Differences in volume, density, electrolyte concentration, and total proteins in the fluid of the paranasal sinuses of freshwater and saltwater drowning victims: a systematic review and meta-analysis.

This study summarized the available evidence on the differences in volume, density, electrolyte concentration, and total proteins in paranasal sinus fluid between freshwater and saltwater drowning victims. A systematic search was conducted in electronic databases and gray literature, resulting in the inclusion of five studies with 234 drowning victims (92 saltwater incidents and 142 freshwater incidents). Meta-analyses using the inverse-of-variance method and a random-effects model were performed, reporting effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI). The findings showed a significantly higher sinus density in saltwater drowning cases compared to freshwater drowning cases (SMD 0.91, 95% CI 0.50 to 1.32). However, no significant differences were observed in sinus fluid volume. Saltwater drowning victims exhibited higher electrolyte concentrations (sodium: SMD 3.77, 95% CI 3.07 to 4.48; potassium: SMD 0.78, 95% CI 0.07 to 1.49; chloride: SMD 3.48, 95% CI 2.65 to 4.31; magnesium: SMD 4.01, 95% CI 3.00 to 5.03) and lower total protein concentrations (SMD - 1.20, 95% CI - 1.82 to - 0.58) in sinus fluid compared to freshwater drowning victims. This meta-analysis highlights the importance of analyzing the characteristics and composition of sinus fluid in forensic investigations of drowning cases. While no differences were found in sinus fluid volume, saltwater drowning victims exhibited higher sinus density, elevated electrolyte concentrations, and lower total protein concentrations compared to freshwater drowning victims.

The role of paranasal sinus fluid in determining drowning as the cause of death: A systematic review and meta-analysis.

Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = -1.4; 95% -2.5 to -0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches.

Deaths in Open Water Swimming Races in Brazil from 2009 to 2019.

Since the inclusion in the Olympic Games (2008), open swimming races have attracted greater media attention and, therefore, have a greater number of practitioners, especially in Brazil, an extremely favorable country for this sport. However, increasing reports of fatal incidents in open water races brought the medical and scientific community to attention. The aim of this study was to review the characteristics of deaths in open waters events in Brazil from 2009 to 2019. The survey was divided into 3 steps: 1) contacting sports-related federations and companies, including swimming and triathlon federations, master associations and event organizing companies; 2) internet search; and 3) personal communication with athletes, coaches, organizers, and health personnel. A total of 12 deaths were observed in open water swimming races, including triathlon swimming segment races in Brazil from 2009 to 2019. The average was 1.1 deaths per year, whereas in the last 3 years (2017-2019) the average was 3 deaths per year. The male participants accounted for 11 deaths (91.7%), the average age was 47 years old, experienced athletes were more affected (80%), and incidents occurred mainly in ocean waters (75%). The increase of deaths in the last 3 years draws attention, and the best way to reduce the deaths by drowning in open waters in Brazil, is to understand the profile and causes, to propose solutions.

Clinical and epidemiological aspects of victims of maritime accidents on the Mar Grande-Salvador crossing, Bahia, Brazil: a case series study

ABSTRACT BACKGROUND: Maritime transportation is an activity of vital importance for societies. The Mar Grande-Salvador crossing is an intercity waterway transport line in Brazil that transports 3,500 passengers/day, including residents and tourists. In 2017, an accident on this crossing was considered to be the biggest maritime tragedy in Bahia in the last decade. OBJECTIVE: To describe the clinical and epidemiology characteristics of victims of this maritime accident, with analysis on bodily injuries, causes of death and means/instruments that caused the fatal injuries. DESIGN AND SETTING: Case-series study at the Forensic Medical Institute of Bahia, Brazil. METHODS: Reports on 73 victims who were examined for bodily injury or were necropsied by the Forensic Medical Institute were analyzed. This study was approved by the institution's Research Ethics Committee (protocol 04012218.1.0000.5032). RESULTS: The victims' mean age was 33.0 years [95% confidence interval, CI, 26.3-47.0]. The mean age of those who died was 43.0 years [95% CI, 30.5-53.5]. Bodily injuries were found in 74% of the victims. The most frequent bodily injuries were ecchymoses among females (69.7%) and abrasions among males (76.2%). Blunt instruments produced most bodily injuries (85.2%). Among the victims who died, 68.4% were female. Mechanical asphyxiation through drowning was the leading cause of death (89.4%). The overall lethality rate was 26%, and this was higher among females (28.2%). CONCLUSION: Women were the main victims of this maritime accident. Bodily injuries occurred more frequently than death, but these injuries proved to be quite significant, thus demonstrating the importance of measures to improve the safety of navigation.

