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1.
Sports Health ; 12(3): 241-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271134

RESUMO

BACKGROUND: Sickle cell trait (SCT) has been associated with an increased risk of sudden death in athletes during strenuous exercise. In August 2010, the National Collegiate Athletic Association (NCAA) began requiring athletes to be screened for SCT, provide proof of SCT status, or sign a waiver and launched an educational campaign for athletes, coaches, and medical staff. The impact of this program is unknown. The purpose of this study was to determine the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes before and after legislation. HYPOTHESIS: NCAA SCT legislation will decrease the incidence of daSCT. STUDY DESIGN: Observational study. LEVEL OF EVIDENCE: Level 2. METHODS: A database of NCAA athlete deaths from 2000 to 2019 was reviewed for daSCT. A total of 8,309,050 athlete-years (AY) were included. Incidence of death was calculated before and after legislation. RESULTS: The incidence of daSCT in Division I (DI) football athletes before legislation (n = 9) was 1:28,145 AY and after legislation (n = 1) was 1:250,468 AY (relative risk [RR], 0.112; 95% CI, 0.003-0.811; P = 0.022), an 89% reduction in risk after legislation was enacted. The incidence of daSCT in African American DI football athletes before legislation (n = 9) was 1:12,519 AY and after legislation (n = 1) was 1:118,464 AY (RR, 0.106; 95% CI, 0.002-0.763; P = 0.017), also an 89% risk reduction after legislation was enacted. For all NCAA athletes, the incidence of daSCT was 1:489,749 AY before legislation (n = 10) and 1:1,705,780 AY after legislation (n = 2) (RR, 0.288; 95% CI, 0.031-1.347; P = 0.146). CONCLUSION: The incidence of daSCT in DI football athletes has decreased significantly since legislation was enacted. Cases of daSCT outside of football are rare. It is unclear whether the decrease is related to screening for SCT, education, or both. CLINICAL RELEVANCE: This is the first evidence that NCAA SCT legislation may save lives.


Assuntos
Morte Súbita/epidemiologia , Testes Obrigatórios/legislação & jurisprudência , Traço Falciforme/complicações , Traço Falciforme/diagnóstico , Esportes/legislação & jurisprudência , Adolescente , Morte Súbita/prevenção & controle , Humanos , Incidência , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
2.
N Z Med J ; 133(1508): 65-71, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945043

RESUMO

AIM: Sudden unexpected death in epilepsy (SUDEP) is well recognised and widely reported but remains poorly understood. SUDEP in young adults is 27 times more common than sudden death in control populations. The incidence of SUDEP in New Zealand is not known but up to 40 people with epilepsy may die from SUDEP every year. A review of coroner's reports of SUDEP was undertaken to learn more about SUDEP in New Zealand. METHOD: Coroner's reports of all cases of possible SUDEP in New Zealand from 2007-2016 (n=190) were obtained and post-mortem and toxicology results were reviewed. Cases were categorised using published criteria. RESULTS: We obtained reports of 190 cases from the coroner's office. Of these 190 cases, we determined that 123 were definite SUDEP, 40 were definite SUDEP plus, three were probable SUDEP, seven were possible SUDEP and 17 were probably not SUDEP. The number of cases per year varied from 11-26 (2013). Cases were aged 1.5-67 years, with 63% aged 15-45 (mean 37 years). Sixty-one percent were male. Eighty-seven percent of the deaths occurred at home, with 74% found dead in their bed or bedroom. The majority were not employed, with only 33% working or retired at the time of death; 15% were children or students. Information regarding work status was not available for 11%. Toxicology results were available for 155 cases; antiepileptic drug (AED) use was detected in 67% of these cases, with a single AED detected in 44%, two AEDs in 21%, and three AEDs in 3% of samples taken at autopsy. Approximately half who took an AED were taking either sodium valproate or carbamazepine. CONCLUSION: This study suggests that people with epilepsy who die from SUDEP in New Zealand are young and are often compliant with their medication. We plan to establish a nationwide SUDEP registry using the EpiNet database to determine the incidence of SUDEP in New Zealand, and to track changes in SUDEP rates. We are also planning to take part in an international case-control study of SUDEP in the hope that we might learn more about risk factors that predispose people with epilepsy to SUDEP, and factors that might reduce the risk.


