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1.
Medicine (Baltimore) ; 98(38): e17212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567975

RESUMO

RATIONALE: Anomalous Origin of Left Coronary Arteries from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland (BWG), is a rare form of coronary artery anomaly that is usually discovered in the first few months of life. Only rarely can patients with this anomaly reach adulthood without symptoms. PATIENT CONCERNS: A 28-year-old female was witnessed suddenly collapse with a seizure-like episode by her colleagues at work. DIAGNOSIS AND INTERVENTION: Routine cardiopulmonary resuscitation was performed by emergency medical service technologists. The patient was unable to be revived. Postmortem examination revealed the patient had ALCAPA with a focal chronic ischemic injury of the left ventricle. Moreover, a high take-off of the right coronary artery was also discovered. OUTCOMES: The patient passed away due to ALCAPA. The mechanism of death was cardiac arrhythmia being triggered by myocardial ischemic changes. LESSONS: In the rare cases where ALCAPA manifests in an asymptomatic adult, the mortality rate is very high. This case demonstrates the importance of awareness of such patients living under the tremendous risk of sudden cardiac death.


Assuntos
Anomalias dos Vasos Coronários/patologia , Artéria Pulmonar/anormalidades , Adulto , Arritmias Cardíacas/etiologia , Doenças Assintomáticas , Autopsia , Morte Súbita Cardíaca , Feminino , Humanos
2.
Pol J Pathol ; 70(1): 33-41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556549

RESUMO

We present an analysis of two first historically documented limb body wall complex (LBWC) cases and our own contemporary perinatal autopsy series of this rare complex. So far it was supposed that the first case of this complex was reported in 1685 by Paul Portal. Studying the Joachim Oelhaf's autopsy report from 1613 with attached engraving showing the neonate with multiple birth defects led our research team to a conclusion that it was genuinely the first description of LBWC in the medical literature so far. We compared the Oelhaf's case from 1613 and the Portal's autopsy report from 1685 with our series of LBWC cases dissected in the Medical University of Gdansk between 1999 and 2011. Reviewing 1100 autopsy reports performed we encountered 9 cases of this unique complex. The analysis was supported by the literature review.


Assuntos
Anormalidades Múltiplas/história , Deformidades Congênitas dos Membros/história , Autopsia , Feminino , História do Século XVII , História do Século XX , História do Século XXI , Humanos , Recém-Nascido , Gravidez
3.
Pol J Pathol ; 70(1): 51-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31556553

RESUMO

Between 1793 and 1914, there were many internationally recognised physicians active in Gdansk. Their scientific activities included, among other things, anatomopathological research, constituting a determinant of progress in medical sciences during this period. One of the most important people was Martin Heinrich Rathke (1793-1860). He is recognised as one of the founders of modern embryology. In Gdansk Rathke's successor was Wilhelm Baum (1799-1883). Baum introduced compulsory post-mortem examinations in the city hospital even after the outbreak, and he was mentor to Theodor Billroth (1829-1894). The successor of Baum as the head of the city hospital was Emil Friedrich Götz (1806-1858). He took up an important topic, which was the consent of the family of the deceased to perform an autopsy. Furthermore, it described the gradual broadening of the scope of anatomopathological activities, consistent with the postulates of the first and second Viennese school, performed in Gdansk in the nineteenth century. However, a detailed analysis of the relationship between the discoveries of nineteenth-century medicine, especially in the field of pathological anatomy, and research carried out in Gdansk, remains in the sphere of research to be done.


Assuntos
Anatomia/história , Autopsia/história , Patologia/história , História do Século XIX , Humanos , Polônia
4.
Fa Yi Xue Za Zhi ; 35(4): 459-466, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532158

RESUMO

Abstract: Human corpses can be found in a variety of aquatic environments. The decomposition of corpses in aquatic environments is different from those on land. A large number of factors influence the decomposition process in water, therefore postmortem submersion interval (PMSI) is difficult to estimate. To date, while studies on aquatic corpses are obviously fewer than those on terrestrial corpses, there are many problems in practical work. This review summarizes the stages and influencing factors of aquatic corpse decomposition, and introduces the relevant research progress of PMSI estimation based on decomposition stages, postmortem phenomena, aquatic insects, biofilm, and physical and chemical methods, in order to provide reference for aquatic decomposition researches and practices.


