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Sample records for aborted sudden death

  1. Aborted Sudden Cardiac Death and a Mother with Suspected Metabolic Myopathy

    PubMed Central

    Finsterer, Josef; Stöllberger, Claudia; Keller, Hans

    2014-01-01

    Aborted sudden cardiac death (SCD) has not been reported as initial manifestation of cardiac involvement in metabolic myopathy (MM). A 20-year-old female with a previous history of three syncopes, hyperhidrosis, and recurrent tick bites experienced aborted SCD. Her mother presented with MM, and a history of pituitary adenoma, nephroptosis, arterial hypertension, depression, migraine, goiter, pancreatitis, osteoporosis, hyperhidrosis, multiple muscle ruptures, and hyperlipidemia. After a few days of disorientation and amnesia, the young female recovered completely. Clinical neurological examination was noticeable for partial ophthalmoparesis and mild hyperprolactinemia. She received an implantable cardioverter defibrillator, which did not discharge so far. Recurrent syncopes and aborted SCD may be the initial manifestation of MM with multiple organ involvement. The family history is important in cases with aborted SCD to guide the diagnostic work-up. Phenotypic heterogeneity between the family members may be an indicator of MM. PMID:25187745

  2. Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

    PubMed

    Finsterer, Josef; Stöllberger, Claudia

    2014-06-01

    Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

  3. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

    PubMed Central

    Eisele, Tom; Nunninger, Peter; Münz, Benedikt

    2017-01-01

    Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

  4. Unusual sudden death.

    PubMed Central

    Warren, J. V.

    1985-01-01

    In contrast to usual sudden death seen in the course of coronary artery disease, individuals dying suddenly from other causes form a complex array of situations. In some the causes are readily identifiable. No simple pattern is available to identify the potential candidate, but on review of the many causes some moves by the physician may be helpful. For example, a more complete physical evaluation of young individuals participating in competitive athletics is in order. This is particularly true if the athlete reports an episode of unexplained syncope. This may well be the warning of a propensity towards sudden death under physical and emotional stress. Knowledge of the specific problems in underwater swimming and diving, in high altitude exposure and in various circumstances such as certain weight reduction diets and industrial exposures may lead to control of some types of unusual sudden death. Clearly, more studies are needed to give answers in so called crib death. As the incidence of usual sudden death falls, these unusual forms of sudden death will represent a more important fraction of sudden death in general. PMID:6537674

  5. Sudden Infant Death Syndrome.

    ERIC Educational Resources Information Center

    Barnett, Henry L.; And Others

    There is a growing body of evidence that Sudden Infant Death Syndrome (SIDS) victims are not completely normal and healthy, as was once believed. A variety of new information from several disciplines strongly suggests that the infant who dies suddenly and unexpectedly may do so because of subtle developmental, neurologic, cardiorespiratory, and…

  6. Sudden death of feedlot cattle.

    PubMed

    Glock, R D; DeGroot, B D

    1998-01-01

    Sudden deaths or the sudden death syndrome are perceived as major concerns in cattle feedlots because most of these deaths occur in cattle near market weight. Etiology and preventive measures are poorly defined. The current literature indicates that sudden deaths are associated most commonly with digestive upsets. Death is thought to be the result of interactions between factors including acidosis, bloat, and endotoxemia. Trauma, peracute interstitial pneumonia, and other identifiable events are specifically defined but relatively uncommon. Enterotoxemia is of questionable significance as a cause of sudden deaths.

  7. Sudden infant death syndrome.

    PubMed

    Adams, Stephen M; Ward, Chad E; Garcia, Karla L

    2015-06-01

    Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended.

  8. Sudden death in Steinert's disease.

    PubMed

    Fayssoil, A; Nardi, O

    2009-08-14

    Steinert's disease is an autosomal dominant neuromuscular disorder. Heart involvement is characterized by conduction system abnormalities, supraventricular and ventricular arrhythmias. Patients with Steinert's disease are reported to have a higher incidence of sudden death. Preventing sudden death is crucial in this disease. It relies on non-invasive and/or invasive approach for risk stratification.

  9. [Genetics of sudden unexplained death].

    PubMed

    Campuzano, Oscar; Allegue, Catarina; Brugada, Ramon

    2014-03-20

    Sudden unexplained death is defined by death without a conclusive diagnosis after autopsy and it is responsible for a large percentage of sudden deaths. The progressive interaction between genetics and forensics in post-mortem studies has identified inheritable alterations responsible for pathologies associated with arrhythmic sudden death. The genetic diagnosis of the deceased enables the undertaking of preventive measures in family members, many of them asymptomatic but at risk. The implications of this multidisciplinary translational medical approach are complex, requiring the dedication of a specialized team.

  10. Sudden infant death syndrome

    MedlinePlus

    Crib death; SIDS ... However, SIDS is still a major cause of death in infants under 1 year old. Thousands of ... affects boys more often than girls. Most SIDS deaths occur in the winter. The following may increase ...

  11. Genetics of sudden cardiac death.

    PubMed

    Bezzina, Connie R; Lahrouchi, Najim; Priori, Silvia G

    2015-06-05

    Sudden cardiac death occurs in a broad spectrum of cardiac pathologies and is an important cause of mortality in the general population. Genetic studies conducted during the past 20 years have markedly illuminated the genetic basis of the inherited cardiac disorders associated with sudden cardiac death. Here, we review the genetic basis of sudden cardiac death with a focus on the current knowledge on the genetics of the primary electric disorders caused primarily by mutations in genes encoding ion channels, and the cardiomyopathies, which have been attributed to mutations in genes encoding a broader category of proteins, including those of the sarcomere, the cytoskeleton, and desmosomes. We discuss the challenges currently faced in unraveling genetic factors that predispose to sudden cardiac death in the setting of sequela of coronary artery disease and present the genome-wide association studies conducted in recent years on electrocardiographic parameters, highlighting their potential in uncovering new biological insights into cardiac electric function.