Assuntos
Morte Súbita/epidemiologia , Epilepsia/mortalidade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Autopsia/estatística & dados numéricos , Causas de Morte/tendências , Criança , Pré-Escolar , Médicos Legistas/estatística & dados numéricos , Epilepsia/tratamento farmacológico , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
Int Heart J ; 60(6): 1253-1258, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666454

RESUMO

On March 11, 2011, a great earthquake, known as the Great East Japan Earthquake, hit northeastern Japan, resulting in a tsunami that caused a nuclear disaster, the Fukushima Daiichi Nuclear Power Plant accident, forcing about 160,000 people to evacuate. We, therefore, sought to examine the effects of this evacuation on the onset of cardiovascular diseases and sudden death (SD) in Fukushima Prefecture, three years after the earthquake. We divided the evacuation zone into two areas, whole evacuation zone (Area 1) and partial evacuation zone (Area 2), and we defined the north district of the prefecture as the control area (Area 3). We cross-referenced the death certificate data with data from the Fukushima Prefecture acute myocardial infarction registration survey. For each area, we tallied the number of people who fell into the SD, myocardial infarction (MI), and MI suspected groups. We calculated the age-adjusted incidence rates and analyzed the differences in the adjusted incidence rates across three years using a Poisson regression model. The age-adjusted death rate of the SD group was significantly higher in 2011 in all areas than in 2012 or 2013 (P < 0.05). The total death rate was higher in Area 1 in March 2011, just after the disaster, than in the other two areas. The rate of SD was also higher in Area 1 than in the other areas in March 2011. The incidence of sudden cardiac death might have increased just after the Great East Japan Earthquake in the evacuation area, but not in other areas in Fukushima Prefecture.


Assuntos
Morte Súbita/epidemiologia , Terremotos , Acidente Nuclear de Fukushima , Cardiopatias/epidemiologia , Tsunamis , Adulto , Idoso , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson
4.
Am J Forensic Med Pathol ; 40(4): 312-317, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688052

RESUMO

BACKGROUND: Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes. METHODS: This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012. RESULT: A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death. CONCLUSIONS: The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.


Assuntos
Morte Súbita/epidemiologia , Esquizofrenia/epidemiologia , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Médicos Legistas , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Adulto Jovem
5.
Med Care ; 57(7): 498-502, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31107395

RESUMO

BACKGROUND: Few studies have evaluated the years of life lost (YLL) and productivity loss due to sudden unexpected death (SUD). The burden of SUD on society is undetermined because of lack of population-based studies and comprehensive adjudication methods. OBJECTIVE: We estimated YLL and productivity loss from SUD in working-age adults and compared it with the leading causes of death in the United States. METHODS: We screened all out of hospital deaths among people aged 20-64 in Wake County, NC from 2013 to 2015 to adjudicate SUDs. We extrapolated Wake County incidence to estimate the age-standardized and sex-standardized rate of SUD in the United States. YLL was calculated based on the remaining life expectancy of the victims. Incorporating market and housekeeping value estimated the present value of lifetime productivity loss because of SUD. RESULTS: SUD incidence rates in the US adults aged 20-64 were 49.3 (95% confidence interval, 41.2-58.3) and 21.7 (95% confidence interval, 16.5-27.8) per 100,000 among men and women, respectively. SUD resulted in the loss of 2 million years of life, accounting for 10.0% of YLL from all causes of death. Among natural causes of death, YLL from SUD was only lower than that from all cancers combined and heart disease. Lifetime productivity loss because of SUD was ~$51 billion, exceeding productivity loss from any individual cancer. CONCLUSION: SUD is an important source of YLL and productivity loss among adults aged 20-64. Such a high burden on society justifies prioritizing health policies and interventions toward preventing SUD.