Assuntos
Autopsia , Cadáver , Insetos , Mudanças Depois da Morte , Água , Animais , Biofilmes , Humanos
5.
Vasc Health Risk Manag ; 15: 253-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496715

RESUMO

Antiphospholipid syndrome (APS) is an autoantibody-mediated acquired thrombophilia characterized by venous and/or arterial thromboses, pregnancy morbidity (predominantly repeated fetal losses), and the presence of phospholipid antibodies. The estimated annual incidence of APS is 5 new cases per 100,000 people. The most common thrombotic events in patients with APS in order of frequency are stroke, transient ischemic attack, deep vein thrombosis, and pulmonary embolism. Patients with APS may develop an intracardiac thrombus, which is a life-threatening complication with a high risk of increased morbidity and mortality; however, it is treatable by surgical removal, extensive anticoagulant administration, and prevention of other complications. Catastrophic APS, which is a rare and severe condition diagnosed based on rapidly progressive thromboembolic events involving three or more organs, systems, or tissues, occurs in less than 1% of all patients with APS. We herein report an autopsy case of catastrophic APS in a 12-year-old Thai boy with multiple thromboembolic events including intracardiac thrombus formation with a positive lupus anticoagulant test result. To the best of our knowledge, this is the youngest reported patient with APS to date.


Assuntos
Síndrome Antifosfolipídica/complicações , Cardiopatias/etiologia , Tromboembolia/etiologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Autopsia , Biomarcadores/sangue , Doença Catastrófica , Criança , Evolução Fatal , Cardiopatias/sangue , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Inibidor de Coagulação do Lúpus/sangue , Masculino , Tromboembolia/sangue , Tromboembolia/diagnóstico , Tromboembolia/terapia
6.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31368316

RESUMO

The objective of this study was to gain better insight into factors associated with the capture-related mortality rate in cheetahs. A link to an online questionnaire was sent to zoo and wildlife veterinarians through the Species Survival Plan Programme and European Endangered Species Programme coordinators and via the 'Wildlife VetNet' Google group forum. The questionnaire consisted of 50 questions relating to the veterinarians' country of residence and experience, the medicine combinations used, standard monitoring procedures, capture-related complications and mortalities experienced in this species under different capture conditions. In addition, necropsy data from the national wildlife disease database of the National Zoological Gardens of South Africa were examined for cases where anaesthetic death was listed as the cause of death in cheetahs. A total of 75 veterinarians completed the survey, with 38 from African countries and a combined total of 37 from Europe, the United States (US) and Asia. Of these, 24% (n = 18/75) had experienced at least one capture-associated cheetah mortality, with almost all of the fatalities (29/30) reported by veterinarians working in Africa. A lack of anaesthetic monitoring and the absence of supplemental oxygen were shown to be significant risk factors for mortality. Hyperthermia, likely to be associated with capture stress, was the most common reported complication (35%). The results suggest that free-ranging rather than habituated captive cheetahs are particularly at risk of dying during immobilisation and transport. The capture-related fatalities in this species do not appear to be associated with either the veterinarian's level of clinical experience or the immobilisation agents used.


Assuntos
Acinonyx , Anestésicos Dissociativos/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Imobilização/veterinária , Mortalidade , Animais , Animais Selvagens , Animais de Zoológico , Autopsia/veterinária , Bases de Dados Factuais , Combinação de Medicamentos , Europa (Continente) , Imobilização/efeitos adversos , Imobilização/métodos , Ketamina/efeitos adversos , Modelos Logísticos , Medetomidina/efeitos adversos , Fatores de Risco , África do Sul/epidemiologia , Inquéritos e Questionários , Tranquilizantes/efeitos adversos , Médicos Veterinários
7.
J Forensic Leg Med ; 67: 49-60, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31431262