Coastal drowning in Costa Rica: incident analysis and comparisons between Costa Rican nationals and foreigners.

International and domestic tourism is a growing industry in Costa Rica, with the most attractive places located along the coast. Despite their beauty, Costa Rican beaches can pose a high risk for foreign visitors: Drowning is the primary cause of unintentional death among international visitors. This study presents a comprehensive analysis of demographics, spatial and temporal trends of national and foreigner fatal drowning occurring at Costa Rican beaches during 2001-2019. For national beachgoers, teens and young male adults, ages 15-30 years are at greatest risk of drowning, while for foreigners, older adults ages 45-60 years exhibit higher risk. Temporal trends in drowning appear to be correlated with the number of beach visitors, which seem to be driven mainly by a combination of socioeconomical and climatic/weather factors. For instance, strong economic indicators for the Costa Rican population combined with good weather fostered during warm phases of El Niño Southern Oscillation attract more national beachgoers, which may increase the number of drowning deaths. These results will help authorities better understand the complex and dynamic drowning situation to develop better prevention strategies and policies that improve beach safety and raise awareness about coastal hazards and risk. Such actions will bolster the reputation of Costa Rica as a safe touristic destination.

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.

Desempenho de corrida e natação de guarda-vidas civis após uma temporada de verão / Running and swimming performance of civilian lifeguards after a summer season

O objetivo do presente estudo foi verificar o desempenho de corrida e natação de guarda-vidas civis após uma temporada de verão em Florianópolis ­ SC. Quatorze guarda-vidas civis (idade: 23.4 ± 5.0 anos; massa corporal: 74.6 ± 8.9 kg; estatura: 176 ± 0.1 cm) realizaram testes de 500m de natação e 1600m de corrida antes e após uma temporada de verão de 5 meses. Não foi realizada nenhuma intervenção na rotina dos guarda -vidas durante esse período. A comparação no desempenho pré e pós temporada foi realizada pelo teste t de Student para dados pareados (bicaudal), enquanto as correlações entre as variáveis foram verificadas pelo coeficiente de correlação de Pearson, com nível de significância de 5% (p < 0.05). Houve piora nos tempos dos testes de 500m de natação (Pré: 501.4 ± 77.9; Pós: 523.1 ± 84.6 s; p < 0.01) e 1600m de corrida (Pré: 371.6 ± 42.3 s; Pós: 393.9 ± 42.7 s; p < 0.01), sem associação entre o tempo de desempenho pré-temporada no teste de natação (r = 0.441, p = 0.115) ou corrida (r = -0.179, p = 0.541) com as magnitudes de piora. Concluiu-se que houve uma piora no desempenho de corrida e natação ao término da temporada de verão nos guarda-vidas civis, o que pode levar a uma perda no rendimento nas atividades que são submetidos rotineiramente. Dessa forma, tornam-se importantes estratégias, como o treinamento sistematizado, para minimizar essa queda no rendimento dos guarda-vidas civis, evitando o risco a si mesmo e a potenciais vítimas.(AU)