Assuntos
Morte Súbita/epidemiologia , Eficiência , Expectativa de Vida/tendências , Adulto , Causas de Morte , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Vigilância da População , Estados Unidos/epidemiologia
6.
JAMA Netw Open ; 2(4): e192739, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-31026025

RESUMO

Importance: Sudden unexplained death in childhood (SUDC) is the fifth leading category of death among toddlers but remains underrecognized and inadequately studied. Objective: To assess the potential role of febrile seizures (FS) and other risk factors associated with SUDC and describe the epidemiology, mechanisms, and prevention of SUDC. Design, Setting, and Participants: This case series study reviewed 622 consecutive sudden child death cases aged 1 to 17 years from 2001 to 2017 from 18 countries. Data were collected from family members of children who died suddenly; these families voluntarily registered with the SUDC Foundation. Data analysis was conducted from November 2017 to February 2019. Main Outcome Measures: Certified manner of death characterized as accident, natural, or undetermined. Results: A total of 391 families with decedents aged 1 to 6 years completed a comprehensive interview on medical and social histories, and circumstances of death with forensic evaluations revealing a cause of death (sudden explained death in childhood [SEDC]) or no cause of death (SUDC). Of these children, 231 (59.1%) were male, the mean (SD) age at death was 24.9 (12.8) months, and 104 (26.6%) had a history of FS. Compared with the general population FS prevalence (2%-5%), FS prevalence among SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) were elevated. The odds of death during sleep was 4.6-fold higher in SUDC than in SEDC cases (odds ratio, 4.61; 95% CI, 1.92-11.09; adjusted P = .008). The siblings of SUDC cases were followed up for 3144 life-years, and none died prematurely from SUDC. Conclusions and Relevance: This analysis of the largest SUDC cohort confirmed an increased FS rate and found significantly increased rates of FS among SEDC. This study suggests that seizures may contribute to some SUDC and SEDC deaths. The risk of sudden death in a sibling was low. To develop and assess preventive strategies, population-based studies are needed to define the epidemiology and spectrum of risk factors and identify biomarkers of patients with FS at high risk of sudden death.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/etiologia , Convulsões Febris/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Convulsões Febris/complicações
7.
Int J Mol Sci ; 20(8)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31018519

RESUMO

Epilepsy is a common neurological disorder associated with increased morbidity and mortality. Sudden unexpected death in epilepsy, also known as SUDEP, is the main cause of death in patients with epilepsy. SUDEP has an incidence of 1.2 per 1000 person-years in adults and 0.2 per 1000 person-years in children. SUDEP accounts for 8-17% of deaths in patients with epilepsy. It is commonly associated with a history of generalized tonic-clonic seizures, and its risk may be increased by other factors such as postictal electroencephalographic suppression, prone sleeping position, altered heart rate variability, conduction abnormalities, gender, or antiepileptic medications. Recently, electrocardiograms, electroencephalograms, and imaging markers have helped clinicians stratify SUDEP risk and identify patients in need of close monitoring. However, the pathophysiology of SUDEP is likely multifactorial and still unknown. Improving the knowledge of SUDEP incidence, risk factors, and biomarkers can help design and implement effective prevention strategies.


Assuntos
Morte Súbita/epidemiologia , Epilepsia/genética , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/genética , Arritmias Cardíacas/patologia , Arritmias Cardíacas/fisiopatologia , Morte Súbita/patologia , Epilepsia/epidemiologia , Epilepsia/patologia , Epilepsia/fisiopatologia , Predisposição Genética para Doença , Humanos , Fatores de Risco
8.
Continuum (Minneap Minn) ; 25(2): 477-491, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30921019

