Histopathological differentiation of drowning in freshwater and saltwater in rats: forensic point of view / Diferenciación histopatológica de ahogamiento en agua dulce y agua salada en ratas: punto de vista forense

SUMMARY: The postmortem diagnosis of death by drowning is one of the most difficult issues in forensic pathology. We investigated possible evidence differentiating saltwater drowning from freshwater drowning by histopathological changes in brain, heart, lungs, liver, and kidneys tissues. A cross section descriptive study was carried out on eighteen 12-week-old male Wistar rats; they were divided equally into 3 groups. Group 1: control group; Group 2: death by drowning in freshwater; Group 3: death by drowning in saltwater. Immediately after death, all tested organs were removed and fixed for histopathological examination. The brain of freshwater group depicted degenerated neurocytes with dystrophic changes in the form of shrunken cell, pyknotic nuclei and deeply eosinophilic cytoplasm. The heart showed clear evidence of myocyte injuries in saltwater drowning compared to the control and freshwater groups. The kidneys of rats drown in saltwater revealed more glomerular destruction with no differences in tubulo-interstitial changes in comparison with those drown in freshwater. In the lungs, the changes in freshwater were restricted to the alveoli, and the bronchial changes were more distinctive in saltwater. No disturbed liver architecture was seen in both test groups, however hydropic degeneration, congested vessels, and sinusoids were more distinct in saltwater group. In conclusion, diagnostic differentiation between fresh and saltwater drowning was reliable in rats' lungs and heart with minimal differentiation in liver, kidneys, and brain. Further studies of drowning with different staining techniques will help to clarify the potential role of histopathological changes in body organs as indicator of drowning.

RESUMEN: El diagnóstico post mortem de muerte por ahogamiento es uno de los temas más difíciles de la patología forense. Investigamos la posible evidencia que diferencia el ahogamiento en agua salada del ahogamiento en agua dulce por cambios histopatológicos en los tejidos del cerebro, el corazón, los pulmones, el hígado y los riñones. Se realizó un estudio descriptivo de corte transversal en dieciocho ratas Wistar macho de 12 semanas de edad; se dividieron por igual en 3 grupos. Grupo 1: grupo control; Grupo 2: muerte por ahogamiento en agua dulce; Grupo 3: muerte por ahogamiento en agua salada. Inmediatamente después de la muerte, se extirparon todos los órganos analizados y se fijaron para el examen histopatológico. El cerebro del grupo de agua dulce mostró neurocitos degenerados con cambios distróficos en forma de células encogidas, núcleos picnóticos y citoplasma profundamente eosinofílico. El corazón mostró una clara evidencia de lesiones de miocitos en los ahogamientos en agua salada en comparación con los grupos de control y de agua dulce. Los riñones de ratas ahogadas en agua salada revelaron una mayor destrucción glomerular sin diferencias en los cambios túbulo-intersticiales en comparación con las ahogadas en agua dulce. En los pulmones, los cambios en agua dulce se restringieron a los alvéolos y los cambios bronquiales fueron más distintivos en agua salada. No se observó una arquitectura hepática alterada en ambos grupos de prueba, sin embargo, la degeneración hidrópica, los vasos congestionados y los sinusoides fueron más distintos en el grupo de agua salada. En conclusión, la diferenciación diagnóstica entre ahogamiento en agua dulce y salada fue confiable en los pulmones y el corazón de las ratas con una diferenciación mínima en el hígado, los riñones y el cerebro. Estudios adicionales de ahogamiento con diferentes técnicas de tinción ayudarán a aclarar el papel potencial de los cambios histopatológicos en los órganos del cuerpo como indicador de ahogamiento.

Quick Rescue self-inflating flotation device for rescuing sea swimmers in distress versus conventional tube or buoy rescues. / Eficacia del Quick Rescue (dispositivo flotante autoinflable para el rescate de ahogados en el mar) en comparación con el tubo y la boya de rescate.

OBJECTIVES: To compare the efficacy of the new self-inflatable Quick Rescue (QR) flotation device to conventional tube and buoy devices. To compare lifeguard fatigue after rescues with different flotation devices. MATERIAL AND METHODS: Forty lifeguards participated in this quasi-experimental field study. Each performed simulated rescues of sea swimmers in distress under 4 conditions (no device, the QR device, a tube, and a buoy) assigned in random order. The swimmer in distress was located at a distance of 100 m. Ambient conditions, victim type, and beach were standardized. Participants underwent training to use the inflatable QR float and all other devices. Expertise was defined as a score of at least 3 on a Likert scale of 1 to 5. We recorded rescue times (total, and approaching, securing and towing back the distressed swimmer) as well as the lifeguards' perceptions of effort (overall and for each stage). RESULTS: Most rescue times did not differ between conditions, with the exception of time needed to secure the victim, which was shorter by 3 seconds when no device was used (P<.05). The rescuers did not perceive differences between devices in overall effort or effort during any of the phases. CONCLUSION: The new self-inflating QR device is as useful as other flotation devices in terms of rescue times and effort expended by lifeguards. We can therefore recommend its use for rescuing sea swimmers in distress.

