Caracterización de la conducta suicida en adolescentes / Characterization of the suicidal behaviour in adolescents

El suicidio es un trastorno de la conducta que provoca impulso o deseo de morir. Alrededor de 1110 personas se suicidan y cientos de miles hacen el intento cada día; por cada suicidio se realizan unos 10 intentos. Se realizó un estudio descriptivo de los adolescentes que ingresaron por conducta suicida en el Hospital Universitario Mártires del 9 de Abril de Sagua la Grande, Villa Clara durante el quinquenio 2008-2012, con el objetivo de caracterizar la conducta suicida en adolescentes. La muestra estuvo conformada por los 53 adolescentes que fueron ingresados. Se estudiaron las variables edad, sexo, municipio de procedencia, grado de escolaridad, ocupación, método utilizado para la conducta suicida y esfera de conflictos afectada. Los adolescentes que realizaron conducta suicida tenían un promedio de edad de 15,9 años; el 81,1 por ciento pertenecía al sexo femenino; el promedio de escolaridad fue de décimo grado; el 90,6 por ciento eran estudiantes de la educación general; la ingestión de tabletas fue el método utilizado por el 92 por ciento de los adolescentes para la conducta suicida; las esferas de conflictos que predominaron fueron la familiar (48,2 por ciento) y la personal (33,9 por ciento). Se concluye que los adolescentes que realizaron conducta suicida estaban comprendidos en el grupo de edad de 17 y 18 años; la mayoría pertenecía al sexo femenino con mayoría en la educación general y como promedio el décimo grado; mayoritariamente la ingestión de tabletas fue el método utilizado para la conducta suicida y las esferas de conflictos que predominaron fueron la familiar y la personal(AU)

Suicide is a dysfunction of the behaviour that causes impulse or desire to die. About 1110 people make suicide and thousands of people make the attempt every day; for each suicide they are carried out about 10 attempts. It was performed a descriptive investigation of the adolescents with suicide attempt and there were admitted at Mártires del 9 de Abril university hospital of Sagua la Grande in Villa Clara during the five-year period 2008-2012, with the objective of characterizing suicide attempt in adolescents. As variables we studied age, sex, municipality of residence, school grade, occupation, method used to commit suicide, and affected conflict sphere. The adolescents with suicide attempt had a 15,9 year- old average; the feminine sex prevailed (81,1 percent); the average school level was tenth grade; 90,6 percent of them were students of the general education; the ingestion of pills was the method used by the 92 percent of adolescents for the suicidal behaviour; the spheres of conflicts that prevailed were the familiar (48,2 percent) and personal (33,9 percent). It is concluded that adolescents who commit suicide were in the group of age of 17 and 18 years old; most of them were female with a majority from general education and a mean of tenth grade; most of them used as a method drinking pills and the conflict area that prevailed were family and personal ones(EU)

A toxicology-based review of fentanyl-related deaths in New Mexico (1986-2007).

Since its approval in the United States, fentanyl has become increasingly popular for the medical management of pain and as a substance of abuse. Fentanyl is unique among the opioids in its widespread use with a transdermal delivery system, which contributes to its unique pharmacokinetics and abuse potential. We examined the demographics of deaths with fentanyl identified on toxicologic analysis and reviewed specific challenges in the laboratory detection of postmortem fentanyl levels. The New Mexico Office of the Medical Investigator database was searched for all cases from January 1986 through December 2007 with fentanyl reported as present or quantified. Those deaths with a cause of death identified as drug overdose were then analyzed separately. From 1986 to 2007, 154 cases were identified with fentanyl present in postmortem samples, with 96 of the cases identified as fentanyl-related drug overdoses. The number of fentanyl-related deaths has increased over the past 20 years, corresponding to both statewide increases in the medical use of fentanyl and the abuse of prescription opioids. The demographics of these fentanyl-related overdoses showed that subjects were more likely to be female, white non-Hispanic, and older than those in previously described overdose deaths. Several cases were identified with central and peripheral blood samples and antemortem and postmortem samples available for fentanyl quantification. Given the uncharacteristic demographics of fentanyl-related deaths and the complexity of the laboratory analysis of fentanyl, forensic scientists must use caution in both the detection and interpretation of fentanyl concentrations.

Multidisciplinary investigation of an unusual apparent homicide/suicide.

The investigation of deaths of individuals whose bodies are decomposed, mummified, or skeletonized is particularly difficult for medical examiners and medicolegal death investigators. Determination of the cause and manner of death in such cases frequently requires consultation with experts in a variety of disciplines in the forensic sciences and necessitates correlation of the autopsy results, scene investigation, medical and social history of the deceased, and laboratory studies. The authors report an unusual case of an apparent homicide/suicide involving 2 individuals and a canine that went undetected for almost 4 years. Determination of the cause and manner of death in these cases involved a multidisciplinary, intercontinental investigation and necessitated the performance of toxicologic studies on specimens not commonly analyzed. These cases illustrate the importance of the multidisciplinary approach to medicolegal death investigations and the necessity of considering nontraditional sources of potential information and specimens for laboratory analysis in selected cases.

Xylazine (veterinary sedative) use in Puerto Rico.

Human xylazine use in Puerto Rico merits particular attention for its unprecedented scale and depth. Although Puerto Rican injecting drug users (IDUs) have reported using this drug since the early 2000s, little is being done in the research and service delivery sectors as it is claimed that xylazine severely impacts the health of its users. This report provides information on xylazine use and its associated harms. Data from one semi-structured interview collected in New York City (2007-2008) as part of a larger research study with migrant Puerto Rican drug users is presented as a case study. Xylazine, a veterinary sedative, is an adulterant and complement to other drugs and its chronic use is reported to be associated with physical deterioration. Because human xylazine use has been reported in other locations outside of Puerto Rico, this substance could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico. Research and interventions are needed to provide adequate services on the island, better understand how the use of xylazine affects its users, and to reduce the possibility of increased xylazine use on the state-side.

Intento de suicidio vía ingesta de fármacos en niños / Suicide attempts secondary to self-inflicted drug poisoning

Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.

Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.