RESUMO

PURPOSE OF REVIEW: For patients living with epilepsy, quality of life is determined not only by seizure control but by mood, antiepileptic drug adverse effects, relationships, and access to education, employment, and transportation. This article reviews some of the most commonly encountered concerns associated with epilepsy, including mood disorders, driving, injuries, mortality, bone health, genetic burden, and impact on relationships. RECENT FINDINGS: People with epilepsy are at increased risk for anxiety, depression, and suicide. Depression is underrecognized in patients with epilepsy, but effective validated screening tools are available for use. Mortality rates for people with epilepsy are 2 times higher than those of the general population, but much of this is attributable to underlying conditions rather than seizures. Sudden unexpected death in epilepsy (SUDEP) occurs in an estimated 1:1000 adults with epilepsy per year, and the risk can be reduced by improved observation and seizure control. An increased risk of injury, including fractures, is also present in patients with epilepsy. Reduced bone health leading to increased fracture risk is an important negative consequence of long-term use of antiepileptic medication. Seizures while driving can also cause accidents and injury. Despite the importance of driving for people with epilepsy, physicians are underperforming in providing counsel about driving. SUMMARY: Optimal care of the patient with epilepsy includes addressing risks to emotional health, physical health including fractures and SUDEP, social health, and an independent lifestyle. Identification of and treatments to reduce these risks can do more to improve quality of life than a narrow clinical focus on seizure control alone.


Assuntos
Aconselhamento , Gerenciamento Clínico , Epilepsia/psicologia , Epilepsia/terapia , Qualidade de Vida , Acidentes de Trânsito/estatística & dados numéricos , Morte Súbita/epidemiologia , Epilepsia/complicações , Epilepsia/mortalidade , Humanos , Relações Interpessoais , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Fatores de Risco , Ferimentos e Lesões/complicações
9.
J Forensic Leg Med ; 63: 31-33, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30851628

RESUMO

This study reviews the circumstances and medical causes of death of motor vehicle drivers who died in circumstances of sudden illness whilst behind the wheel in Victoria, Australia 2012-13. The driver's fitness to drive assessment history was also examined to identify prevention opportunities. Deaths included in the study were those referred to a panel responsible for determining whether the driver fatality should be included in the official road toll, where prior doubt exists. A research team comprising of forensic physicians examined the case file of each death involving sudden illness. Forty-five driver deaths during the two-year period were reviewed. Ischaemic heart disease was the most common cause of death. Over 80% of drivers were male with a median age of 64 years. While limited medical history was available, significantly impacting study analysis, findings identified minimal opportunity to improve the fitness to drive review process.


Assuntos
Condução de Veículo , Morte Súbita/epidemiologia , Acidentes de Trânsito/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Causas de Morte , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Estudos Retrospectivos , Distribuição por Sexo
10.
BMJ Case Rep ; 12(3)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30846452

RESUMO

Venous thromboembolism prophylaxis guidelines are clear for major orthopaedic surgeries, but data regarding ankle surgery are insufficient. Death from pulmonary embolism (PE) after ankle surgery is rare with the frequency of less than 0.037%. 1 We present a case of a fatal PE after ankle surgery to raise awareness about this rare but potentially fatal complication. Our patient had a left ankle fracture status postsurgical fixation and was discharged without venous thromboembolism (VTE) prophylaxis. Twenty days later, she presented with a sudden onset of dyspnoea and palpitations and was diagnosed to have extensive right-sided PE. Intravenous heparin and thrombolytics were given, but she had multiple pulseless electrical activity arrests, developed disseminated intravascular coagulation and died. Our case depicts an unusual complication of ankle surgery and highlights the importance of considering VTE as one of the complications. Medical personnel should evaluate the need for VTE prophylaxis after ankle surgery on a case to case basis.


Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Embolia Pulmonar/complicações , Adulto , Fraturas do Tornozelo/complicações , Conscientização , Morte Súbita/epidemiologia , Morte Súbita/etiologia , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Evolução Fatal , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/prevenção & controle
11.
Forensic Sci Int ; 298: 39-47, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30878464

