RESUMO
BACKGROUND: The COVID-19 pandemic had many negative effects worldwide. These effects involved mental health status issues such as suicide, depression, and the pattern of death associated with drug/poisonings. One of the major concerns of the healthcare community during the pandemic was mortality from poisonings. This study aimed to investigate the trends of mortality from different types of poisonings before and after COVID-19. METHODS: The patients who died from six different categories of drugs or poisons were identified by forensic analysis of body fluids/tissues in Tehran, Iran. The pandemic was separated into the pre-COVID-19 period (April 2018 to January 2020), and the COVID pandemic (February 2020-April 2022). Demographic characteristics were collected from each victim, and comparisons of death trends before and after the pandemic were conducted using the interrupted time series analysis. The absolute number of deaths and proportion of deaths from each type of drug/poisoning were used for the analyses. RESULTS: A total of 6,316 deaths from drugs/poisoning were identified between April 2018-Mar 2022). During this period, 2,485 deaths occurred pre-COVID, and 3,831 were during the COVID-19 era. There were no statistical differences in terms of demographic characteristics before and after the pandemic, except for job status. There was a sharp increase in proportion of methanol death among all poisonings after the start of the pandemic (16.5%, p-value = 0.025), while there was a decreasing trend during the pandemic (-0.915 deaths monthly, p-value = 0.027). The trends for opioids, stimulants, and drug-related deaths changed from decreasing to increasing. No change was seen in the trends for ethanol and volatile substance deaths. This pattern was mirrored in the proportion of each type of poisoning relative to the total number. CONCLUSION: Changes in poisoning-related mortality patterns showed dramatic changes after the start of the pandemic, especially deaths from methanol. Other poisonings such as opioids, stimulants, and drugs should also be addressed as there was an increasing trend during the COVID-19 period, compared to the pre-COVID data.
Assuntos
COVID-19 , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Análise de Séries Temporais Interrompida , Analgésicos Opioides , Metanol , Irã (Geográfico)/epidemiologia , PandemiasRESUMO
The epidemic of deaths by homicide affects every society around the world and represents a major public health crisis. Detailed information on the characteristics of homicides victims from Islamic countries is limited. This article presents forensic epidemiological data on homicides in Isfahan, Iran, during 2013-2015. Isfahan has a population of more than 5 million and 69,387 deaths with 246 homicides between 2013 and 2015. Most victims were male (73%), between the ages of 15 to 29 years (39.5%), married (54%), and employed (54%). The relationship between the actor and the victims showed that 12% were married, 15% friends, 25% strangers, and 47% others or unknown. The most frequent method of homicides was by stabbing (45%), followed by firearms (23%), strangulation (14%), and blunt force trauma (7%). The top 3 methods among males were stabbing, firearms, and strangulation, whereas among females, it was stabbing, strangulation, and by other methods. There was no significant effect on homicide rates by month, weekday, or temperature. Investigators examining deaths in Muslin countries must understand and adjust for the culture, norms, and religious ideology.
Assuntos
Homicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Asfixia/mortalidade , Criança , Pré-Escolar , Vítimas de Crime/estatística & dados numéricos , Feminino , Incêndios/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto JovemRESUMO
INTRODUCTION: The issue of child and adolescent injury and violence is often absent from discussions and is largely invisible in public health policies. The purpose of this study was to describe the frequency and pattern of unnatural deaths during childhood and adolescence in Isfahan province in Iran. MATERIALS AND METHODS: This retrospective, descriptive study involved unnatural deaths among individuals under the age of 20 years who died from unnatural causes as determined by a forensic autopsy at the Legal Medicine Center of Isfahan. During the study period, 8,010 unnatural deaths occurred, 1,222 of which were individuals under 20 years old. RESULTS: All 1,222 of these unnatural deaths were identified through autopsy. Among the 1,222 cases, 895 (73.2%) were male, and 327 were female (26.8%). Accidental deaths were found to be the most frequent manner of death comprising 1,029 (83.96%) cases, followed by suicide (120, 9.82%), undetermined cause of death (39, 3.19%), and homicide (9, 2.86%) cases. Road traffic accidents were the number 1 cause of death (597, 49%), followed by burns (122, 10%) and hanging (90, 7.4%). DISCUSSION: Injuries and violence that occur during childhood and adolescence represent a global public health problem, especially in low- and middle-income regions, and require urgent action.
