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1.
J Thromb Thrombolysis ; 50(1): 239-241, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32394237

RESUMO

Coronavirus disease 2019 (COVID-19) is an infectious disease that primarily affects the respiratory system, but it may cause cardiovascular complications such as thromboembolism. Rarely, pulmonary embolism may be encountered in patients with severe COVID-19 infection, especially in intensive care units. An asymptomatic young case of COVID-19 presenting with sudden death due to acute massive pulmonary embolism has not been previously described. We report a 41-year-old woman presented to emergency department with sudden death during physical activity. She had only history of diabetes mellitus and she was asymptomatic until sudden death. CT pulmonary angiography and chest CT scans revealed acute massive embolism and typical imaging findings of COVID-19 pneumonia, respectively. Interestingly, the patient had no symptoms or signs of infection and also had no risk factors for thromboembolism. COVID-19 infection appears to induce venous thromboembolism, especially pulmonary embolism. The case is remarkable in terms of showing how insidious and life-threatening COVID-19 infection can be.


Assuntos
Infecções por Coronavirus/complicações , Morte Súbita/etiologia , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Adulto , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Humanos , Pandemias , Embolia Pulmonar/diagnóstico por imagem
3.
Epilepsia ; 61(2): e13-e16, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31944280

RESUMO

The mechanism(s) for sudden death in epilepsy (SUDEP) remain(s) unknown, but seizure spread to brainstem areas serving autonomic and respiratory function is critical. In a rat model, we established a mechanism for SUDEP that involves seizure-induced laryngospasm and obstructive apnea lasting until respiratory arrest. We hypothesized that DBA/2J mice, which display lethal audiogenic seizures, would be protected from death by implanting a tracheal T-tube as a surrogate airway. In a 2 × 2 design, mice were implanted with either open or closed tracheal T-tubes and treated with either low-dose ketamine/xylazine to moderate thoracic spasm during the tonic seizure phase or no drug. Animals receiving both treatments had the highest survival rate, followed by animals receiving the open tube without ketamine/xylazine. The odds ratio for survival was >20 higher with an open T-tube (odds ratio = 24.14). The impact of open tracheal tubes indicates that the mechanism of death in DBA/2J mice involves seizure-induced upper airway obstruction until respiratory arrest. These results, our rat work, and our demonstration of inspiratory effort-based electromyographic signals and electrocardiographic abnormalities in rats and humans suggest that seizure-induced laryngospasm and obstructive apnea directly link seizure activity to respiratory arrest in these sudden death examples.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Epilepsia Reflexa/genética , Próteses e Implantes , Convulsões/complicações , Convulsões/terapia , Traqueia , Obstrução das Vias Respiratórias/cirurgia , Animais , Morte Súbita/etiologia , Eletrocardiografia , Desenho de Equipamento , Parada Cardíaca , Laringismo/etiologia , Camundongos , Camundongos Endogâmicos DBA , Morte Súbita Inesperada na Epilepsia
4.
Am J Forensic Med Pathol ; 41(1): 70-74, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31850919

RESUMO

We present a case of a 22-year-old man who died unexpectedly after a seizure due to a previously undiagnosed calcifying pseudoneoplasm of the neuraxis (CAPNON). Calcifying pseudoneoplasm of the neuraxis is a rare entity, and this is, to our knowledge, the first described case of sudden death due to CAPNON. Sudden death due to undiagnosed central nervous system mass lesions is rare, and most cases are attributable to hemorrhage, hydrocephalus, or increased intracranial pressure due to mass effect. Seizure is a rare cause of sudden death due to central nervous system mass lesions. This case highlights that mass lesions may cause sudden death due to seizure, even without other pathologic evidence of a cause of death, such as hemorrhage or edema. Furthermore, benign, reactive, and low-grade mass lesions may cause sudden death due to seizure. Seizure should remain in the autopsy differential as a cause of death, even where there is no pathologically evident mechanism by which a mass lesion caused death.


