and in 9280 male controls who worked at the same plant. SMRs for diseases of the respiratory system were 107 (14 observed vs. 13.07 expected) in the chemical workers and 119 (292 observed vs. 245.75 expected) in the controls. In a group of 106 males who were acutely exposed to high levels of phosgene, there were 41 deaths observed vs. 33.87 expected (SMR = 121; 95% confidence limits = 86 and 165). One death, occurring within 24 hours of exposure, was from pulmonary edema due to phosgene poisoning (coded to accidental causes). Five deaths were coded to diseases of the respiratory system (SMR = 266; 95% CL = 86 and 622); in 2 of these 5 deaths, bronchitis due to phosgene exposure had been reported in 1945. Among 91 female workers with acute high-level phosgene exposure, frequencies of symptoms and early health effects (pneumonitis and bronchitis) differed from those reported for the 106 male cases; preliminary data on vital status of these females are too incomplete for analysis, and further follow-up is needed

Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals.

Science.gov (United States)

Walton, Merrilyn; Harrison, Reema; Chevalier, Anna; Esguerra, Esmond; Van Duong, Dang; Chinh, Nguyen Duc; Giang, Huong

2016-01-01

Viet Nam does not have a system for the national collection of death data that meets international requirements for mortality reporting. It is identified as a 'no-report' country by the WHO. Verbal autopsy reports are used in the community but exclude deaths in hospitals. This project was undertaken in Bach Mai National General Hospital and Viet Duc Surgical and Trauma Hospital in Viet Nam from 1 March 2013 to 31 March 2015. In phase 1, a modified hospital death report form, consistent with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was developed. Small group training in use of the report form was delivered to 427 doctors. In phase two, death data were collected, collated and analysed. In phase three, a random sample (7%) of all report forms was checked for accuracy and completeness against medical records. During the 23 months of the study, 3956 deaths were recorded. Across both hospitals, 222 distinct causes of deaths were recorded. Traumatic cerebral oedema was the immediate cause of death (15% of cases, 575/3956 patients), followed by septic shock (13%, 528/3956), brain compression (11%, 416/3956), intracerebral haemorrhage (8%, 336/3956) and pneumonia (5%, 186/3956); 67% (2639/3956) of patients were discharged home to die and 33% (1314/3956) of deaths were due to a road traffic accident, or injury at home or at work. This study confirms the viability of implementing a death report form system compliant with international standards in hospitals in Viet Nam and provides the foundation for introducing a national death report form scheme. These data are critical to comprehensive knowledge of causes of death in Viet Nam. Death data about patients discharged home to die is presented for the first time, with implications for countries where this is a cultural preference.

Death from seizures induced by chronic alcohol abuse--does it exist?

DEFF Research Database (Denmark)

Christoffersen, S

2007-01-01

aetiologies, but in police reports a person known to have seizures is most likely to be reported as suffering from epilepsy. It is a well-known fact that alcoholics have seizures either due to "alcohol-induced epilepsy" or due to withdrawal from drinking. It also seems to be generally accepted that alcoholics...... may die from these seizures. A literature study was performed of deaths due to alcohol-induced seizures, either during withdrawal or as late-onset seizures where the aetiology was established as long time alcohol abuse and a necropsy had shown no other possible cause of death than a seizure. RESULTS......: It was not possible to find any well-documented cases. It is, however, difficult to compare cases in the literature, as there is no generally accepted classification or nomenclature of seizures related to alcohol abuse....

Trichoderma viride infection in a liver transplant recipient

NARCIS (Netherlands)

Jacobs, F.; Byl, B.; Bourgeois, N.; Coremans-Pelseneer, J.; Florquin, S.; Depré, G.; van de Stadt, J.; Adler, M.; Gelin, M.; Thys, J. P.

1992-01-01

A liver transplant recipient developed infection of a perihepatic haematoma due to Trichoderma viride. Before the infection was diagnosed, the patient received intense immuno-suppressive and prolonged antibacterial and anti-fungal therapies. Although the death of the patient was not directly related

Variation in Definition of Prolonged Mechanical Ventilation.