RESUMO

For forensic clinicians and pathologists, photography of bodily regions, injuries and skin lesions present a number of technical challenges including proper framing, avoidance of distortion, choice of background and inclusion of a properly orientated scale. Photography of internal organs at autopsy presents further difficulties with regard to correct exposure, light reflections and limited depth of field. Situations commonly arise in clinical forensic and autopsy practice which require photographic documentation but which may not warrant calling upon the clinical photographer or police Scenes of Crime Officer. This article provides a brief explanation of various technical considerations which will allow forensic practitioners and technicians to take their own high quality external and internal photographs. Technical aspects discussed include aperture, shutter speed, ISO, depth of field, camera shake, and use of flash, scales, focal planes and backgrounds. The possible pitfalls encountered in several common photographic situations are illustrated and discussed, together with suggested workarounds and camera settings. Whilst the photographic examples presented here mostly relate to autopsy practice, the general principles and technical discussion also apply to wider clinical forensic photography practice.


Assuntos
Fotografação/métodos , Autopsia , Medicina Legal , Humanos , Iluminação , Fotografação/instrumentação
10.
Medicine (Baltimore) ; 98(27): e16348, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277191

RESUMO

Medical staff face the risk of exposure to blood-borne infectious agents during postmortem examinations. This study investigated the effectiveness of non-slip work gloves worn over 2 layers of surgical latex gloves (outer and inner gloves) as a means of reducing hand and finger injuries. Complete sets of outer and inner gloves worn during postmortem examinations were collected from participating forensic staff. Latex gloves were categorized into 2 groups based on the users' actions during the examination: the wearing group if the wearer wore their work gloves continuously without interruption, and the taking-off group if the wearer removed them at least once. Perforation rates, locations, and shapes were compared between these groups. Outer-glove perforation occurred significantly more often in the taking-off group (n = 102 pairs) than in the wearing group (n = 91 pairs) (30.4% vs 3.8%, P < .001). Inner-glove perforation occurred at rates of 2.0% and 0.5% (P = .38), respectively. The wearers did not incur hand or finger injuries. Perforation rates were similar between the dominant and non-dominant hands (P = .18). Regarding location, gloves were punctured most frequently at the thumb, followed by the index finger. Most examiners (85.6%) did not notice the perforation when the damage occurred. Therefore, we could not confirm that a specific operation within a set of plural operations affected the rate of perforation. Additionally, we could not prove a relationship between glove perforation and each operation performed with/without work gloves. The perforation appearances varied greatly in shape and size, suggesting multiple causes of perforation. The continuous (i.e., uninterrupted) wear of work gloves during postmortem examinations reduced the incidence of perforations in both latex glove layers and thus reduced the risk of hand and finger injury.


Assuntos
Autopsia/instrumentação , Falha de Equipamento , Luvas Cirúrgicas , Traumatismos da Mão/prevenção & controle , Látex , Patógenos Transmitidos pelo Sangue , Desenho de Equipamento , Humanos
11.
Pan Afr Med J ; 32: 187, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312299

RESUMO

The study of mortality enables to identify the major public health problems in the countries under consideration. It can give an indication on the preventive and "medico-curative" measures as well as on the investments in research that could increase life expectancy of the population. This study aims to evaluate the causes of death in the general population based on the informations contained in the register of deaths in Dakar. Our specific aim was to determine the causes of death, to identify the socio-demographic factors influencing death and to identify the kinds of death and types of death. We conducted a retrospective study on the cases of death in the general population who underwent an autopsy in Dakar, from 2003 to 2012. Data were taken from the autopsy registers from the Aristide Le Dantec Hospital (HALD) and the General Hospital of Grand Yoff (HOGGY), which are the only hospitals in Dakar where autopsies are made. The informations contained in the different data sources were recorded on a survey form and analyzed using Epi-Info 6.04. During the study period, 985 patients died among whom 693 of violent death (70.3%), 261 of natural death (26.5%), and 14 of unspecified cause (1.4%). There was a predominance of traffic accidents (394; 40%). With respect to the kind of death, more than half of the cases were due to traffic accidents (violent deaths). Traffic-related deaths most often occurred during the pre-hospitalization period or on arrival to the hospital. The Ministry of Health should continue to promote measures for preventing and managing communicable diseases. The two priorities should be as follows: cardiovascular diseases and traumas.


Assuntos
Causas de Morte , Política de Saúde , Saúde Pública , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Senegal , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidade , Adulto Jovem
12.
J Glob Health ; 9(2): 020501, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360450

RESUMO

Background: The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods: Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results: Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions: The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real-world cohorts with detailed, time-varying information on neonatal mortality.