Assuntos
Encefalopatias/patologia , Calcinose/patologia , Morte Súbita/etiologia , Encefalopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Masculino , Convulsões/etiologia , Tomografia Computadorizada por Raios X , Substância Branca/patologia , Adulto Jovem
5.
Forensic Sci Med Pathol ; 15(4): 667-670, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673870

RESUMO

In this paper, we describe the case of a 29-year-old Caucasian male who was reported dead in his home. In 2010, a diagnosis of acrogeria, Gottron type was obtained by genetic analysis of a COL3A1 gene mutation. External examination showed typical characteristics of acrogeria, Gottron type. Autopsy showed a full-thickness laceration in the inferior vena cava wall, which caused hemorrhage and death. Samples of inferior vena cava were processed by Masson trichrome staining, which revealed a reduction in vessel wall thickness and a decrease in the amount of elastic fibers. An antibody reaction with BCL-2 was intensely positive. Our case is extremely rare in the medical field and in the world of scientific literature, both because the patient had a variant of acrogeria, Gottron type and because of the cause of death, which is not typical of Ehlers-Danlos syndrome. To the best of our knowledge, this very rare event has not previously been reported in the international scientific literature.


Assuntos
Morte Súbita/etiologia , Progéria , Veia Cava Inferior/lesões , Adulto , Humanos , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/imunologia , Veia Cava Inferior/patologia
6.
Diabetes Res Clin Pract ; 158: 107878, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669624

RESUMO

BACKGROUND: Sudden nocturnal death is a syndrome that usually affects patients with diabetes mellitus type 1 (DM1), being described mainly due to ventricular arrhythmias in response to nocturnal hypoglycemia. OBJECTIVES: Evaluate the relation between hypoglycemia and ventricular arrhythmias in patients with DM1 and normal structural heart. METHOD: Prospective, observational study with DM1 patients and normal structural heart on echocardiogram aged 18-60 years, of both sexes receiving insulin therapy for at least five years. Intermittent glucose reading device was implanted (iPro2 - Medtronic/USA) and 24hr ambulatory electrocardiographic recording by the Holter system (Cardios Systems - Brazil). Patients were monitored for hypoglycemia without any type of induction (interstitial glucose <70 mg/dl) and cardiac arrhythmias within 24 h. RESULTS: Thirty-two patients were evaluated, with mean-age of 35 years, being 16 men. Eleven patients (34%) did not have hypoglycemia, other 3 (27.3%) also had no arrhythmia, while 8 (72.7%) had arrhythmias interpreted as irrelevant. The other 21 patients (66%) presented some hypoglycemic episodes and 10 (47.6%) did not present arrhythmias, whereas 11 (52.4%) presented arrhythmias considered not clinically significant, as also found in non-diabetic individuals. CONCLUSION: In patients with DM1 without structural heart disease there was no relationship between cardiac arrhythmia and episodes of hypoglycemia.


Assuntos
Arritmias Cardíacas/etiologia , Morte Súbita/etiologia , Diabetes Mellitus Tipo 1/complicações , Eletrocardiografia/métodos , Hipoglicemia/complicações , Adolescente , Adulto , Arritmias Cardíacas/patologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , Hipoglicemia/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
7.
Arch Pediatr ; 26(8): 479-482, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685408

RESUMO

We report the sudden death of a 33-month-old child owing to acute respiratory distress syndrome due to human metapneumovirus (hMPV) infection. Of 30 children attending the same day care centre, 26% and 59% had hMPV and multiple infections, respectively; three of six children with pneumonia had a diagnosis of hMPV. hMPV infection is common in childhood viral co-infections but it can cause sudden death.


Assuntos
Morte Súbita/epidemiologia , Metapneumovirus , Infecções por Paramyxoviridae/epidemiologia , Creches , Pré-Escolar , Morte Súbita/etiologia , Estudos Epidemiológicos , Feminino , França/epidemiologia , Humanos , Infecções por Paramyxoviridae/complicações
8.
Forensic Sci Int ; 304: 109962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610334

RESUMO

Melatonin (MEL) is a neurohormone in humans produced in a number of locations. Starting with the amino acid tryptophan, MEL is produced through a number of enzymatic steps that includes serotonin as an intermediate compound. The primary production of MEL is in the pineal gland located in the brain. It is directly associated with the the suprachiasmatic nucleus (SCN) located in the hypothalamus. In young and adult humans, the blood levels of MEL are typically in the picogram levels and produced in a cyclic schedule highly regulated by light detected in the retina by intrinsically photosensitive retinal ganglion cells (ipRGCs), resulting in production primarily during periods of darkness. During periods of light, MEL levels are typically very low or undetectable. Basal levels of MEL in infants have been observed to be either undetectable or also in the picogram levels, although some medical treatment has involved administration of exogenous MEL resulting in peak levels in the nanogram range. MEL is considered to be well tolerated and there have been limited reports of toxicity. In this case, an infant was found unresponsive and cause of death was ruled as Undetermined. Melatonin was detected in the peripheral blood at a concentration of 1,400ng/mL.