OBJETIVO: El Quick Rescue es un nuevo dispositivo flotante de rescate (DFR) autoinflable. Se compara su eficacia frente al tubo y la boya de rescate ante una víctima con distrés en el mar, y la fatiga del socorrista tras los rescates con los distintos DFR. METODO: Estudio cuasiexperimental con aleatorización de condiciones (sin DFR, con tubo de rescate, con boya de rescate y con Quick Rescue). Cada participante realizó cuatro rescates de víctima con distrés a 100 m en el mar, con estandarización de las condiciones ambientales, tipo de víctima y playa. Se registró el tiempo de rescate (total, aproximación, control de víctima y remolque) y la percepción del esfuerzo (total y segmentaria) de los socorristas. RESULTADOS: En general, no hubo diferencias entre las cuatro condiciones en los tiempos de rescate. A excepción del tiempo de control de la víctima, que sin material fue en torno a 3 segundos inferior que en las tres condiciones con DFR (p < 0,05). No hubo diferencias en la percepción del esfuerzo total ni segmentaria entre condiciones. CONCLUSIONES: El DFR autoinflable Quick Rescue presenta una validez similar a los DFR habituales en relación a los tiempos de rescate y la fatiga. Por lo tanto, recomendamos su uso para víctimas distrés en el mar.

[Unintentional asphyxia in Mexico: a hidden public health problem]. / Las asfixias accidentales en México: un problema de salud pública oculto.

OBJECTIVE: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017. METHOD: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares. RESULTS: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed. CONCLUSIONS: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem.

Identificación de marcadores tempranos de mala evolución neurológica en niños ahogados que presentaron paro cardiorrespiratorio / Identification of markers early of bad evolution neurological in drowned children who presented unemployment cardiorespiratory

Introducción: Los ahogamientos son una amenaza grave y desatendida de salud pública, constituyen la primera causa de muerte en niños <3 años. Más del 90% de esas muertes ocurren en países de bajos y medianos ingresos. El objetivo de este trabajo es identificar los marcadores pronósticos tempranos de mala evolución neurológica en niños ahogados con paro cardiorrespiratorio que ingresaron en la Unidad de Cuidados Intensivos Pediátricos. Materiales y Métodos: Estudio retrospectivo, de observación y analítico. Se estudiaron pacientes entre el mes de vida y los 15 años que ingresaron en la Unidad de Cuidados Críticos, entre el 1 de enero de 2010 y el 31 de diciembre de 2015. Se examinaron las siguientes variables al ingreso: edad, sexo, ácido láctico, pH, exceso de base, bicarbonato y glucemia plasmática, puntaje PRISM, lugar del accidente y supervisión de las víctimas. Resultados: Ingresaron 11 pacientes con diagnóstico de ahogamiento y paro cardiorrespiratorio. La mediana de la edad fue de 29 meses. El 54% eran niñas y el 48%, varones. Tres pacientes fallecieron. Entre los supervivientes, tres ni- ños sufrieron daño neurológico grave. El peor pronóstico se asoció con ácido láctico >6 mmol/l y glucemia >300 mg% al ingresar. El puntaje PRISM mostró una relación directamente proporcional a la Pediatric Cerebral Performance Categorization Scale Conclusión: En nuestra población, se asociaron a mal pronóstico la lactacidemia >6 mmol/l, la glucemia plasmática >300 mg% y el puntaje PRISM elevado en los grupos de peor pronóstico (AU)