Assuntos
Acidentes/mortalidade , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Medicina Legal , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
The field of forensic epidemiology was initially introduced as a systematic approach to the investigation of acts of bioterrorism. In recent years, however, the applications of forensic epidemiology have expanded greatly, covering a wide range of medicolegal issues routinely encountered in both criminal and civil court settings. Forensic epidemiology provides a method of evaluating causation in groups and individuals based in the application of the Hill Criteria, with conclusions given in terms of relative or comparative risk, or as a Probability of Causation. The purpose of this paper is to give a brief overview of the methods and applications of forensic epidemiology.
Assuntos
Causalidade , Métodos Epidemiológicos , Medicina Legal , Carcinógenos Ambientais/toxicidade , Causas de Morte , Exposição Ambiental , Humanos , Imperícia/legislação & jurisprudência , Modelos Estatísticos , Farmacovigilância , Probabilidade , Papel Profissional , Ferimentos e LesõesRESUMO
BACKGROUND: Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care. METHODS: All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation. RESULTS: One hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34). CONCLUSIONS: Telestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.
Assuntos
Centros Médicos Acadêmicos , Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Telemedicina , Terapia Trombolítica , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Distribuição de Qui-Quadrado , Atenção à Saúde , Feminino , Fibrinolíticos/administração & dosagem , Acessibilidade aos Serviços de Saúde , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Consulta Remota , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento , Comunicação por VideoconferênciaAssuntos
Acidentes de Trânsito/mortalidade , Condução de Veículo/estatística & dados numéricos , Autopsia/estatística & dados numéricos , Coleta de Dados/métodos , Atestado de Óbito , Estatísticas Vitais , Acidentes de Trânsito/estatística & dados numéricos , Automóveis , Causas de Morte , Médicos Legistas/estatística & dados numéricos , Coleta de Dados/estatística & dados numéricos , Diagnóstico , Humanos , Vigilância da População , Estados UnidosRESUMO
We present the case of a 24-year-old driver who died when a metal pole entered the front windshield, traveled through the victim's neck, and then exited via the back windshield. This case illustrated an unusual penetration injury and the importance of a thorough and complete death scene investigation.
Assuntos
Acidentes de Trânsito , Lesões do Pescoço/patologia , Ferimentos Penetrantes/patologia , Adulto , Epiglote/lesões , Epiglote/patologia , Patologia Legal , Toxicologia Forense , Fraturas de Cartilagem/patologia , Humanos , Osso Hioide/lesões , Osso Hioide/patologia , Laringe/lesões , Laringe/patologia , Masculino , Morfina/sangue , Entorpecentes/sangue , Cartilagem Tireóidea/lesões , Cartilagem Tireóidea/patologia , Glândula Tireoide/lesões , Glândula Tireoide/patologia , Adulto JovemRESUMO
Hereditary hemochromatosis (HH) is one of the most common genetic disorders and may present clinically in a variety of ways. The most common presentation is micronodular cirrhosis with possible associated diabetes. However, HH may also present with cardiac dysfunction and sudden death. The confirmation of unsuspected HH at autopsy is complicated by the growing number of genetic abnormalities, which are not detected by current commercial genetic testing for C282Y and H63D mutations. Consequently, quantitative liver iron studies on fresh or paraffin embedded liver is recommended in confirming HH. The importance of detection and confirmation of HH cannot be overemphasized given the need to screen surviving family members in preventing organ damage of asymptomatic individuals. We present a case of a 38-year-old white woman with micronodular cirrhosis secondary to unsuspected HH that was confirmed by a quantitative liver iron study. The possible presentation of cardiac sudden death from HH, confirmation issues and implications of a HH diagnosis for surviving family members are also discussed.