Assuntos
Depressores do Sistema Nervoso Central/envenenamento , Morte Súbita/etiologia , Melatonina/envenenamento , Depressores do Sistema Nervoso Central/administração & dosagem , Depressores do Sistema Nervoso Central/sangue , Cromatografia Líquida , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Lactente , Melatonina/administração & dosagem , Melatonina/sangue , Espectrometria de Massas em Tandem , Gêmeos
9.
Fa Yi Xue Za Zhi ; 35(4): 455-458, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532157

RESUMO

Abstract: "Karoshi" originates from Japan's economic take-off period in the 1960s and 1970s. It is generally believed that overwork lead to the accumulation of fatigue, which triggers the outbreak of potential diseases, and results in sudden death. Karoshi causes great harm to both the community and families because it occurs primarily in 30 to 60 year old young adults. Japan put Karoshi into the category of industrial injury for the first time in 2001 and started to undertake a series of studies in the sociological and pathological fields. However, there is a tremendous gap in the forensic pathological diagnosis domain. In China, research on Karoshi started from the 1990s and is closely related to the reform and opening up policy as well as economic development. According to the incomplete statistics, 600 thousand people die from overwork each year in China, the highest in the world. Karoshi has become one of the most serious social problems in China at the present stage, thus a systematic study in the sociology and forensic pathology fields is urgently required. This paper summarizes the past and present status of Karoshi, and puts forward the problems that need attention during the judicial expertise of Karoshi from forensic pathology perspective.


Assuntos
Morte Súbita/etiologia , Patologia Legal , Estresse Ocupacional/epidemiologia , Adulto , China , Fadiga/epidemiologia , Humanos , Pessoa de Meia-Idade , Fatores de Risco
10.
Neurology ; 93(15): e1485-e1494, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31484709

RESUMO

OBJECTIVE: To determine the relationship between serum serotonin (5-HT) levels, ictal central apnea (ICA), and postconvulsive central apnea (PCCA) in epileptic seizures. METHODS: We prospectively evaluated video EEG, plethysmography, capillary oxygen saturation (SpO2), and ECG for 49 patients (49 seizures) enrolled in a multicenter study of sudden unexpected death in epilepsy (SUDEP). Postictal and interictal venous blood samples were collected after a clinical seizure for measurement of serum 5-HT levels. Seizures were classified according to the International League Against Epilepsy 2017 seizure classification. We analyzed seizures with and without ICA (n = 49) and generalized convulsive seizures (GCS) with and without PCCA (n = 27). RESULTS: Postictal serum 5-HT levels were increased over interictal levels for seizures without ICA (p = 0.01), compared to seizures with ICA (p = 0.21). In patients with GCS without PCCA, serum 5-HT levels were increased postictally compared to interictal levels (p < 0.001), but not in patients with seizures with PCCA (p = 0.22). Postictal minus interictal 5-HT levels also differed between the 2 groups with and without PCCA (p = 0.03). Increased heart rate was accompanied by increased serum 5-HT levels (postictal minus interictal) after seizures without PCCA (p = 0.03) compared to those with PCCA (p = 0.42). CONCLUSIONS: The data suggest that significant seizure-related increases in serum 5-HT levels are associated with a lower incidence of seizure-related breathing dysfunction, and may reflect physiologic changes that confer a protective effect against deleterious phenomena leading to SUDEP. These results need to be confirmed with a larger sample size study.


Assuntos
Apneia/complicações , Apneia/metabolismo , Morte Súbita/etiologia , Epilepsia/complicações , Epilepsia/metabolismo , Serotonina/metabolismo , Adolescente , Adulto , Idoso , Apneia/fisiopatologia , Eletroencefalografia/métodos , Epilepsia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/complicações , Convulsões/fisiopatologia
11.
Forensic Sci Int Genet ; 42: 203-212, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31376648