: The aim of this study was verify the performance of the running and swimming of civilian lifeguards after a summer season in Florianópolis - SC. Fourteen civilian lifeguards (age: 23.4 ± 5.0 years; body mass: 74.6 ± 8.9 kg; height: 176 ± 0.1 cm) performed tests of 500m swimming and 1600m running before and after a summer season of 5 months. There was no intervention in the routine of the lifeguards during this period. Statistical analysis consisted of a paired t-test (two-tailed) for the pre and post-season comparison, with the correlations between the variables being verified by Pearson's correlation coefficient, with level of significance of 5% (p < 0.05) for all tests. There was an impairment in the 500m swimming test (Pre: 501.4 ± 77.9; Post: 523.1 ± 84.6 s; p <0.01) and 1600m running test (Pre: 371.6 ± 42.3 s; Post: 393.9 ± 42.7 s; p <0.01), without association between the pre-season performance time and the swimming (r = 0.441, p = 0.115) or running (r= -0.179, p = 0.541) impairment magnitudes. It was concluded that running and swimming performance are impaired at the end of the summer season on civilian lifeguards, which could cause a loss of performance in routine activities. Thus, become important strategies, such as systematic training, to minimize this fall in the performance of civilian lifeguards, avoiding the risk to themselves and potential victims. (AU)

Characterization of fatal injuries in oil and gas industry-related helicopter accidents in the Gulf of Mexico, 2004-2014.

BACKGROUND: Transportation events are the most common cause of offshore fatalities in the oil and gas industry, of which helicopter accidents comprise the majority. Little is known about injury distributions in civilian helicopter crashes, and knowledge of injury distributions could focus research and recommendations for enhanced injury prevention and post-crash survival. This study describes the distribution of injuries among fatalities in Gulf of Mexico oil and gas industry-related helicopter accidents, provides a detailed injury classification to identify potential areas of enhanced safety design, and describes relevant safety features for mitigation of common injuries. METHODS: Decedents of accidents during 2004-2014 were identified, and autopsy reports were requested from responsible jurisdictions. Documented injuries were coded using the Abbreviated Injury Scale (AIS), and frequency and proportion of injuries by AIS body region and severity were calculated. Injuries were categorized into detailed body regions to target areas for prevention. RESULTS: A total of 35 autopsies were coded, with 568 injuries documented. Of these, 23.4% were lower extremity, 22.0% were thorax, 13.6% were upper extremity, and 13.4% were face injuries. Minor injuries were most prevalent in the face, neck, upper and lower extremities, and abdomen. Serious or worse injuries were most prevalent in the thorax (53.6%), spine (50.0%), head (41.7%), and external/other regions (75.0%). The most frequent injuries by detailed body regions were thoracic organ (23.0%), thoracic skeletal (13.3%), abdominal organ (9.6%), and leg injuries (7.4%). Drowning occurred in 13 (37.1%) of victims, and drowning victims had a higher proportion of moderate brain injuries (7.8%) and lower number of documented injuries (3.8) compared with non-drowning victims (2.9 and 9.4%, respectively). CONCLUSIONS: Knowledge of injury distributions focuses and prioritizes the need for additional safety features not routinely used in helicopters. The most frequent injuries occurred in the thorax and lower extremity regions. Future research requires improved and expanded data, including collection of detailed data to allow characterization of both injury mechanism and distribution. Improved safety systems including airbags and helmets should be implemented and evaluated for their impact on injuries and fatalities.

Postmortem findings in Magellanic penguins (Spheniscus magellanicus) caught in a drift gillnet.

BACKGROUND: Penguin interaction with gillnets has been extensively reported in the Atlantic and Pacific Oceans, and is considered a major conservation threat. Among penguin species, Magellanic penguins (Spheniscus magellanicus) are currently considered of great concern, particularly in Brazil, where they are highly susceptible to gillnet bycatch. Nevertheless, information about drowning-associated microscopic findings in penguins is limited. RESULTS: We describe the anatomopathological findings of 20 Magellanic penguins that drowned after getting entangled in a drift gillnet while wintering along the Brazilian shelf and washed ashore still enmeshed in Santa Catarina, Brazil. All 20 birds (19 juveniles and 1 adult; 18 females and 2 males) were in good body condition. Major gross findings were abrasion, bruising, and local erythema and edema of the wings, multiorgan congestion, jugular vein engorgement, pulmonary edema and hemorrhage, splenomegaly and hepatomegaly, fluid in the trachea, serous bloody fluid in the lungs, gastrointestinal parasites (nematodes, cestodes and trematodes), and debris in the stomach. The most common histopathological findings were cerebral and pulmonary congestion, pulmonary edema, splenic histiocytosis, lymphoid splenic hyperplasia, acute splenitis, extramedullary hepatic hematopoiesis, and parasitic enteritis. Although unspecific, the observed multiorgan congestion and pulmonary edema are consistent with previous reports of drowning in birds and may be indicative of this process. CONCLUSIONS: Drowning may be a challenging diagnosis (e.g., carcass decomposition, predation), but must be considered as a differential in all beach-cast seabird postmortem examinations. To the authors' knowledge this is the largest anatomopathological study based on microscopic examination in drowned penguins.