Science.gov (United States)

Rose, Louise; McGinlay, Michael; Amin, Reshma; Burns, Karen Ea; Connolly, Bronwen; Hart, Nicholas; Jouvet, Philippe; Katz, Sherri; Leasa, David; Mawdsley, Cathy; McAuley, Danny F; Schultz, Marcus J; Blackwood, Bronagh

2017-10-01

Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym. We screened 5,331 references, reviewed 539 full-text references, and excluded 120. Of the 419 studies (representing 38 countries) meeting inclusion criteria, 297 (71%) reported data on a heterogeneous subject cohort, and 66 (16%) included surgical subjects only (46 of those 66, 70% cardiac surgery). Other studies described COPD (16, 4%), trauma (22, 5%), neuromuscular (17, 4%), and sepsis (1, 0.2%) cohorts. A total of 741 terms were used to refer to the 419 study cohorts. The most common terms were: prolonged mechanical ventilation (253, 60%), admission to specialized unit (107, 26%), and long-term mechanical ventilation (79, 19%). Some authors (282, 67%) defined their cohorts based on duration of mechanical ventilation, with 154 studies (55%) using this as the sole criterion. We identified 37 different durations of ventilation ranging from 5 h to 1 y, with > 21 d being the most common (28 of 282, 7%). For studies describing a surgical cohort, minimum ventilation duration required for inclusion was ≥ 24 h for 20 of 66 studies (30%). More than half of all studies (237, 57%) did not provide a reason/rationale for definitional criteria used, with only 28 studies (7%) referring to a consensus definition. We conclude that substantial variation exists in the terminology and definitional criteria for cohorts of subjects receiving prolonged mechanical ventilation. Standardization of

Acute Right Ventricular Dysfunction Complicating Prolonged ...

African Journals Online (AJOL)

We report a case of transient right ventricular dysfunction associated with prolonged cardiac tamponade, an unusual complication of uncertain etiology. We believe that in this case dynamic coronary flow restriction resulted in ischemic injury and stunning of the right ventricle. Other possible causes are briefly reviewed. Right ...

Cancer as a cause of death among people with AIDS in the United States

Science.gov (United States)

Simard, Edgar P.; Engels, Eric A.

2010-01-01

Background People with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), are at increased risk for cancer. Highly active antiretroviral therapy [(HAART), widely available since 1996] has resulted in dramatic declines in AIDS-related deaths. Methods We evaluated cancer as a cause of death in a U.S. registry-based cohort of 83,282 people with AIDS (1980–2006). Causes of death due to AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) were assessed. We evaluated mortality rates and the fraction of deaths due to cancer. Poisson regression assessed rates according to calendar year of AIDS onset. Results Overall mortality declined from 302 (1980–1989), to 140 (1990–1995), to 29 per 1,000 person-years (1996–2006). ADC mortality declined from 2.95 (1980–1989) to 0.65 per 1,000 person-years (1996–2006) (PAIDS-related deaths. Non-Hodgkin lymphoma was the commonest cancer-related cause of death (36% during 1996–2006). Likewise, NADC mortality declined from 2.21 to 0.84 per 1,000 person-years (1980–1989 vs. 1996–2006, PAIDS, cancers account for a growing fraction of deaths. Improved cancer prevention and treatment, particularly for non-Hodgkin lymphoma and lung cancer, would reduce mortality among people with AIDS. PMID:20825305

The efficacy of antipsychotics for prolonged delirium with renal dysfunction

Directory of Open Access Journals (Sweden)