RESUMO

Drug-induced arrhythmia is an adverse drug reaction that can be potentially fatal since it is mostly related to drug-induced QT prolongation, a known risk factor for Torsade de Pointes and sudden cardiac death (SCD). Several risk factors have been described in association to these drug-induced events, such as preexistent cardiac disease and genetic variation. Our objective was to study the genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying suspected drug-induced arrhythmias and sudden unexplained deaths in 32 patients. The genetic component in the pharmacodynamic pathway was studied by analysing 96 genes associated with higher risk of SCD through massive parallel sequencing. Pharmacokinetic-mediated genetic susceptibility was investigated by studying the genes encoding cytochrome P450 enzymes using medium-throughput genotyping. Pharmacodynamic analysis showed three probably pathogenic variants and 45 variants of uncertain significance in 28 patients, several of them previously described in relation to mild or late onset cardiomyopathies. These results suggest that genetic variants in cardiomyopathy genes, in addition to those related with channelopathies, could be relevant to drug-induced cardiotoxicity and contribute to the arrhythmogenic phenotype. Pharmacokinetic analysis showed three patients that could have an altered metabolism of the drugs they received involving CYP2C19 and/or CYP2D6, probably contributing to the arrhythmogenic phenotype. The study of genetic variants in both pharmacodynamic and pharmacokinetic pathways may be a useful strategy to understand the multifactorial mechanism of drug-induced events in both clinical practice and forensic field. However, it is necessary to comprehensively study and evaluate the contribution of the genetic susceptibility to drug-induced cardiotoxicity.


Assuntos
Arritmias Cardíacas/etiologia , Morte Súbita/etiologia , Predisposição Genética para Doença , Variantes Farmacogenômicos , Adolescente , Adulto , Canalopatias/genética , Criança , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2C9/genética , Citocromo P-450 CYP2D6/genética , Citocromo P-450 CYP3A/genética , Canal de Potássio ERG1/genética , Feminino , Variação Genética , Genótipo , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Síndrome do QT Longo , Masculino , Pessoa de Meia-Idade , Testes Farmacogenômicos , Canais de Potássio de Abertura Dependente da Tensão da Membrana/genética , Adulto Jovem
12.
Forensic Sci Med Pathol ; 15(4): 591-594, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31446611

RESUMO

The body of a 43-year-old African woman with a history of aortic aneurysm and hypertension was forensically investigated after her sudden death. The cause of death was related to a cardiac tamponade due to a ruptured aneurysm of the ascending aorta. Post-mortem gross examination showed an abnormal whitish discoloration of the intima with fibrous thickening of the aortic wall. Several arteries (left main and circumflex coronaries, carotid, renal and iliac arteries) showed similar features. Upon histological examination, the aortic aneurysm as well as the other arteries sampled showed mucoid degeneration, excess mucopolysaccharides and pools of mucin inside the intima and the media associated with collagen and elastic fiber destruction and loss of smooth muscle cells. This pattern strongly suggested the diagnosis of intimomedial mucoid degeneration (IMMD), a rare arterial disorder consisting of a progressive deposition of mucin into the intima and media, with a strong prevalence in middle-aged black African females with high blood pressure. In addition to the typical features of IMMD, histological examination of the ascending aorta showed a thickening of the adventita with sparse mixed inflammatory infiltrates and fibrosis, suggesting an additional chronic infectious aortitis. No infectious agent was detected. The body of literature on IMMD is reviewed and the origin of death is discussed in this case report.


Assuntos
Aorta/patologia , Aneurisma Aórtico/patologia , Glicosaminoglicanos/metabolismo , Mucinas/metabolismo , Túnica Íntima/patologia , Túnica Média/patologia , Adulto , Túnica Adventícia/patologia , Grupo com Ancestrais do Continente Africano , Vasos Coronários/patologia , Morte Súbita/etiologia , Feminino , Fibrose/patologia , Patologia Legal , Humanos , Hipertensão/complicações , Túnica Íntima/metabolismo , Túnica Média/metabolismo
13.
PLoS One ; 14(8): e0221345, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31437200