Anoxia Effects in Asphyxiated Green Sea Turtles (Chelonia mydas) Caught in an Artisanal Fishing Net on the Coast of Brazil.

Among studies of drowning in green sea turtles (Chelonia mydas), none have associated drowning with injuries of organs other than the lung. We describe the gross and microscopical findings in 23 green sea turtles found dead in a fishing net. Deprived of air, these animals experienced hypoxia and anoxia before dying, which caused congestion, hydropic degeneration and necrosis in several organs. There was no evidence of an alternative cause of death. These findings demonstrate a pattern characteristic of death by asphyxia caused by drowning.

Drowning Classification: A Reappraisal of Clinical Presentation and Prognosis for Severe Cases.

BACKGROUND: Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles. METHODS: This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman. RESULTS: During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process. CONCLUSIONS: On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.

[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.

Identificação de vítima de afogamento por meio de documentação ortodôntica: relato de caso / Drowned victim identification through orthodontic documentation: Case report

Introdução: A identificação humana pelos arcos dentais é considerada uma forma segura para se obter um resultado, pois possuem unicidade no conjunto de características, como morfologia dos dentes, formato da arcada, presença de alterações patológicas ou terapêuticas, ausências, e anomalias numéricas, morfológicas ou posicionais. Com frequência, cadáveres encontrados na água em estágio avançado de putrefação impossibilitam a identificação papiloscópica, tornando a Odontologia Legal necessária, evitando exames mais caros e demorados, como o DNA. Os dentes e os materiais odontológicos utilizados são de grande resistência à ação do fogo e da água, e o prontuário odontológico, arquivado com o cirurgião-dentista deve conter registro de todos os procedimentos realizados no paciente em vida, bem como modelos de gesso, radiografias, fotografias e demais exames de imagem. Objetivo: O presente artigo tem como objetivo relatar o caso de um adulto afogado que teve a sua identificação confirmada através da documentação ortodôntica. Conclusão: Concluiu-se que a associação da documentação ortodôntica fornecida pelos familiares com fotos, radiografias, e pareceres, e os dados odontolegais obtidos no exame cadavérico, permitiram a confirmação da identidade do indivíduo.

Introduction: Human identification by the dental arch is considered a safe way to obtain a result, since the dental arch has uniqueness in the set of characteristics, such as morphology of the elements, arch format, presence of pathological or therapeutic alterations, absences, and numerical, morphological or positional anomalies. Often, corpses found in the water at an advanced stage of putrefaction make it impossible to identify by finger prints, making Forensic Dentistry necessary for the identification of the corpse, avoiding more expensive and time-consuming exams, such as DNA. The teeth and dental materials used are highly resistant to the action of fire and water, and the dental record, filed with the dental surgeon, contains a record of all procedures performed on the patient during life, as well as plaster models, radiographs, photographs and other image exams. Aim: This article aims to report the case of a drowned man who had his identification confirmed through orthodontic documentation. Conclusion: It was concluded that the association of orthodontic documentation provided by the family with photos, radiographs, and opinions, and the dental data obtained in the cadaveric examination allowed the confirmation of the individual's identity.

Is drowning a mere matter of resuscitation?