Assuntos
Mortalidade Infantil/tendências , Autopsia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
14.
Fa Yi Xue Za Zhi ; 35(3): 332-336, 2019 Jun.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31282631

RESUMO

Abstract: With the emergence of new technologies and devices including minimally invasive catheters and rotary couplers, the application of imaging technology such as traditional ultrasound and optical coherence tomography (OCT) is gradually expanded. In recent years, intravascular ultrasound (IVUS) and OCT have become increasingly mature as coronary intravascular imaging techniques, and therefore become an important complementary means of coronary angiography. Although studies on feasibility of clinical applications of IVUS and OCT have been confirmed in the evaluation of previous cadaver studies, these techniques have been neglected in forensic autopsy. This paper reviews the application value of IVUS and OCT in forensic autopsy, especially in the adjuvant evaluation of coronary artery disease. Including the characteristics of IVUS and OCT imaging technology, the problems of coronary examination in traditional autopsy and the specific application of new intravascular imaging technology in forensic autopsy.


Assuntos
Autopsia , Doença da Artéria Coronariana , Vasos Coronários , Angiografia Coronária , Patologia Legal , Humanos , Valor Preditivo dos Testes , Tomografia de Coerência Óptica
15.
Medicine (Baltimore) ; 98(23): e15788, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169678

RESUMO

Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them.A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed.In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1-12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis.This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.


Assuntos
Morte Fetal/etiologia , Doenças Fetais/mortalidade , Morte do Lactente/etiologia , Doenças do Recém-Nascido/mortalidade , Morte Perinatal/etiologia , Asfixia Neonatal/mortalidade , Autopsia , Causas de Morte , China , Feminino , Patologia Legal , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome de Aspiração de Mecônio/mortalidade , Pneumonia/mortalidade , Gravidez , Estudos Retrospectivos
17.
Cancer Sci ; 110(8): 2386-2395, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206934

RESUMO

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer by providing new options in addition to existing therapies. However, peptide vaccination therapies still represent an attractive approach, because of the antigen specificity. We identified survivin 2B peptide (SVN-2B), a 9-mer antigenic peptide encoded by survivin, and an SVN-2B peptide vaccine-based phase II randomized clinical trial targeting unresectable and refractory pancreatic carcinoma was undertaken. The SVN-2B peptide vaccine did not have any statistically significant clinical benefits in that study. Therefore, we undertook an autopsy study to analyze the immune status of the pancreatic cancer lesions at the histological level. Autopsies were carried out in 13 patients who had died of pancreatic cancer, including 7 who had received SVN-2B peptide vaccination and 6 who had not, as negative controls. The expression of immune-related molecules was analyzed by immunohistochemical staining. Cytotoxic T lymphocytes were analyzed by tetramer staining and enzyme-linked immunospot assay. Histological analysis revealed dense infiltration of CD8+ T cells in some lesions in patients who had received the SVN-2B peptide vaccine. A high rate of programmed cell death ligand 1 expression in cancer cells was observed in these cases, indicating that CTLs were induced by SVN-2B peptide vaccination and had infiltrated the lesions. The lack of a significant antitumor effect was most likely attributable to the expression of immune checkpoint molecules. These findings suggest that the combination of a tumor-specific peptide vaccine and an ICI might be a promising approach to the treatment of pancreatic carcinoma in the future.


Assuntos
Vacinas Anticâncer/imunologia , Neoplasias Pancreáticas/imunologia , Neoplasias Pancreáticas/terapia , Peptídeos/imunologia , Survivina/imunologia , Adulto , Idoso , Antígenos de Neoplasias/imunologia , Autopsia/métodos , Linfócitos T CD8-Positivos/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Citotóxicos/imunologia , Vacinação/métodos
18.
N Z Vet J ; 67(5): 257-263, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31208293