RESUMO

Knowing the specific pattern of forensic toxicology cases in a region is vital to help the local government establish an effective prevention and treatment system; currently, there have been no published reports investigating various types of forensic toxicology cases based on a large autopsy series and city size. The data in this study were obtained from records kept at the Academy of Forensic Science (AFS) between February 2017 and December 2017, and the cases were mainly from the Public Security Organs People's Police in Shanghai, China. There were 299 autopsies; the leading cause of death was traffic accidents (37.1%), and the manners of death were mainly accidental (54.8%). From a total of 9083 cases, 1992 involved traffic accidents, 6787 were drug abuse, 269 were poisonings, and 35 were drug-facilitated sexual assaults (DFSAs). We also investigated the pattern of unnatural deaths and the alcohol-positive (with a blood alcohol concentration (BAC) ≥0.20 mg/ml) rate among the various cases. The BAC ranged from 0.08 to 7.24 mg/ml in traffic cases, and the mean BAC of the total alcohol-positive drivers was 1.44 mg/ml. It was found that 80.8% of the drivers involved had a BAC ≥ 0.20 mg/ml (limit of civil offense), and 72.8% had a BAC ≥ 0.80 mg/ml (limit of criminal offense). Among the drug abuse cases, there were 4073 cases (60.0%) that were positive for at least one euphoriant; the most frequently abused drug group was amphetamine-type stimulants (ATS). Poisonings by natural toxins (such as scopolamine and tetrodotoxin) account for a significant portion of accidental deaths. Pesticide poisoning was also constituted a large portion, and organophosphorus were the cause of the majority of those cases. Suicide by pesticide showed the highest frequency in the present study. Among the 35 DFSA cases, dexmedetomidine was frequently detected in our study, which has rarely been reported previously in DFSA cases.


Assuntos
Causas de Morte , Acidentes de Trânsito/mortalidade , Concentração Alcoólica no Sangue , China/epidemiologia , Morte Súbita/epidemiologia , Ciências Forenses , Homicídio/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Ferimentos e Lesões/mortalidade
12.
Wilderness Environ Med ; 30(1): 22-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30737154

RESUMO

INTRODUCTION: Cardiac events are one of the leading causes of death in the Spanish population. Given the increase in the nontraumatic medical conditions found in mountain rescues, the objective of this study was to report on the heart conditions of patients rescued in the mountains of Aragón in the Spanish Pyrenees. METHODS: We conducted a retrospective observational study based on data collected from patients' medical histories for rescues undertaken in from 2010 to 2016 (at altitudes between 500 m [1640 ft] and 3404 m [11,168 ft]). RESULTS: Of the 2079 individuals rescued from 2010 to 2016, 34 (2%) were diagnosed with heart conditions, accounting for 21% of all nontraumatic medical conditions. The data showed a statistically significant increase in the age of the rescued patients with heart conditions (55±15 y) and those with acute coronary syndrome/sudden death (60±8 y). Eighty-five percent of the rescued patients with heart conditions were men, 62% were rescued above 2000 m (6500 ft), 42% had acute coronary syndrome (of whom 56% had inferior infarction), and 35% died suddenly. CONCLUSIONS: Aragón mountain rescues show an increase in patient age in recent years. The most common medical case among rescued individuals with heart conditions was a hiker over the age of 50 y with cardiovascular risk factors, inferior infarction, and occurrence at an altitude above 2000 m. Based on our observations, appropriate training should be undertaken, especially by older hikers, who may also benefit from cardiac screening, and rescue vehicles/personnel and mountain huts should be equipped with semiautomatic external defibrillators.


Assuntos
Morte Súbita/epidemiologia , Cardiopatias/epidemiologia , Adolescente , Adulto , Idoso , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Montanhismo , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
13.
Am J Cardiol ; 123(3): 474-481, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30477804