Asano S

2017-11-01

Full Text Available Satoko Asano, Yasuto Kunii, Hiroshi Hoshino, Yusuke Osakabe, Tetsuya Shiga, Shuntaro Itagaki, Itaru Miura, Hirooki Yabe Department of Neuropsychiatry, School of Medicine Fukushima Medical University, Fukushima, Japan Aim: Delirium is commonly encountered in daily clinical practice. To identify predictors influencing outcomes, we retrospectively examined the characteristics of inpatients with delirium who required psychiatric medication during hospitalization.Methods: We extracted all new inpatients (n=523 consulted for psychiatric symptoms at Fukushima Medical University Hospital between October 2011 and September 2013. We selected 203 inpatients with delirium diagnosed by psychiatrists. We analyzed data from 177 inpatients with delirium who received psychiatric medication. We defined an “early improvement group” in which delirium resolved in ≤3 days after starting psychiatric medication, and a “prolonged group” with delirium lasting for >3 days. Among the 83 inpatients with renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2, we defined an “early improvement group with renal dysfunction” in which delirium resolved in ≤3 days after starting psychiatric medication and a “prolonged group with renal dysfunction” with delirium lasting for >3 days. We then examined differences between groups for different categorical variables.Results: Dose of antipsychotic medication at end point was significantly lower in the prolonged group with renal dysfunction than in the early improvement group with renal dysfunction.Conclusion: The results suggest that maintaining a sufficient dose of antipsychotics from an early stage may prevent prolongation of delirium even in inpatients with renal dysfunction. Keywords: antipsychotic, prolonged delirium, chronic kidney disease, pharmacokinetics 

Dynamics of heterogeneous liners with prolonged plasma creation

International Nuclear Information System (INIS)

Aleksandrov, V.V.; Branitskii, A.V.; Volkov, G.S.; Grabovskii, E.V.; Zurin, M.V.; Nedoseev, S.L.; Oleinik, G.M.; Samokhin, A.A.; Smirnov, V.P.; Fedulov, M.V.; Frolov, I.N.; Sasorov, P.V.

2001-01-01

Prolonged plasma creation in heterogeneous liners, in which the liner substance is separated into two phase states (a hot plasma and a cold skeleton), is investigated both experimentally and theoretically. This situation is typical of multiwire, foam, and even gas liners in high-current high-voltage facilities. The main mechanisms governing the rate at which the plasma is created are investigated, and the simplest estimates of the creation rate are presented. It is found that, during prolonged plasma creation, the electric current flows through the entire cross section of the produced plasma shell, whose thickness is comparable with the liner radius; in other words, a current skin layer does not form. During compression, such a shell is fairly stable because of its relatively high resilience. It is shown that, under certain conditions, even a thick plasma shell can be highly compressed toward the discharge axis. A simplified numerical simulation of the compression of a plasma shell in a liner with prolonged plasma creation is employed in order to determine the conditions for achieving regimes of fairly compact and relatively stable radial compression of the shell

Severe bradycardia and prolonged hypotension in ciguatera.

Science.gov (United States)

Chan, Thomas Yan Keung

2013-06-01

Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

Parents' Death and its Implications for Child Survival.

Science.gov (United States)

Atrash, Hani K

Reduction of child mortality is a global public health priority. Parents can play an important role in reducing child mortality. The inability of one or both parents to care for their children due to death, illness, divorce or separation increases the risk of death of their children. There is increasing evidence that the health, education, and socioeconomic status of mothers and fathers have significant impact on the health and survival of their children. We conducted a literature review to explore the impact of the death of parents on the survival and wellbeing of their children and the mechanisms through which this impact is mediated. Studies have generally concluded that the death of a mother significantly increased the risk of death of her children, especially during the early years; the effect continues but is significantly reduced with increasing age through the age of 15 years. The effect of the loss of a father had less impact than the effect of losing a mother although it too had negative consequences for the survival prospect of the child. A mother's health, education, socioeconomic status, fertility behavior, environmental health conditions, nutritional status and infant feeding, and the use of health services all play an important role in the level of risk of death of her children. Efforts to achieve the Millennium Development Goal No. 4 of reducing children's under-5 mortality in developing countries by two thirds by 2015 should include promoting the health and education of women.

Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children.

Science.gov (United States)

Master, Christina L; Master, Stephen R; Wiebe, Douglas J; Storey, Eileen P; Lockyer, Julia E; Podolak, Olivia E; Grady, Matthew F

2018-03-01

Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children. A retrospective cohort of pediatric patients with concussion. A subspecialty pediatric concussion program. Four hundred thirty-two patient records were abstracted. Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program. The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels. Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time. Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.