RESUMO

Aim: To compare the pharmacokinetic profiles of tilmicosin, administered orally at a single dose of 20 mg/kg bodyweight, in healthy pigs and in pigs experimentally infected with Actinobacillus pleuropneumoniae. Methods: Twelve healthy crossbred pigs, aged approximately 8 weeks, were randomly assigned to uninfected and infected groups, with six pigs per group. Pigs in the infected group were inoculated intranasally with a bacterial suspension of A. pleuropneumoniae containing approximately 108 cfu. Each pig received a single oral dose of 20 mg/kg bodyweight of tilmicosin, given 3-4 hours after inoculation in infected pigs. Blood samples were collected before drug administration and up to 48 hours after tilmicosin administration. Concentrations of tilmicosin in plasma samples were determined by HPLC. Throughout the experimental period pigs were observed for signs of inappetence and clinical abnormalities. After sampling was complete pigs were subject to euthanasia and samples collected for gross and histopathology as well as microbiology. Results: Infected pigs showed signs of bradykinesia, nasal discharge dyspnoea, and coughing 1 hours after inoculation and A. pleuropneumoniae was cultured from the lungs of all infected pigs postmortem. Comparing pharmacokinetic parameters in uninfected and infected pigs, the maximum plasma concentration of tilmicosin was higher in uninfected pigs (1.17 (SD 0.17) vs. 0.96 (SD 0.17) µg/mL), the time to reach maximum concentration was shorter (1.53 (SD 0.23) vs. 2.40 (SD 0.37) hours), and the half-life of the absorption phase and half-life of the elimination phase were both shorter (0.66 (SD 0.08) vs. 1.00 (SD 0.27) hours) and (12.93 (SD 0.96) vs. 16.53 (SD 0.55) hours), respectively. The apparent volume of distribution was smaller in uninfected than infected pigs (1.91 (SD 0.22) vs. 2.16 (SD 0.21) L/kg). The relative bioavailability of tilmicosin in infected relative to uninfected pigs was 108.6 (SD 9.71)%. Conclusions and clinical relevance: The results of this study indicate that A. pleuropneumoniae infection significantly changed certain pharmacokinetic parameters of tilmicosin in pigs. In infected pigs tilmicosin exhibited a longer drug persistence and a better extent of absorption. These results indicate that it is necessary to monitor and adjust the dose of tilmicosin administration during the presence of pleuropneumonia. It is expected that this can optimise clinical efficacy and help avoid the development of resistance.


Assuntos
Infecções por Actinobacillus/veterinária , Actinobacillus pleuropneumoniae/efeitos dos fármacos , Antibacterianos/farmacocinética , Doenças dos Suínos/tratamento farmacológico , Tilosina/análogos & derivados , Infecções por Actinobacillus/tratamento farmacológico , Animais , Antibacterianos/sangue , Autopsia/veterinária , China , Cromatografia Líquida de Alta Pressão/veterinária , Modelos Animais de Doenças , Feminino , Meia-Vida , Pulmão/microbiologia , Masculino , Distribuição Aleatória , Suínos , Doenças dos Suínos/microbiologia , Tilosina/sangue , Tilosina/farmacocinética
19.
Environ Health Prev Med ; 24(1): 31, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084599

RESUMO

In Japan, because the most common site of drowning among patients with epilepsy is the bathtub, showering is generally recommended as an alternative to bathing. We herein report a case involving a female patient with epilepsy who drowned while showering. She had been diagnosed with epilepsy approximately 25 years previously, and her condition had progressed to refractory epilepsy. Carbamazepine, levetiracetam, lamotrigine, clobazam, and perampanel were prescribed daily. One day while showering, the patient was found lying with her face immersed in water that had accumulated on the floor of the bathtub. A forensic autopsy revealed water in the stomach, trachea, and proximal regions of both lung bronchi as well as white and red foam on the pharynx and larynx. A total of 1.9 µg/mL of lamotrigine, 0.14 µg/mL of carbamazepine, and 0.069 µg/mL of perampanel were detected in the patient's blood. The patient's cause of death was determined to be drowning due to an epileptic seizure. Although the patient was prescribed five types of antiepileptic medication, only three were detected in her blood. The current case demonstrates that drowning can occur while showering, suggesting that it is unsafe for patients with medication nonadherence. To prevent unintentional deaths in the bathroom, we recommend that patients with epilepsy maintain high adherence to all prescriptions and are supervised by a family member, even when showering. The current case is the first autopsy report of a patient with epilepsy who drowned while showering.