Introduction: Drowning is a serious and neglected threat in public health, it is the leading cause of death in children under 3 years. Over 90% of these deaths occur in low and middle income countries. The objective of this work is to identify early prognostic markers of poor neurological outcome in drowned children with cardiorespiratory arrest admitted to the Pediatric Intensive Care Unit. Materials and Methods: Retrospective, observational and analytical study. Patients between the month of life and 15 years admitted to the Critical Care Unit between January 1st, 2010 and December 31st, 2015 were studied. The following variables were examined on admission: age, sex, lactic acid, pH, base excess, bicarbonate, and plasma glucose levels, PRISM score, scene and supervision of the victims. Results: Eleven patients were admitted with a diagnosis of drowning and cardiac arrest. The median age was 29 months. 54% were female and 48% male. Three patients died. Among the survivors, three children suffered severe neurological damage. Poor prognosis was associated with lactic acid >6 mmol/l, glucose >300 mg% at admission. The PRISM score was directly proportional to the Pediatric Cerebral Performance Categorization Scale. Conclusion: In our population, poor prognosis was associated with the presence of lactate >6 mmol/l, plasma glucose >300 mg% and a high PRISM score in the worst prognosis group.(AU)

Perfil epidemiológico dos afogamentos em praias de Salvador, Bahia, 2012* / Epidemiological profile of drowning on beaches in Salvador, Bahia, Brazil, 2012

Descrever o perfil epidemiológico e a frequência dos afogamentos em praias do município de Salvador, estado da Bahia, Brasil, cobertas pela Coordenadoria de Salvamento Marítimo de Salvador (Salvamar), em 2012. Métodos: foram descritos os dados obtidos do banco de informações sobre as vítimas atendidas pelo Salvamar. Resultados: foram registrados 733 afogamentos; houve predomínio do sexo masculino (65,5 por cento), adolescentes (40,8 por cento), estudantes (67,7 por cento) e moradores de Salvador (69,4 por cento); a idade média das vítimas era de 22,2 anos; quase todos os afogamentos foram não fatais (98,9 por cento), a maioria deles aconteceu entre 10 e 16 horas (89,5 por cento) e os meses com maior ocorrência foram janeiro (20,9 por cento) e fevereiro (16,4 por cento). Conclusão: predominaram, entre as vítimas, homens, jovens e estudantes, e os afogamentos não fatais; as ocorrências foram registradas, principalmente, nos meses do verão; as ações de prevenção a afogamentos deveriam focar os subgrupos identificados como mais vulneráveis...

To describe the epidemiological profile and the frequency of drowning on beaches in Salvador, Bahia, Brazil, covered by the Salvador Maritime Rescue Service (Salvamar) in 2012. Methods: the described data were obtained from the database of Salvamar on drowning accidents. Results: 733 people drowned in the period; victims were mostly male (65.5 per cent), adolescents (40.8 per cent), students (67.7 per cent) and inhabitants of Salvador (69.4 per cent). Mean age was 22.2 years. Almost all cases were not fatal (98.9 per cent) and the majority happened between 10 a.m. and 4 p.m. (89.5 per cent) in January (20.9 per cent) and February (16.4 per cent). Conclusion: this study indicated that Salvador had a high frequency of non-fatal drowning among males, youth and students. Summer time drowning prevention actions. should be focused on these vulnerable subgroups...

[Recommendations for the prevention of drowning]. / Recomendaciones sobre la prevención de ahogamientos.

Drowning is the second leading cause of non-intentional death in children under the age of 19 in Europe. Weather conditions in Spain allow an extended period of contact with water, therefore increasing the risk of drowning (due to the increased exposure), and constitutes the second leading cause of accidental death in children less than 14 years of age. In children younger than 5 years, drowning occurs mostly in pools belonging to private homes or communities, while in older children, drowning is often linked to aquatic recreational activities in lakes, sea, rivers and canals, and at times associated with alcohol consumption. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of architectonic, educational and legislative recommendations to prevent such incidents.

Ahogamiento incompleto, valoración de la injuria cerebral al ingreso: terapia intensiva pediátrica / Nearly drowning, valuation of the cerebral injury when entering the hospital: intensive pediatric therapy

Se realizó una investigación descriptiva retrospectiva que incluyó a todos los pacientes que fueron ingresados en el Servicio de Terapia Intensiva del Hospital Eliseo Noel Caamaño, en el período comprendido desde junio de 1982 hasta junio de 2004, con el diagnóstico de Ahogamiento Incompleto, con el propósito de determinar el estado neurológico y su relación con diferentes variables que pueden haber influido en la intensidad del daño, así como la sobrevivencia final de los mismos. Los resultados obtenidos nos permitieron conocer el manejo del paciente pediátrico que ha sufrido este tipo de accidentes, así como su estado a la llegada al Servicio. El 68 por ciento de los pacientes tuvieron una afección de moderada a severa según las escalas de Conn y Glasgow, además existió una correlación de hasta un 97 por ciento entre dichos métodos de evaluación. Dentro de las variables que influenciaron en el estado de los niños al ingreso se destacó un tiempo de inmersión mayor de 5 minutos para los clasificados como severos, 70 por ciento de la muestra, fallecieron el 7 por ciento de todos los pacientes estudiados, todos ellos clasificados como severos.