RESUMO

BACKGROUND: The gut microbiome is thought to remain stable into old age. Gut bacteria and their translocation may play a role in the development of coronary heart disease (CHD) by modulating cholesterol levels and immune responses, as well as by producing toxic metabolites and bacterial endotoxins. The association of changes in the gut microbiome with the severity of coronary atherosclerosis and the ability of gut bacteria themselves to translocate into coronary plaques has not been studied. MATERIALS AND METHODS: As a part of the Tampere Sudden Death Study, we measured age-dependent changes in the relative ratios of major intestinal bacterial communities (Bacteroides species [spp.], the Clostridium leptum group, the Clostridium coccoides group, Bifidobacterium spp., Enterobactericeae, Lactobacillus spp.) and Streptococcus spp. in both feces and coronary plaques of the same male autopsy cases (n = 67, age range 44-95) using real-time quantitative PCR (qPCR). The area of coronary atherosclerotic lesions were measured by computer-assisted morphometry. Fecal bacterial DNA measurements from healthy volunteers served as a control for gut bacterial analyses of autopsy cases. The relative amount of bacterial DNA in a sample was determined with the comparative Cq method. RESULTS: The relative ratios of fecal Lactobacillus spp., Bifidobacterium spp., the Clostridium coccoides group, and Bacteroides spp. did not differ between controls and autopsy cases and showed no age-dependence. In contrast, the ratios of the Clostridium leptum group, Enterobactericeae, and Streptococcus spp. increased with age. Elevated relative ratios of fecal Enterobactericeae associated with a larger coronary plaque fibrotic area (p = 0.001), and the Clostridium leptum group with a larger calcification area (p = 0.015). Intestinal bacterial DNA could be amplified in 67.6% of the coronary plaques, the most common being Streptococcus spp. (41.0%), followed by Enterobactericeae (12.1%), Clostridium leptum (2.4%), and Lactobacillus spp. (2.4%). The percentages of Streptococcus spp. DNA decreased, and those of Enterobactericeae increased in coronary plaques along with age. CONCLUSIONS: DNA of the Clostridium leptum group and pathogenic Enterobactericeae increase in the gut microbiome with age and can be detected in the same individual's coronary plaques along with pathogenic Streptococcus spp., associating with more severe coronary atherosclerosis.


Assuntos
Aterosclerose/microbiologia , Doença da Artéria Coronariana/microbiologia , DNA Bacteriano/genética , Morte Súbita/patologia , Microbioma Gastrointestinal/genética , Placa Aterosclerótica/microbiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Aterosclerose/mortalidade , Aterosclerose/patologia , Translocação Bacteriana , Técnicas de Tipagem Bacteriana , Bacteroides/classificação , Bacteroides/genética , Bacteroides/isolamento & purificação , Bifidobacterium/classificação , Bifidobacterium/genética , Bifidobacterium/isolamento & purificação , Estudos de Casos e Controles , Clostridiales/classificação , Clostridiales/genética , Clostridiales/isolamento & purificação , Clostridium/classificação , Clostridium/genética , Clostridium/isolamento & purificação , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/patologia , Morte Súbita/etiologia , Enterobacteriaceae/classificação , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Fezes/microbiologia , Humanos , Lactobacillus/classificação , Lactobacillus/genética , Lactobacillus/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/mortalidade , Placa Aterosclerótica/patologia , Índice de Gravidade de Doença , Streptococcus/classificação , Streptococcus/genética , Streptococcus/isolamento & purificação
15.
Pesqui. vet. bras ; 39(8): 635-642, Aug. 2019. tab, graf
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1040724

RESUMO

Boxer dogs with arrhythmogenic right ventricular cardiomyopathy (ARVC) can experience sudden cardiac death regardless of presence/absence of clinical signs. The aims of this retrospective study were two-fold: 1) to investigate the coupling interval (CI) and prematurity index (PI) of ventricular arrhythmias (VA), and the heart rate variability (HRV) in Boxers, and 2) to evaluate their impact on overall survival time. The first 24-hour Holter 36 client-owned Boxer dogs meeting inclusion/exclusion criteria were evaluated for the number, morphology, site of origin, complexity, CI and PI, of ventricular premature complexes (VPCs), and time domain HRV. The effect on survival was assessed, considering the presence/absence of ventricular tachycardia (VT), and syncope. All-cause mortality was considered as the end-point, with median survival times being obtained by Kaplan-Meier analyses and compared by log-rank test. Polymorphic VPCs were more common in symptomatic dogs than asymptomatic. VPCs in dogs with VT were less premature, due to the influence of heart rate on PI despite comparable CI. The PI and mean heart rate (HRme) were significantly different between VT and non-VT dogs but did not discriminate adequately between groups as standalone tests. Median survival time was shorter in Boxer dogs with VT (463 vs 1645 days, HR: 4.31, P=0.03). The HRV parameters, SDNN and SDANN, were both associated with prognosis. The CI and PI were not demonstrated to be prognostic surrogates in Boxer dogs with VA. HRme≥112bpm is 100% sensitive but only 46% specific for detecting VT in Boxers on the 24-hour Holter. Presence of VT, SDNN≤245ms, or SDANN≤134ms at the time of the first 24-hour Holter was associated with a shorter survival.(AU)