Identifying vulnerable populations to death and injuries from residential fires.

Science.gov (United States)

Gilbert, Stanley W; Butry, David T

2017-08-03

This study proposes and evaluates the theory that people who are susceptible to injury in residential fires are not susceptible to death in residential fires and vice versa. It is proposed that the population vulnerable to death in residential fires can be proxied by 'frailty', which is measured as age-gender adjusted fatality rates due to natural causes. This study uses an ecological approach and controls for exposure to estimate the vulnerability of different population groups to death and injury in residential fires. It allows fatalities and injuries to be estimated by different models. Frailty explains fire-related death in adults while not explaining injuries, which is consistent with the idea that deaths and injuries affect disjoint populations. Deaths and injuries in fire are drawn from different populations. People who are susceptible to dying in fires are unlikely to be injured in fires, and the people who are susceptible to injury are unlikely to die in fires. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Study on smoking-attributed mortality by using all causes of death surveillance system in Tianjin].

Science.gov (United States)

Jiang, Guohong; Zhang, Hui; Li, Wei; Wang, Dezheng; Xu, Zhongliang; Song, Guide; Zhang, Ying; Shen, Chengfeng; Zheng, Wenlong; Xue, Xiaodan; Shen, Wenda

2016-03-01

To understand the smoking-attributed mortality by inclusion of smoking information into all causes of death surveillance. Since 2010, the information about smoking status, smoking history and the number of cigarettes smoked daily had been added in death surveillance system. The measures of training, supervision, check, sampling survey and telephone verifying were taken to increase death reporting rate and reduce data missing rate and underreporting rate. Multivariate logistic regression analysis was conducted to identify risk factors for smoking-attributed mortality. During the study period (2010-2014), the annual death reporting rates ranged from 6.5‰ to 7.0‰. The reporting rates of smoking status, smoking history and the number of cigarettes smoked daily were 95.53%, 98.63% and 98.58%, respectively. Compared with the nonsmokers, the RR of males was 1.38 (1.33-1.43) for all causes of death and 3.07 (2.91-3.24) for lung cancer due to smoking, the RR of females was 1.46 (1.39-1.54) for all causes of death and 4.07 (3.81-4.35) for lung cancer due to smoking, respectively. The study of smoking attributed mortality can be developed with less investment by using the stable and effective all causes of death surveillance system in Tianjin.

Smoking prolongs the infectivity of patients with tuberculosis.

LENUS (Irish Health Repository)

Siddiqui, U A

2010-10-01

We sought to establish if smokers on anti-tuberculosis treatment are more likely to have a prolonged period of infectivity, compared to non-smoking tuberculosis patients, in a low tuberculosis prevalence country. We conducted a cross-sectional, retrospective study in Ireland that recruited 53 microbiologically confirmed cases of pulmonary tuberculosis (PTB). The age-sex adjusted odds ratios (AOR) suggest that the infectivity status of PTB on treatment was four times more likely to be prolonged beyond 6-8 weeks, if the cases had a smoking history (AOR: 4.42; 95% CI: 1.23; 15.9). Smoking was associated with delayed sputum smear conversion in PTB patients on treatment.

Deaths of the elderly exposed to violence in Turkey.

Science.gov (United States)

Ince, Haluk; Aliustaoglu, Suheyla; Yazici, Yüksel; Ince, Nurhan

2008-06-01

Due to the socio-cultural and demographical changes that have been taking place in Turkey, differences in types of violence are coming on the scene. The purpose of the present study is to reveal the number of violence deaths and the variation by time in the types of violence resulting in death in the elderly of ages 65 and above in Turkey. Using a retrospective (descriptive) epidemiological method, this study was carried out with 1,326 subjects of ages 65 and above among 17,015 criminal autopsies between years 1996-2001. According to the crime scene investigations, the percentage of deaths caused by firearm injuries increased to 4.0% in 2001 from 1.9% in 1994. The dispersion of the subjects according to autopsy findings were pathologically caused death (32.3%), negative autopsy (20.3%), general body trauma (20.1%) and hanging (6.3%). Changes in the rates of deaths caused by cutting/piercing tool injuries are 1.9% and 4.3%, respectively. Regulations are needed to reinforce and financially support the family, to secure humanely life standards for the elderly, and to ensure homecare to an optimum extent.