We carried out a descriptive retrospective study including all the patients that were entered in the Service of Intensive Therapy of the hospital Eliseo Noel Caamaño, in the period from June 1982 to June 2004, with the diagnosis of nearly drowning, with the purpose of determining the neurological state and its relation with different variables that might have influence in the intensity of the damage, as well as in the final surviving of the patients. The obtained results allowed us knowing the managing of the paediatrics patient that have suffered this kind of accidents, as well as their state at the arrival to the service; 68 percent of the patients had a moderated to severe affection according to the Conn and Glasgow scales; moreover, there was a correlation of up to 97 percent between these evaluation methods. Among the variables that influenced in the state of the children at the entering, there was an immersion time of more than 5 minutes for those classified as severe, 70 percent of the sample; 7 percent of all the studied patients died, all of them classified as severe.

Tendencia de la mortalidad a consecuencia de asfixia por inmersión en México, 1979-2005 / Trends in mortality from drowning, Mexico, 1979-2005

Objetivo. Describir la tendencia de la mortalidad a consecuencia de asfixia por inmersión en México y sus estados federativos durante el período comprendido entre 1979 y 2005. Métodos. Se estimaron tasas de mortalidad y tendencias durante el período estudiado a partir de los datos oficiales de mortalidad en México, según la Clasificación Internacional de Enfermedades (9.a y 10.a revisiones). Los resultados se analizaron por grupos de edad, sexo y año en que se registró el suceso, así como por el estado federativo y el tamaño de la localidad deresidencia. Resultados. Entre 1979 y 2005 se registraron 107 319 muertes a consecuencia de asfixia por inmersión. La mortalidad en el país se redujo 65,31% (de 6,58 por 100 000 habitantes en 1979–1981 a 2,28 por 100 000 habitantes en 2003–2005). Esta reducción se observó en todos los grupos de edad (desde 68,10% en el de 5 a 9 años hasta 54,30% en el de 1 a 4 años) y estados (desde 87,19% en Colima hasta 36,58% en Nayarit). En el trienio 2003–2005, la mortalidad fue relativamente mayor en hombres y niños que en mujeres y niñas (razón: 5,46; IC95%: 5,15 a 5,80); en los grupos de edad de 1 a 4 años (4,27 por 100 000) y de 60 años o más (3,37 por 100 000 habitantes); en el estado de Tabasco (5,92 por 100 000 habitantes); y en las poblaciones de menos de 2 499 habitantes (4,03% por 100 000 habitantes). Conclusiones. La mortalidad a consecuencia de asfixia por inmersión en México presenta una tendencia descendente, a pesar de lo cual se mantiene como un importante problema de salud pública. Es necesario profundizar en la consolidación de la información sobre las muertes accidentales por esta causa, tanto desde el punto de vista de la vigilancia epidemiológica como de las intervenciones que se deben implementar para su erradicación.

Objective. To examine the trends in mortality from drowning in Mexico and each of its federal states during the period from 1979–2005. Methods. Mortality rates and trends were estimated for the study period from Mexico’s official data based on the International Classification of Diseases, 9th and 10th revisions. Results were analyzed by age group, sex, and year registered, as well as by state and size of city or town of residence. Results. From 1979–2005, there were 107 319 deaths by drowning registered. Themortality from drowning rate decreased 65.31% (from 6.58 per 100 000 inhabitants in 1979–1981 to 2.28 per 100 000 inhabitants in 2003–2005). This decrease was evident in all the age groups (ranging from 68.10% among 5–9 year olds to 54.30% among 1–4 years) and by state (ranging from 87.19% in Colima to 36.58% in Nayarit). During the three-year period from 2003–2005, drowning mortality was relatively greater among men and boys than among women and girls (rate: 5.46 (95%CI: 5.15–5.80); among theage groups 1–4 years (4.27 per 100 000) and 60 years or older (3.37 per 100 000 inhabitants); in the Tabasco state (5.92 per 100 000 inhabitants); and among towns with fewer than 2 499 inhabitants (4.03% per 100 000 inhabitants). Conclusions. In Mexico, the drowning mortality drowning rate is on a downward trend, although it remains a serious public health problem. Intensified efforts are needed to harness information regarding accidentals death from this cause, both from the epidemiological surveillance angle as well as through the implementation of eradicating interventions.