RESUMO

Detection of pulmonary artery aneurysms (PAA) in pulmonary arterial hypertension (PAH) is increasing. We sought to determine the frequency of PAA in a PAH cohort, variables related to its development and its prognostic impact. We conducted a retrospective analysis of PAH patients who underwent a computed tomography or magnetic resonance. PAA was defined as a pulmonary artery >40 mm. Baseline, echocardiographic, and hemodynamic findings at PAH diagnosis were compared. Freedom from death or lung transplant was estimated by Kaplan-Meier method and compared by log-rank test. Predictors of PAA development were analyzed with multivariate models. Two-hundred patients underwent a computed tomography and/or magnetic resonance. In 77 (38%), a PAA (48.3 ± 7.2 mm) was detected. Time-course (months) of PAH was an independent risk factor for PAA (hazard ratio 1.01; 95% confidence interval 1.002 to 1.019; p = 0.016) whilst connective tissue disease was associated with a lower risk (hazard ratio 0.236; 95% confidence interval 0.060 to 0.920; p = 0.037). PAA patients showed lower rates of death and lung transplant from PAH diagnosis (p = 0.005), but no differences appeared when survival analysis was performed from first imaging test (p = 0.269). PAA patients presented a nonsignificant higher rate of sudden death (5% PAA vs 1% no-PAA; p = 0.073). In conclusion, the frequency of PAA was 38%. PAH time-course was an independent risk factor for PAA development whereas connective tissue disease -related PAH patients showed a lower risk. PAA patients showed lower rates of death or lung transplant from PAH diagnosis but no differences were found from imaging test. PAA patients had a nonsignificant higher rate of sudden death.


Assuntos
Aneurisma/diagnóstico por imagem , Aneurisma/mortalidade , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar/diagnóstico por imagem , Adulto , Aneurisma/complicações , Doenças Assintomáticas , Estudos de Coortes , Morte Súbita/epidemiologia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Transplante de Pulmão/estatística & dados numéricos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Insuficiência da Valva Tricúspide/complicações
14.
Int Heart J ; 60(1): 12-18, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30518714

RESUMO

Emery-Dreifuss muscular dystrophy (EDMD) is a group of hereditary muscular dystrophy syndrome caused by deficiency of genes encoding nuclear envelope proteins. Patients having EDMD show the triad of muscle dystrophy, joint contracture, and cardiac disease. In almost all patients, cardiac involvement is prevalent and is the most severe aspect of EDMD. Cardiac disease is predominantly shown by conduction defects, atrial fibrillation/flutter, and atrial standstill. Sudden death and heart failure because of left ventricular dysfunction are important causes of mortality, particularly in those patients that have the LMNA mutation. Medical treatment of EDMD is limited to addressing symptoms and ambulation support; moreover, pacemaker implantation is necessary when there are severe conduction defects and bradycardia occurs. Note that automated defibrillation devices may be considered for those patients who have a high risk of sudden death, rate, or rhythm control. Also, anticoagulation should be initiated in those patients who have atrial fibrillation/flutter. Thus, for optimal management, a multidisciplinary approach is required.


Assuntos
Fibrilação Atrial/terapia , Distrofia Muscular de Emery-Dreifuss/genética , Disfunção Ventricular Esquerda/mortalidade , Anormalidades Múltiplas/epidemiologia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Cardiomiopatias/fisiopatologia , Fissura Palatina/complicações , Fissura Palatina/epidemiologia , Contratura/complicações , Contratura/epidemiologia , Morte Súbita/epidemiologia , Feminino , Doenças Genéticas Inatas/fisiopatologia , Átrios do Coração/anormalidades , Átrios do Coração/fisiopatologia , Bloqueio Cardíaco/fisiopatologia , Cardiopatias/complicações , Cardiopatias/epidemiologia , Humanos , Hidrocefalia/complicações , Hidrocefalia/epidemiologia , Comunicação Interdisciplinar , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/epidemiologia , Masculino , Distrofias Musculares/complicações , Distrofias Musculares/epidemiologia , Distrofia Muscular de Emery-Dreifuss/complicações , Distrofia Muscular de Emery-Dreifuss/diagnóstico , Distrofia Muscular de Emery-Dreifuss/terapia , Marca-Passo Artificial/normas , Disfunção Ventricular Esquerda/epidemiologia
15.
J Forensic Sci ; 64(3): 773-777, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30286513

RESUMO

With limited knowledge on epidemiological and morphological characteristics of sudden unexplained nocturnal death syndrome (SUNDS), this study was aimed to identify such data in Thai SUNDS autopsy cases. All the cases were men and nondrug abusers aged 20-49 years old. Most cases were originated in the Northeastern region of Thailand. Half of them were found dead from midnight to 6 a.m., with a peak time at 2 a.m. The death rate was relatively higher in May and June. Most SUNDS cases were blue-collar workers (93.2%) and nonsmokers (60%), with a normal BMI (72.1%). Approximately one-fifth of the cases had detectable blood alcohol concentrations. Symptoms before death were respiratory difficulty, seizures, and urinary incontinence. Their mean heart weight was 329.8 ± 35.1 g. Their lungs (88.6%) had some degree of congestion. Acute pancreatitis was not found in these SUNDS cases, and approximately half (40.9%) of the cases had their gastric content <100 mL.