Cães da raça Boxer com cardiomiopatia arritmogênica do ventrículo direito (CAVD) podem apresentar morte súbita independentemente da presença/ausência de sinais clínicos. Os objetivos desse estudo retrospectivo foram: 1) investigar o intervalo de acoplamento (IA) e o índice de prematuridade (IP) das arritmias ventriculares e a variabilidade da frequência cardíaca (VFC) em Boxers, e 2) avaliar o impacto de tais características sob o tempo de sobrevida global. O primeiro Holter de 24 horas de 36 Boxers selecionados para os critérios de inclusão/exclusão foram avaliados para o número, morfologia, local de origem, complexidade, IA e IP dos complexos ventriculares prematuros (CVPs) e da VFC no domínio do tempo. O efeito na sobrevida foi avaliado, considerado a presença/ausência de taquicardia ventricular (TV), e síncope. O desfecho final foi a mortalidade global, com o tempo de sobrevida mediano sendo obtido pela análise de Kaplan-Meier e comparado pelo teste de log-rank. CVPs polimórficos foram mais comuns em cães sintomáticos. Os CVPs em Boxers com TV foram menos prematuros, devido à influência da frequência cardíaca (FC) sobre o IP, apesar de IA comparáveis. O IP e a FC média diferiram entre os cães com TV e os sem, mas não discriminam adequadamente os grupos como variáveis isoladas. A sobrevida global foi menor nos cães com TV (463 dias vs 1645 dias, HR=4,31, P=0,03). Os parâmetros da VFC, SDNN e SDANN, foram associados ao prognóstico. O IA e o IP não possuem valor prognóstico em Boxers com arritmias ventriculares. A FC média ≥112bpm é 100% sensível, mas apenas 46% específica para detectar Boxers com TV no Holter de 24 horas. A presença de TV, SDNN≤245ms, ou SDANN≤134ms no momento do primeiro Holter de 24 horas estão associados a menor sobrevida global no Boxer.(AU)


Assuntos
Animais , Cães , Arritmias Cardíacas/veterinária , Sistema Nervoso Simpático/fisiopatologia , Displasia Arritmogênica Ventricular Direita/veterinária , Morte Súbita/etiologia , Morte Súbita/veterinária , Frequência Cardíaca
16.
J Forensic Leg Med ; 66: 138-143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31302444

RESUMO

Hip arthroplasty (hip replacement) surgery is a very common procedure and is particularly common in elderly individuals, where it is typically performed following traumatic hip fracture. As with any surgical procedure, hip arthroplasties are associated with a certain degree of morbidity and mortality, with many deaths occurring in the post-operative period. As most of these cases result from trauma (fractured hips), they are typically referred for medicolegal death investigation. Occasionally, sudden cardiorespiratory collapse and death occurs during hip arthroplasty surgery. In certain medicolegal jurisdictions, all intra-operative deaths must be investigated. Although many post-operative arthroplasty-related deaths might not require autopsy, those that occur intra-operatively may require autopsy. While clinical decision-making during recent years has resulted in fewer arthroplasty-related deaths, intraoperative deaths may still occur. In this review, the authors present their experience with three intra-operative arthroplasty-related deaths, followed by a discussion related to possible mechanisms involved in the deaths.


Assuntos
Artroplastia de Quadril/efeitos adversos , Morte Súbita/etiologia , Complicações Intraoperatórias , Idoso de 80 Anos ou mais , Cardiomiopatia Dilatada/patologia , Doença da Artéria Coronariana/patologia , Embolia Gordurosa/patologia , Feminino , Parada Cardíaca/etiologia , Fraturas do Quadril/cirurgia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/patologia
17.
J Forensic Leg Med ; 66: 144-146, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31302445