Assuntos
Afogamento/etiologia , Afogamento/patologia , Epilepsia Resistente a Medicamentos/patologia , Adulto , Anticonvulsivantes/sangue , Anticonvulsivantes/uso terapêutico , Autopsia , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Feminino , Humanos , Japão , Adesão à Medicação
20.
Mikrobiyol Bul ; 53(2): 179-191, 2019 Apr.
Artigo em Turco | MEDLINE | ID: mdl-31130122

RESUMO

Viral respiratory infections are one of the leading causes of morbidity and mortality, especially in children, elderly and immunocompromised patients. The inclusion of post-mortem studies to diagnose the infection causing mortality could be beneficial in specifying new pathogens and determining strategies for treatment and prevention. The aim of this study was to research viral etiology by applying multiplex real-time polymerase chain reaction (Rt-PCR) method in autopsy cases who have been considered to have a respiratory infection and to assess whether the viruses detected are the primary cause of the infection and whether they have any contributory effect on the mortality together with histopathological evidence. In this study, we included a total of 834 cases consisting of sudden death cases from infantile-pediatric age group and autopsy cases from > 18 year age group with suspected respiratory tract infection in our laboratory between January 2013 and May 2017. Of 834 cases, 468 (56.1%) were male and 366 (43.9%) were female, there were 191 (22.9%) cases between 0-1 months, 593 (71.1%) cases between 1 month-18 years, and 50 (6%) cases in the > 18 years age group. In 728 of 834 (87.3%) cases nasopharyngeal/tracheal swab samples and in 106 (12.7%) of them paraffin-embedded lung tissue samples were studied by the use of "FTD Respiratory 21 (Fast-Tract Diagnostics Luxemburg)" kit, with multiplex Rt-PCR method. The post-mortem samples were evaluated for human rhinovirus (HRV), parainfluenza viruses (PIV) (1, 2, 3, 4), influenza virus type A and B (INF-A, INF-B), enterovirus (EV), human bocavirus (HBoV), adenovirus (AdV), human coronavirus (HCoV 229,63,HKU,43), human metapneumovirus A ve B (HMPV-A/B), parechovirus, respiratory syncytial virus (RSV A/B) and Mycoplasma pneumoniae. In our study, at least one respiratory virus was detected by Rt-PCR in 379 (45.4%) of total 834 cases, whereas no viral agent was identified in 455 (54.6%) of the cases. One viral agent was detected in 278 (33.3%), two viral agents were detected in 83 (9.94%) and three viral agents were detected in 18 (2.16%) cases. Overall, the most common viral agent was HRV 110 (13.2%) followed by AdV 39 (4.7%) and RSV A/B 33 (4%). In pediatric cases the rate of positive results for respiratory viruses was 31.8% and in adult group it was 20% (p= 0.032). The most common virus detected among children was HRV and INF-A in adult group. In 101 (12.1%) cases infections caused by two or three agents were diagnosed. Infections with two causative agents were detected as 2.6% (5/191) in 0-1 month age group, 13% (77/593) in 1 month-18 year age group and 2% (1/50) in > 18 age group. The most frequently observed co-infections with double causative agents were HRV and INF-B, HRV and PIV, HRV and HBoV, HRV and AdV combinations. Infections with three causative agents were detected completely among 1 month-18 year age [3% (18/593)] group. In our study, 318 (38.1%) cases had no signs of infection in the postmortem histopathological examination of the lung tissues, while the most common finding was lobular pneumonia/purulent bronchitis in 233 (28%) cases and the second was interstitial pneumonia in 168 (20.1%) cases. When all cases were evaluated in terms of infection, positive results were detected in 469 (56.2%) cases. As a result; postmortem microbiological diagnosis with autopsy and histopathological detection of the patients who are thought to have respiratory tract infection will also determine the infectious agents causing death.


Assuntos
Reação em Cadeia da Polimerase Multiplex , Infecções Respiratórias , Viroses , Vírus , Adolescente , Adulto , Autopsia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/virologia , Viroses/diagnóstico , Viroses/virologia , Vírus/genética , Vírus/isolamento & purificação , Adulto Jovem
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