Religiosity and the Construction of Death in Turkish Death Announcements, 1970-2009

Science.gov (United States)

Ergin, Murat

2012-01-01

Death and rituals performed after death reflect and reproduce social distinctions despite death's popular reputation as a great leveler. This study examines expressions of religiosity and constructions of death in Turkish death announcements, paying particular attention to gendered, ethnic, and temporal variations as well as markers of status and…

Gun ownership and firearm-related deaths.

Science.gov (United States)

Bangalore, Sripal; Messerli, Franz H

2013-10-01

A variety of claims about possible associations between gun ownership rates, mental illness burden, and the risk of firearm-related deaths have been put forward. However, systematic data on this issue among various countries remain scant. Our objective was to assess whether the popular notion "guns make a nation safer" has any merits. Data on gun ownership were obtained from the Small Arms Survey, and for firearm-related deaths from a European detailed mortality database (World Health Organization), the National Center for Health Statistics, and others. Crime rate was used as an indicator of safety of the nation and was obtained from the United Nations Surveys of Crime Trends. Age-standardized disability-adjusted life-year rates due to major depressive disorder per 100,000 inhabitants with data obtained from the World Health Organization database were used as a putative indicator for mental illness burden in a given country. Among the 27 developed countries, there was a significant positive correlation between guns per capita per country and the rate of firearm-related deaths (r = 0.80; P ownership and mental illness as independent covariates, gun ownership was a significant predictor (P <.0001) of firearm-related deaths, whereas mental illness was of borderline significance (P = .05) only. The number of guns per capita per country was a strong and independent predictor of firearm-related death in a given country, whereas the predictive power of the mental illness burden was of borderline significance in a multivariable model. Regardless of exact cause and effect, however, the current study debunks the widely quoted hypothesis that guns make a nation safer. Copyright © 2013 Elsevier Inc. All rights reserved.

Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes

DEFF Research Database (Denmark)

Flethøj, M.; Schwarzwald, C. C.; Haugaard, M. M.

2016-01-01

Doppler imaging, and two-dimensional speckle tracking. Correlation between echocardiographic variables and cardiac troponin I was evaluated. Results: Early diastolic myocardial velocities decreased significantly in longitudinal (baseline: −17.4 ± 2.4cm/s; end of ride: −15.8 ± 3.2cm/s (P = .013); morning......Background: Prolonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown. Objectives :To investigate the effects of prolonged exercise on LV systolic...... and diastolic function in horses. Animals: Twenty-six horses competing in 120–160 km endurance rides. Methods: Cross-sectional field study. Echocardiography was performed before and after rides, and the following morning, and included two-dimensional echocardiography, anatomical M-mode, pulsed-wave tissue...

Causes of death among undocumented migrants in Sweden, 1997–2010

Directory of Open Access Journals (Sweden)

Anna Wahlberg

2014-06-01

Full Text Available Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR. Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants. Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation. Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8% were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52 and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82 compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14. Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

On social death: ostracism and the accessibility of death thoughts.

Science.gov (United States)

Steele, Caroline; Kidd, David C; Castano, Emanuele

2015-01-01

Being rejected, excluded, or simply ignored is a painful experience. Ostracism researchers have shown its powerful negative consequences (Williams, 2007), and sociologists have referred to such experiences as social death (Bauman, 1992). Is this is just a metaphor or does being ostracized make death more salient in people's minds? An experiment was conducted in which participants experienced ostracism or inclusion using the Cyberball manipulation, and the accessibility of death-related thoughts was measured via a word-stem completion puzzle. Results showed enhanced death-thought accessibility in the ostracism condition, as well as a negative effect of dispositional self-esteem on the accessibility of death-related thoughts.

Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse

DEFF Research Database (Denmark)

Schäfer, Carolyn; Guldager, Helle Skov; Jørgensen, H L

2011-01-01

and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency...

Prolonged hypoxia modulates platelet activating factor receptor-mediated responses by fetal ovine pulmonary vascular smooth muscle cells.

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Renteria, Lissette S; Raj, J Usha; Ibe, Basil O

2010-12-01

Hypoxia augments PAF receptor (PAFr) binding and PAFr protein expression in venous SMC (SMC-PV). We compared effect of acute and prolonged hypoxia (pO(2)<40 torr) on PAFr-mediated responses in arterial SMC (SMC-PA) and SMC-PV. Cells were studied for 30 min (acute) or for 48 h (prolonged) hypoxia and compared to normoxic (pO(2) ~100 torr) conditions. PAF binding was quantified in fmol/10(6) cells (mean ± SEM). PAF binding in normoxia were SMC-PA, 5.2 ± 0.2 and in SMC-PV, 19.3 ± 1.1; values in acute hypoxia were SMC-PA, 7.7 ± 0.4 and in SMC-PV, 27.8 ± 1.7. Prolonged hypoxia produced 6-fold increase in binding in SMC-PA, but only 2-fold increase in SMC-PV, but binding in SMC-PV was still higher. Acute hypoxia augmented inositol phosphate release by 50% and 40% in SMC-PA and SMC-PV, respectively. During normoxia, PAFr mRNA expression by both cell types was similar, but expression in hypoxia by SMC-PA was greater. In SMC-PA, hypoxia and PAF augmented intracellular calcium flux. Re-exposure of cells to 30 min normoxia after 48 h hypoxia decreased binding by 45-60%, suggesting immediate down-regulation of hypoxia-induced PAFr-mediated effects. We speculate that re-oxygenation immediately reverses hypoxia effect probably due to oxygen tension-dependent reversibility of PAFr activation and suggest that exposure of the neonate to prolonged state of hypoxia will vilify oxygen exchange capacity of the neonatal lungs. Copyright © 2010 Elsevier Inc. All rights reserved.

Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006.

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Prado, Marli; Silva, Marcelo Barbosa da; Laurenti, Ruy; Travassos, Luiz R; Taborda, Carlos P

2009-05-01

Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (approximately 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006

Directory of Open Access Journals (Sweden)

Marli Prado

2009-05-01

Full Text Available Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (~ 51.2%. When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9% appeared at the top of the list, followed by candidiasis (30.2%, histoplasmosis (10.1% and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Diet-consumer nitrogen isotope fractionation for prolonged fasting arthropods.

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Mizota, Chitoshi; Yamanaka, Toshiro

2011-12-01

Nitrogen acquisition for cellular metabolism during diapause is a primary concern for herbivorous arthropods. Analyses of naturally occurring stable isotopes of nitrogen help elucidate the mechanism. Relevant articles have cited (58 times up to mid-June 2011) anomalously elevated δ(15)N (per mil deviation of (15)N/(14)N, relative to atmospheric nitrogen=0 ‰) values (diet-consumer nitrogen isotope fractionation; up to 12 ‰) for a prolonged fasting raspberry beetle (Byturus tomentosus Degeer (Coleoptera: Byturidae)), which feeds on red raspberries (Rubus idaeus: δ(15)N= ~ +2 ‰). Biologists have hypothesised that extensive recycling of amino acid nitrogen is responsible for the prolonged fasting. Since this hypothesis was proposed in 1995, scientists have integrated biochemical and molecular knowledge to support the mechanism of prolonged diapausing of animals. To test the validity of the recycling hypothesis, we analysed tissue nitrogen isotope ratios for four Japanese arthropods: the shield bug Parastrachia japonensis Scott (Hemiptera: Cydnidae), the burrower bug Canthophorus niveimarginatus Scott (Hemiptera: Cydnidae), leaf beetle Gastrophysa atrocyanea Motschulsky (Coleoptera: Chrysomelidae) and the Japanese oak silkworm Antheraea yamamai (Lepidoptera: Saturniidae), all of which fast for more than 6 months as part of their life-history strategy. Resulting diet-consumer nitrogen isotope discrimination during fasting ranged from 0 to 7‰, as in many commonly known terrestrial arthropods. We conclude that prolonged fasting of arthropods does not always result in anomalous diet-consumer nitrogen isotope fractionation, since the recycling process is closed or nearly closed with respect to nitrogen isotopes.

Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy

DEFF Research Database (Denmark)

Lynge, Thomas Hadberg; Risgaard, Bjarke; Jabbari, Reza

2016-01-01

AIMS: Hypertrophic cardiomyopathy (HCM) is a frequent cause of sudden cardiac death (SCD) among the young (SCDY). The aim of this study was to characterize symptoms before SCDY due to HCM. METHODS AND RESULTS: Through review of all death certificates, we identified all SCDs in Danes aged 1-35 years...... in 2000-2009. Nationwide we included all deaths (n = 8756) and identified 431 autopsied SCDYs. All available records from hospitals and general practitioners were retrieved. To compare symptoms, we included a control groups consisting of traffic accident victims (n = 74). In the 10-year study period, 431...... autopsied SCDY cases were reviewed and 38 cases (9%) were included, of which 22 (58%) had morphologic findings diagnostic of HCM and 16 (42%) had findings suggestive, but not diagnostic, of HCM ('possible HCM'). Cardiac symptoms >1 h prior to death were reported in 21 (55%) of cases, and 16 (42%) sought...

Changes in CR-39 proton sensitivity due to prolonged exposure to high vacuums relevant to the National Ignition Facility and OMEGA.

Science.gov (United States)

Manuel, M J-E; Rosenberg, M J; Sinenian, N; Rinderknecht, H; Zylstra, A B; Séguin, F H; Frenje, J; Li, C K; Petrasso, R D

2011-09-01

When used at facilities like OMEGA and the NIF, CR-39 is exposed to high vacuum environments before and after irradiation by charged particles and neutrons. Using an electrostatic linear accelerator at MIT, studies have been conducted to investigate the effects of high vacuum exposure on the sensitivity of CR-39 to fusion protons in the ~1-9 MeV energy range. High vacuum conditions, of order 10(-5) Torr, experienced by CR-39 samples at these facilities were emulated. It is shown that vacuum exposure times longer than ~16 h before proton irradiation result in a decrease in proton sensitivity, whereas no effect was observed for up to 67 h of vacuum exposure after proton irradiation. CR-39 sensitivity curves are presented for samples with prolonged exposure to high vacuum before and after proton irradiation. © 2011 American Institute of Physics

Occupational fatalities due to electrocutions in the construction industry.

Science.gov (United States)

Janicak, Christopher A

2008-01-01

Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry. Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity. This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall. The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.

Explosive death of conjugate coupled Van der Pol oscillators on networks

Science.gov (United States)

Zhao, Nannan; Sun, Zhongkui; Yang, Xiaoli; Xu, Wei

2018-06-01

Explosive death phenomenon has been gradually gaining attention of researchers due to the research boom of explosive synchronization, and it has been observed recently for the identical or nonidentical coupled systems in all-to-all network. In this work, we investigate the emergence of explosive death in networked Van der Pol (VdP) oscillators with conjugate variables coupling. It is demonstrated that the network structures play a crucial role in identifying the types of explosive death behaviors. We also observe that the damping coefficient of the VdP system not only can determine whether the explosive death state is generated but also can adjust the forward transition point. We further show that the backward transition point is independent of the network topologies and the damping coefficient, which is well confirmed by theoretical analysis. Our results reveal the generality of explosive death phenomenon in different network topologies and are propitious to promote a better comprehension for the oscillation quenching behaviors.

Prolonged parenteral nutrition after neonatal gastrointestinal surgery

DEFF Research Database (Denmark)

Estmann, Anne; Qvist, Niels; Husby, Steffen

2002-01-01

to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

The driving force of the Na+/Ca2+-exchanger during metabolic inhibition