International data severely underestimates actual drowning numbers. Almost all victims are able to help themselves or are rescued in time. This study aims to report the occurrence of Drowning Chain of Survival actions and resuscitations needed in a fully operational lifeguard service. METHODOLOGY: Data was collected from Dec-2009 to Mar-2015 by lifeguards at a 6km-long beach in Brazil. The Drowning Chain of Survival links were summarized into 3 main action-response sections: Prevention; rescue; and provide care. Rescues were classified by severity. RESULTS: Lifeguards reported 1,565,699 actions during the study period. Preventative actions comprised 1,563,300(99.8%) and 2044 (0.1%) involved recognizing a person in stress/distress and rescuing them. Of those requiring rescue, 355(0.02%) needed medical assistance due to respiratory symptoms, isolated respiratory arrest, or cardiopulmonary arrest. Those cases were classified by severity as: Grade 1 = 234(65.9%), grade 2 = 78(22%), grade 3 = 22(6.2%), grade 4 = 7(2%), grade 5 = 4(1.1%), and Grade 6 = 10(2.8%). From all 2044 rescues, 14(0.7%) were grade 5 and 6 and needed respiratory or cardiorespiratory resuscitation. An estimative incident rate for each day at a lifeguarded beach revealed: 1 rescue for every 4.227 beach attendances, 1 drowning for every 24,338 beach attendances, and 1 instance of CPR being performed for every 617,142 beach attendances. The prevalent misconception that majority of drowning require resuscitation is perpetuated by the media and publishers. We are only just seeing the tip of the iceberg and urgently need to look at the problem in its entirety. Considering all the intervention undertaken by lifeguards in a fully operational system, the incidence of resuscitation being performed is only one in every 112,000 lifeguarding actions (0.0009%).

Cognitive performance in transient global hypoxic brain injury due to moderate drowning.

INTRODUCTION: Drowning is a serious and frequently neglected public health threat. Primary respiratory impairment after submersion often leads to brain dysfunction. Depending on the period of global hypoxia (respiratory failure), clinical aspects of neurological dysfunction are evident on the first evaluation after the water rescue. Nowadays, many neuropsychological assessments after drowning are inconclusive, with some studies reporting only minor neurological or cognitive impairments. The aim of this study is to identify measures in neuropsychological tests that most contribute to classify volunteers as moderate drowning subjects or healthy controls. To the best of our knowledge, this study is the first neuropsychological prospective case-control study of moderate drowning in a country with large coastal cities. METHOD: Fifteen moderate drowning patients (DP), who met the inclusion criteria, were compared with 18 healthy controls (HC). All subjects were assessed on memory, learning, visual spatial ability, executive function, attention, and general intellectual functioning and underwent structural magnetic resonance (MR) imaging of the brain at 3.0 T, in order to exclude subjects with anatomic abnormalities. RESULTS: Neuropsychological tests assessing learning, execution function, and verbal fluency-Rey Auditory Verbal Learning Test (RAVLT) general learning ability, Digit Span total, Phonological Verbal Fluency (total FAS correct), and Brief Visuospatial Memory Test Revised (BVMT) correct recognition-have the strongest discriminating ability, using predictive models via the partial least squares (PLS) approach for data classification, while the other tests have shown similar predictive values between groups. CONCLUSIONS: Learning, execution function, and verbal fluency domains were the most critically affected domains. Serious impairments in the same domains have already been reported in severe drowning cases, and we hypothesize that subtle alterations found in moderate drowning cases, although not sufficient to be detected in daily routine, may possibly have a negative impact on cognitive reserve.

Incidence and Consequences of Near-Drowning-Related Pneumonia-A Descriptive Series from Martinique, French West Indies.

Drowning represents one major cause of accidental death. Near-drowning patients are exposed to aspiration that may result in pneumonia with life-threatening consequences. We designed this descriptive study to investigate the frequency, nature, and consequences of post-drowning pneumonia. One hundred and forty-four near-drowning patients (33 children and 111 adults) admitted during four years to the University Hospital of Martinique, French Indies, were included. Patients presented pre-hospital cardiac arrest (41%) and exhibited acute respiratory failure (54%), cardiovascular failure (27%), and lactic acidosis (75%) on admission. Empirical antibiotics, as decided by the physicians in charge, were administered in 85 patients (59%). Post-drowning early onset bacterial pneumonia was diagnosed as "possible" in 13 patients (9%) and "confirmed" in 22 patients (15%). Tracheal aspiration revealed the presence of polymorphous pharyngeal flora (59%) or one predominant bacteria species (41%) including Enterobacter aerogenes, Enterobacter cloacae, Staphylococcus aureus, Pseudomonas aeruginosa, Aeromonas hydrophilia, and Morganella morgani. Despite adequate supportive care, drowning resulted in 45 fatalities (31%). Early onset bacterial aspiration pneumonia (either possible or confirmed) did not significantly influence the risk of death. In conclusion, near-drowning-related bacterial aspiration pneumonia seems rare and does not influence the mortality rate. There is still a need for practice standardization to improve diagnosis of post-drowning pneumonia and near-drowning patient management.

