Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism.

The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y(n) = α ⋅ n (ß) where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and ß > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism.

Characteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn.

Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51-60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmental-geographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.

Deadly heroin or the death of heroin -- overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Rates of illicit drug use and drug-related deaths have continuously increased in developed countries since the 1960s even though the patterns of use and thus the related mortality differ from region to region. In Europe heroin is the drug most often implicated in overdoses. The decedents are most often male, between 20 and 30 years of age and have a long history of drug use. According to the majority of available studies a concomitant use of alcohol and benzodiazepines is one of the risk factors of heroin overdose. In our study we have examined the basic demographic and toxicological features of illicit drug related death cases in Budapest, Hungary between 1994 and 2012. Drug overdose death cases have been divided into two subgroups according to the substances responsible for the death of the subjects: an opioid group and a non-opioid group. The huge majority (87.9%) of decedents died due to heroin overdose and were male (87%). There has been a significant increase in the mean age of the opioid group for the past 19 years. The majority of heroin overdose cases (58%) has had no other psychofarmacons present at the toxicological examination. We have found a slight but significant positive correlation (p=0.0204, r=0.349) between the number of heroin overdose death cases and the mean concentration of street level purity heroin. Most of the examined demographic and toxicological features of the population studied have been in concordance with data previously reported. However, in contrast to other studies we report a strikingly high proportion of "pure" heroin overdose cases where no other psychoactive substances were found. The reason for this is currently unknown; we can only speculate that it can be related to the fact that heroin is used and abused differently from other countries. The remarkable phenomenon of the "ageing" of heroin users may also support a change in the drug use habits of the youngest population. The emergence and spread of new designer drugs also change the mortality characteristics of the youngest abusers and pose a new challenge for researchers.

Homicides against infants, children and adolescents in Budapest (1960-2005).

INTRODUCTION: The objective of this study was to determine the characteristics and trends of fatal child abuse that would assist family doctors in detecting signs of maltreatment. SUBJECTS: There were 363 (193 males, 170 females) such cases autopsied at the Department of Forensic and Insurance Medicine at Budapest from 1960 to 2005. Information was collected from forensic autopsy records. Data were analyzed according to age, gender, type of abuse, injured body region, and seasonal distribution. The first detection of fatal injuries and death certification were usually done by GPs or ambulance at the scene of the homicide or hospital paediatricians in cases with survival period between the injuries and death. RESULTS: Our results suggest a definitive decrease in fatal child abuse cases during the investigated period. In the first part of study period suffocation of infants represent a great number of cases. Infanticide rapidly dropped after the mid 1970s. In this material 89.3% of fatal cases was detected and reported by family doctors. CONCLUSIONS: Rate of homicides against infants, children and adolescents reflect the effectiveness of the preventative strategies, the child protection policy and the unique primary health care system for youth. GPs have an important role in the investigation of infanticides and homicide cases against children and adolescents.

Evaluation of meteorological factors on sudden cardiovascular death.

Climatic and seasonal triggering factors have received an increasing attention among risk factors of sudden cardiac death. The relationship between cold weather conditions and ischemic heart disease death is well established. In this study, there were 7450 (4967 males, 2483 females) cardiovascular death cases medico-legally autopsied between 1995 and 2004. In most of the cases (76%) cardiac death occurred at the scene, and 17% had acute ischemic heart disease. In order to examine the relationship between daily maximum, minimum and mean temperature, air humidity, air pressure, wind speed, global radiation and the daily numbers of death cases, statistical analysis were accomplished using correlation coefficients, and Box-Whisker-plot diagrams. A significant negative correlation was detected between daily mean temperature and cardiovascular mortality. A remarkable seasonal variation was found. Cold and dry weather may be an important risk factor in bringing on the onset of sudden cardiac death.

Alcohol-related mortality risk in natural and non-natural death cases.

Determination of the associations between alcohol influence and sudden natural death represents challenges for medicolegal investigations. The aim of this study was to investigate the prevalence of alcohol influence in medicolegal autopsies. In our study of natural and non-natural deaths cases (5496 total: 4045 males, 1451 females) were examined. Blood alcohol concentrations (BACs) were detected by headspace gas chromatographic method. We investigated the alcohol-related mortality using hierarchical log-linear statistical models. Severe BACs were detected among suicidal victims in the oldest age group (>65 years) (InF = 0.442) and among the homicide victims between the age of 40-65 years (InF = 0.234). Correlations we found between manner-of-death and sex suggested that the rate of males in accidents (lnF = 0.140) and the rate of females in homicides (lnF = 0.193) were higher. It was concluded that the accurate statistical mortality database may provide a huge support for the determination of alcohol effects on human health and mortality.

Relationship between suicidal cases and meteorological conditions.

Meteorological factors are well known to modulate human health status and the rate of death cases. The suicidal rate might have been influenced by climatic and seasonal triggering factors. In this study 4918 suicidal cases (3099 male, 1819 female) in Budapest were investigated in connection with climatic data, as daily maximum, minimum temperature, and air humidity. The most frequent methods of suicide were intoxication, hanging and jumping. A mild seasonal variation was found, however, the rate of suicidal death was influenced by warm temperatures. Higher frequency of suicidal deaths was detected in warm weather with low relative humidity, which implies dominantly dry anticyclonic meteorological conditions. Our results suggest that the medico-legal investigation may help specific suicide prevention programme regarding to the climate change and meteorological conditions as potential risk factors of suicidal cases.

Fatal asphyxia due to laryngomucocele.

Laryngocele is a rare benign lesion of the larynx resulting from an abnormal dilation of the laryngeal saccule, however, severe airway obstruction and even asphyxia may occur. We report the case of a 55-year-old woman who presented with a feeling of discomfort and mild asphyxia. There was a smooth, firm swelling, 2 cm in diameter, upon palpation on the right side of the neck. Laryngoscopy revealed a bulging near the ventricular and right aryepiglottic folds. CT scan, MRI investigation and in-hospital observation were suggested, the patient, however, refused acute treatment and hospitalization and died suddenly, a few minutes after leaving. Autopsy revealed combined laryngocele with internal and external components. As the presented case shows, the internal part of the laryngocele may cause rapid and complete obstruction. The examining physician should therefore call the patient's attention to this potential life threatening condition.

Jumping and falling death in children, adolescents, and young adults.

INTRODUCTION: Evaluation of fatal jumps and falls from height in children, adolescents and young adults needs careful medico-legal investigation. The aim of this study was to examine the distribution of undetermined falling from height, accidental falling, and suicidal jumping cases between 1990-2003. METHODS: Copies of death certificates relating to falling from height and jumping deaths in Hungarian youths from the ages of 0-24 years of those resident in Hungary were obtained. RESULTS: 215 (34.1%) accidental falls, 394 (62.6%) suicidal jumping, and 21 (3.3%) undetermined intent were investigated. A significant increase was detected in suicidal jumping death in the age group of 15-19 years (OR=0.7, CI=0.49-0.98, p=0.039), and in the age group of 20-24 years (OR=0.72, CI=0.54-0.96, p=0.025) in the most recent 5 year study period. CONCLUSION: Data concerning the scene investigation, detailed forensic autopsy, and family history have important role in the differentiation of fatal jumping or falling cases. Further investigation about the characteristics injuries may help the final determination of violent death causes at youth, and more effort should be directed to an effective prevention strategy for jumping or falling death cases.