Assuntos
Morte Súbita/epidemiologia , Sono , Adulto , Distribuição por Idade , Concentração Alcoólica no Sangue , Doença da Artéria Coronariana/patologia , Patologia Legal , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , não Fumantes/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Tamanho do Órgão , Estudos Retrospectivos , Estações do Ano , Convulsões/epidemiologia , Fumantes/estatística & dados numéricos , Ronco/epidemiologia , Tailândia/epidemiologia , Incontinência Urinária/epidemiologia , Adulto Jovem
16.
Acta Neurol Scand ; 139(3): 220-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30443951

RESUMO

Sudden unexpected death in epilepsy (SUDEP) is one of the most important direct epilepsy-related causes of death, with an incidence in adults of 1.2 per 1000 person-years. Generalized tonic-clonic seizures have consistently emerged as the leading risk factor for SUDEP, particularly when such seizures are uncontrolled. High seizure burden, lack of antiepileptic drug (AED) treatment, polytherapy, intellectual disability, and prone position at the time of death are other key risk factors. Unfortunately, despite advances in treatment, overall mortality rates in epilepsy are rising. It is imperative that we learn more about SUDEP so that effective prevention strategies can be implemented. To help identify persons at greater risk of SUDEP and in need of closer monitoring, biomarkers are needed. Candidate biomarkers include electrocardiographic, electroencephalographic, and imaging abnormalities observed more frequently in those who have died suddenly and unexpectedly. As our knowledge of the pathophysiologic mechanisms behind SUDEP has increased, various preventative measures have been proposed. These include lattice pillows, postictal oxygen therapy, selective serotonin reuptake inhibitors, and inhibitors of opiate and adenosine receptors. Unfortunately, no randomized clinical trials are available to definitively conclude these measures are effective. Rather, gaining the best control of seizures possible (with AEDs, devices, and resective surgery) still remains the intervention with the best evidence to reduce the risk of SUDEP. In this evidence-based review, we explore the incidence of SUDEP and review the risk factors, biomarkers, and latest prevention strategies.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/etiologia , Epilepsia/mortalidade , Adulto , Biomarcadores , Eletroencefalografia/efeitos adversos , Feminino , Humanos , Incidência , Fatores de Risco
17.
Epilepsy Behav ; 90: 99-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30522060

RESUMO

BACKGROUND: Sudden Unexpected Death in Epilepsy (SUDEP) is a significant cause of death in childhood epilepsy, and causes considerable concern to patients and their families. Despite this, the condition remains poorly understood. This systematic review investigates the risk factors, pathophysiology, and circumstances associated with childhood SUDEP. It aimed to explore the etiology of SUDEP and inform clinicians approaching SUDEP risk disclosure. METHODS: A structured electronic database search of MEDLINE, CENTRAL, EMBASE, and ISI web of science was conducted. Studies were included if they described clinical details of one or more patients, aged 18 years of age and below, who had SUDEP. Two reviewers independently reviewed each article for data extraction and quality assessment. RESULTS: Information on 108 cases of pediatric SUDEP was extracted from 22 included studies. These comprised five cohort studies, four retrospective case control studies, seven case series, and five case reports. Factors that appeared to be linked to pediatric SUDEP included those associated with severe epilepsy (early age of onset, high seizure frequency, intellectual impairment and developmental delay, multiple antiepileptic drug therapy, and structural abnormalities). The majority of included studies was noncomparative and had significant risk of bias. CONCLUSIONS: There is currently insufficient evidence to determine the etiology of pediatric SUDEP. Current best practice to prevent pediatric SUDEP is to optimize the management of epilepsy. A national SUDEP registry would provide invaluable high-quality data and insights into modifiable risk factors, genetic predispositions, and novel prevention strategies.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Epilepsia/epidemiologia , Epilepsia/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Criança , Estudos de Coortes , Morte Súbita/etiologia , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Epilepsia/complicações , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
18.
Psychiatr Q ; 90(1): 129-136, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30338420