Neurologic complications of acute environmental injuries.

Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

Brain injury after moderate drowning: subtle alterations detected by functional magnetic resonance imaging.

To describe cerebral (structural and functional MRI) and neuropsychological long term changes in moderate drowning victim's compared to healthy volunteers in working memory and motor domains. We studied 15 adult drowning victim's in chronic stage (DV - out of 157 eligible cases of sea water rescues with moderate drowning classification) paired to 18 healthy controls (HC). All participants were investigated using intelligence, memory, and attention neuropsychological standard tests and underwent functional (motor and working memory tasks) and structural magnetic resonance imaging (MRI) in a 3 T system. All images were preprocessed for head movement correction and quantitative analysis was performed using FSL and freesurfer software packages. We found no between group differences in neuropsychological assessments. No MRI brain lesion was observed in patients, neither difference on morphometric parameters in any cortical or subcortical brain structure. In constrast, functional MRI revealed that patients showed increased brain response in the motor (left putamen and insula) and memory (left cuneus and lingual gyrus - not the classical memory network) tasks. Functional brain changes in motor and visual brain regions in victims of moderate drowning may indicate reduced brain reserve, despite the lack of structural and behavior alterations. More attention should be given to investigate ageing effects in this nonfatal drowning group.

Fenómeno de diente rosado en asfixia por sumersión / Pink tooth phenomenon in suffocation asphyxiation

Resumen:El presente documento expone el caso del cadáver de un masculino desconocido en cuya autopsia se observó el fenómeno de "Diente Rosado",según la historia médico legal este sujeto había sido arrastrado por la corriente mientras nadaba en el mar y su cadáver fue hallado tres días mástarde.Al momento del levantamiento del cuerpo, este se encontraba en avanzado estado de descomposición sin datos evidentes de trauma, sus dientes se encontraban intactos y con una coloración rosada que llamaba la atención al examen externo del cadáver y se determinó que la causa de la muerte fue asfixia por sumersión.Este fenómeno ha sido vinculado con un posible mecanismo asfíctico, ya que ha sido observado en casos de estrangulación, sofocación y asfixia por sumersión principalmente, sin embargo ha sido tema de discusión y refutado por muchos autores en el tema.

Abstract:This document sets out the case of the corpse of an unknown male in whose autopsy was observed the phenomenon of " Pink teeth", according to the legal medical history this subject had been dragged by the current while swimming in and his body was found three days later.At the time of the first forensic valuation, this was in an advanced state of decomposition without obvious facts of trauma, their teeth were intact and with a important pinkness to the external examination of the body and them was determined that the cause of death was asphyxiation by drowning.This phenomenon has been linked with a possible legal consecuences, since it has been observed in cases of strangulation, suffocation, and drowning mainly.

Near-drowning-associated pneumonia with bacteremia caused by coinfection with methicillin-susceptible Staphylococcus aureus and Edwardsiella tarda in a healthy white man: a case report.

BACKGROUND: Edwardsiella tarda is an Enterobacteriaceae found in aquatic environments. Extraintestinal infections caused by Edwardsiella tarda in humans are rare and occur in the presence of some risk factors. As far as we know, this is the first case of near-drowning-associated pneumonia with bacteremia caused by coinfection with methicillin-susceptible Staphylococcus aureus and Edwardsiella tarda in a healthy patient. CASE PRESENTATION: A 27-year-old previously healthy white man had an episode of fresh water drowning after acute alcohol consumption. Edwardsiella tarda and methicillin-sensitive Staphylococcus aureus were isolated in both tracheal aspirate cultures and blood cultures. CONCLUSION: This case shows that Edwardsiella tarda is an important pathogen in near drowning even in healthy individuals, and not only in the presence of risk factors, as previously known.