Assuntos
Morte Súbita/etiologia , Hemocromatose/diagnóstico , Ferro/análise , Cirrose Hepática/patologia , Fígado/química , Adulto , Feminino , Patologia Legal , Humanos , Fígado/patologia , Cirrose Hepática/genética , Pancreatite/patologia , Pericardite/patologia , Esplenomegalia/patologiaAssuntos
Prova Pericial , Enfermagem Forense/organização & administração , Papel do Profissional de Enfermagem , Prova Pericial/legislação & jurisprudência , Prova Pericial/métodos , Prova Pericial/normas , Governo Federal , Regulamentação Governamental , Guias como Assunto , Humanos , Estados UnidosRESUMO
The note left by a suicide victim is a key piece of forensic evidence in the investigation of a sudden death. This article provides some general information regarding suicide notes while also dispelling some of the myths.
Assuntos
Correspondência como Assunto , Suicídio/psicologia , Pessoas Famosas , Enfermagem Forense , Psiquiatria Legal , Humanos , Comportamento de MassaRESUMO
Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states. This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD. Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.
Assuntos
Acidentes por Quedas/mortalidade , Atestado de Óbito , Alta do Paciente , Estatísticas Vitais , Acidentes por Quedas/estatística & dados numéricos , Acidentes/estatística & dados numéricos , Idoso , Causas de Morte , Feminino , Medicina Legal , Controle de Formulários e Registros , Mortalidade Hospitalar , Humanos , Masculino , Pennsylvania/epidemiologia , Vigilância da População , Estudos Retrospectivos , Suicídio/estatística & dados numéricosRESUMO
A study of elderly homicide victims brought to a Pennsylvania medical examiner's office reveals interesting findings about cause of death.
Assuntos
Causas de Morte , Homicídio/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Médicos Legistas , Feminino , Humanos , Masculino , Pennsylvania , Distribuição por SexoRESUMO
The process of swallowing or inserting illegal packets of drugs for the purpose of evading law enforcement officers carries risks other than criminal charges. It can be fatal. Individuals engaged in such activities are called "Body Packers" or "Mules". The most frequent cause of the death among body packers is acute drug intoxication due to rupture of the package(s) within the gastrointestinal tract. We present the first documented case of a body packer that died from cocaine intoxication following the rupture of packets of cocaine in Western Pennsylvania.
Assuntos
Cocaína/intoxicação , Crime , Inibidores da Captação de Dopamina/intoxicação , Corpos Estranhos/complicações , Adulto , Cocaína/sangue , Inibidores da Captação de Dopamina/sangue , Overdose de Drogas , Evolução Fatal , Medicina Legal , Trato Gastrointestinal/patologia , Humanos , MasculinoRESUMO
Suicidal deaths involving an explosive, unrelated to a terrorist act, are rare. The rarity of such events presents a unique environment for those investigating such a death. We report a case of suicide involving a 29-year-old white male who detonated a firework in his mouth, resulting in massive craniocerebral destruction. He was discovered in his residence shortly after the explosion. Initially, the case was believed to be a fatal gunshot wound by the paramedics and homicide detectives at the scene. Several small pieces of red colored paper and a possible end cap were located throughout the scene. Analysis of the paper and end cap showed trace components consistent with flash powder. The victim had used a pyrotechnic device to commit suicide. Therefore, it is critical for those who investigate deaths be able to identify cases that involve explosives in order to properly collect and analyze the evidence.
Assuntos
Traumatismos por Explosões/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Medicina Legal/métodos , Suicídio , Adulto , Traumatismos por Explosões/patologia , Traumatismos Craniocerebrais/patologia , Humanos , Masculino , ManufaturasRESUMO
Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.