RESUMO

An autopsy case of sudden death due to pulmonary arterial hypertension (PAH) in a 5-year-old boy whose cause of death was not determined during autopsy, but was later determined by postmortem examination, is presented. The boy developed convulsions that subsequently stopped, but remained unconscious. He was transported to hospital by ambulance, but died soon after. The boy had been found to have right ventricular overload on ECG 2 weeks earlier. A plan had been made to consult a doctor for a specialist visit 2 months later. During autopsy, significant abnormalities or injuries were not observed on the body's external surface. Internal examination showed congested organs, and the blood remaining in the body was dark red with fluidity. The heart was significantly enlarged (146 g), with nearly equivalent thickness of the left and right ventricles, showing right ventricular hypertrophy. Obvious macroscopic abnormalities were not observed at the origin and main trunk of the pulmonary artery. The lungs were slightly swollen (right lung 100 g, left lung 95 g), severely congested, and edematous. A postmortem CT scan displayed some patchy shadows in both lungs; however, no significant abnormalities were detected. Histopathological examination suggested a diagnosis of PAH. Three genes (BMPR2, ALK1, and ENG) were tested, revealing a heterozygous insertion of five nucleotides, TTTCC, between nucleotides 2677 and 2678 within exon 12 of the BMPR2 gene. Therefore, the subject was considered to have had heritable PAH due to a BMPR2 gene mutation.


Assuntos
Receptores de Proteínas Morfogenéticas Ósseas Tipo II/genética , Morte Súbita/etiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/genética , Mutação , Pré-Escolar , Humanos , Hipertrofia Ventricular Direita/patologia , Pulmão/patologia , Masculino , Miocárdio/patologia , Tamanho do Órgão , Edema Pulmonar/patologia
18.
Leg Med (Tokyo) ; 40: 17-21, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31299424

RESUMO

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.


Assuntos
Anafilaxia/mortalidade , Morte Súbita/etiologia , Equinococose/mortalidade , Adulto , Autopsia , Causas de Morte , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tunísia
19.
J Forensic Leg Med ; 66: 134-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31301637

RESUMO

PURPOSE: The purpose of the work is to show and compare three reported cases of Excited Delirium Syndrome, which happened in Warsaw, Poland, from 2013 to 2017. We compared the results of three autopsy and toxicological findings of unexpectedly deceased males and the circumstances of their death, based on the police records. RESULTS: There were no significant findings of chronic diseases or multiple traumas leading us to the clear explanation of cause of death. We noted a rapid cardiopulmonary failure accompanied by drug abuse in all three cases, that happened following a stressful stimulus, evoked by a police restraint in prone position. All patients resembled similar external characteristics and BMI and had used drugs before death. CONCLUSION: A lack of the autopsy findings suggests the Excited Delirium Syndrome as a cause of death. The syndrome may be diagnosed after death, following the definition of exclusion of other somatic causes of death, preceded by symptoms during a stressful event. The syndrome occurs in overweight males, abusing especially stimulants. The physical restraint plays an important role in the initiation of the symptoms. The pathophysiology of the syndrome is poorly understood, but some theories underline dopamine transporters stimulation. To this day, there are no published Excited Delirium guidelines for forensic specialists or pathologists.


Assuntos
Morte Súbita/etiologia , Delírio/diagnóstico , Restrição Física/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Índice de Massa Corporal , Humanos , Masculino , Entorpecentes/análise , Obesidade/complicações , Polícia , Prisioneiros , Decúbito Ventral , Detecção do Abuso de Substâncias
20.
J Forensic Sci ; 64(6): 1926-1928, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162649

RESUMO

A 53-year-old woman was admitted to the hospital due to unexpected dizziness and died the following morning. To investigate the cause of death, a forensic autopsy along with histological examination was performed 3 days after her death. The major findings of the autopsy were that a fish bone had pierced the left subclavian artery after perforating the esophagus with 680 mL of blood in the stomach and bloody and tarry contents were present in the intestines, and the cause of death was confirmed to be subsequent hemorrhagic shock. Unfortunately, none of her family realized that she had eaten a fish 4 days before the tragedy until the fish bone was found. The present case is rare and instructive. The histopathological findings of left subclavian artery-esophageal fistula induced by a fish bone can be used as a reference in forensic practice.


Assuntos
Morte Súbita/etiologia , Fístula Esofágica/patologia , Perfuração Esofágica/patologia , Corpos Estranhos/patologia , Artéria Subclávia/patologia , Fístula Vascular/patologia , Animais , Fístula Esofágica/etiologia , Perfuração Esofágica/etiologia , Feminino , Peixes , Corpos Estranhos/complicações , Humanos , Pessoa de Meia-Idade , Artéria Subclávia/lesões , Fístula Vascular/etiologia
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