RESUMO

The medical community and the general public are aware of sudden deaths in apparently healthy infants (SIDS) and in cases of cardiac arrest (SCD). However, there is a third, less-well known, form of sudden death that occurs in persons with epilepsy (SUDEP). This paper provides a detailed overview what is known about SUDEP, including the current important, unresolved issues being considered in the field (research, education, informed consent). This paper also includes an overview of the grieving process common to all three conditions. Again, the current issues being considered in the field of grieving are presented (major depression, posttraumatic stress disorder). It is written for physicians, including psychiatrists, and for the health community beyond neurologists and serves as a provider resource for persons with epilepsy, their families, and for the general public. This information about SUDEP and grief becomes also additionally important as national health care moves toward an interdisciplinary primary care model of service delivery.


Assuntos
Morte Súbita , Transtorno Depressivo Maior , Epilepsia , Pesar , Transtornos de Estresse Pós-Traumáticos , Morte Súbita/epidemiologia , Morte Súbita/etiologia , Epilepsia/mortalidade , Humanos
19.
Leg Med (Tokyo) ; 36: 21-27, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30312835

RESUMO

BACKGROUND: Sudden unexpected deaths in bathtubs among elderly Japanese adults occur predominantly during the cold season. This study investigated the relationship between these deaths and bathing day temperature among elderly adults in Tokyo. METHODS: Data for 1408 cases of bath-related deaths from January 1 to December 31, 2015 were obtained from the Tokyo Medical Examiner's Office. We excluded 409 cases for the following reasons: criminal death, injury-related death, suicide, intoxication, non-sudden death, not bathtub-related death, out-of-bathroom death, subject aged under 65 years, undetermined bathing date, institutional housing, and bathing not at subject's home. Ultimately, 999 cases were analyzed. Daily mean temperature data were collected. A time-series regression study was performed to estimate the influence of sex, age, and bathing day temperature. Monthly changes in the population bathing in a bathtub were considered in the model. RESULTS: The relative risk (RR) of sudden unexpected death in a bathtub was 1.381 for males (95% confidence interval [CI]: 1.218-1.564) compared to females. The RRs were 4.182 (95% CI: 3.523-4.986) and 9.382 (95% CI: 7.836-11.273) among those aged 75-84 years and ≥85 years, respectively, compared to among those aged 65-74 years. The RR increased to 1.092 (95% CI: 1.082-1.102) as the daily mean temperature decreased by 1 °C. CONCLUSION: Sudden unexpected death in a bathtub correlated with bathing day temperature among elderly Japanese adults, and extremely low temperature, male sex, and older age increased the risk of such death. Our findings provide insight into preventing sudden unexpected deaths in bathtubs.


Assuntos
Banhos/mortalidade , Morte Súbita/epidemiologia , Morte Súbita/etiologia , Temperatura , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Análise de Regressão , Risco , Fatores Sexuais , Tóquio/epidemiologia
20.
Rev Esp Cardiol (Engl Ed) ; 72(7): 553-561, 2019 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30177458

RESUMO

INTRODUCTION AND OBJECTIVES: Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. METHODS: Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). RESULTS: We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). CONCLUSIONS: The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.


Assuntos
Aneurisma Dissecante/complicações , Aorta/patologia , Aneurisma da Aorta Torácica/complicações , Morte Súbita/epidemiologia , Adolescente , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Autopsia , Criança , Pré-Escolar , Morte Súbita/etiologia , Morte Súbita/patologia , Feminino , Humanos , Incidência , Lactente , Masculino , Espanha , Adulto Jovem
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