  12. Sudden death in Marfan syndrome.

    PubMed

    Hugar, Basappa S; Praveen, Shivaramareddy; Kainoor, Sunil K; Shetty, Akshith Raj S

    2014-07-01

    Marfan syndrome is an autosomal dominant genetic disorder of the connective tissue. The most serious complications of this syndrome are defects of the heart valves and aorta. Aneurysms of thoracic aorta are known to develop in Marfan syndrome. Other causes for development of aneurysms of the thoracic aorta are trauma, infections, valve and arch anomalies, genetic disorders, and atherosclerosis. These aneurysms upon rupture may lead to sudden deaths. They are usually detected during routine screening or follow-up of such persons suffering from Marfan syndrome and upon death will be certified by the treating physician. Thus, an autopsy surgeon rarely comes across such deaths. One such case of sudden death due to cardiac tamponade consequent upon rupture of dissecting aortic aneurysm in a 33-year-old male who complained of throbbing pains in the chest, radiating to back, became breathless, cyanotic and died on the way to hospital is being presented here.

  13. [The Sudden Infant Death Syndrome.

    ERIC Educational Resources Information Center

    Florida's Health, 1976

    1976-01-01

    This collection of articles on the Sudden Infant Death Syndrome (SIDS), drawn from a southeastern regional symposium on the subject, summarizes much of what is known about the occurrence of SIDS, including current information about its causes. The background of state action in Florida is reviewed, with emphasis on the need for increased public and…

  14. Sudden Cardiac Death in Athletes

    PubMed Central

    Wasfy, Meagan M.; Hutter, Adolph M.; Weiner, Rory B.

    2016-01-01

    There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed. PMID:27486488

  15. Sudden cardiac death: A reappraisal.

    PubMed

    Steinberg, Christian; Laksman, Zachary W M; Krahn, Andrew D

    2016-11-01

    Sudden cardiac death (SCD) is still among the leading causes of death in women and men, accounting for over 50% of all fatal cardiovascular events in the United States. Two arrhythmia mechanisms of SCD can be distinguished as follows: shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia) and non-shockable rhythms including asystole or pulseless electrical activity. The overall prognosis of cardiac arrest due to shockable rhythms is significantly better. While the majority of SCDs is attributed to coronary artery disease or other structural heart disease, no obvious cause can be identified in 5% of all events, and those events are labeled as sudden unexplained deaths (SUD). Those unexplained events are typically caused by rare hereditary electrical disorders or arrhythmogenic cardiomyopathies. A systematic approach to the diagnosis of cardiac arrest followed by tailored therapy based on etiology has emerged in the last 10-15 years, with significant changes of medical practice and risk management of cardiac arrest victims. The aim of this review is to summarize our contemporary understanding of SCD/SUD in adults and to discuss current concepts of management and secondary prevention in cardiac arrest victims. A full discussion of the topic of primary prevention of SCD is beyond the scope of this article.

  16. Hypokalemia and sudden cardiac death.

    PubMed

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient reductions in plasma potassium concentration are of importance. Hypokalemia is present in 7% to 17% of patients with cardiovascular disease. Furthermore, up to 20% of hospitalized patients and up to 40% of patients on diuretics suffer from hypokalemia. Importantly, inadequate management of hypokalemia was found in 24% of hospitalized patients. Hypokalemia is associated with increased risk of arrhythmia in patients with cardiovascular disease, as well as increased all-cause mortality, cardiovascular mortality and heart failure mortality by up to 10-fold. Long-term potassium homeostasis depends on renal potassium excretion. However, skeletal muscles play an important role in short-term potassium homeostasis, primarily because skeletal muscles contain the largest single pool of potassium in the body. Moreover, due to the large number of Na(+)/K(+) pumps and K(+) channels, the skeletal muscles possess a huge capacity for potassium exchange. In cardiovascular patients, hypokalemia is often caused by nonpotassium-sparing diuretics, insufficient potassium intake and a shift of potassium into stores by increased potassium uptake stimulated by catecholamines, beta-adrenoceptor agonists and insulin. Interestingly, drugs with a proven significant positive effect on mortality and morbidity rates in heart failure patients all increase plasma potassium concentration. Thus, it may prove beneficial to pay more attention to hypokalemia and to maintain plasma potassium levels in the upper normal range. The more at risk of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis.

  17. Sudden death due to pulmonary aspergillosis.

    PubMed

    Bhagavath, Prashantha; Rastogi, Prateek; Menezes, Ritesh G; Valiathan, Manna; Mohan Kumar, T S; Raghavendra Babu, Y P; Kanchan, Tanuj; Monteiro, Francis N P; Nayak, Vinod C

    2009-01-01

    Sudden death due to respiratory pathology is not uncommon and tuberculosis with its complications is well known to cause death. We report a case of a male, train passenger, who started coughing out blood and died on reaching the hospital. Medicolegal autopsy confirmed the sudden unexpected death to be due to pulmonary aspergillosis in the person with past medical history of tuberculosis.

  18. Sudden death in infective endocarditis

    PubMed Central

    Almeida, Germana; Siciliano, Rinaldo Focaccia

    2016-01-01

    The case fatality rate of infective endocarditis (IE) is high and is associated with varying causes. Among them, acute myocardial infarction due to an embolism in a coronary artery is rare; the incidence of this complication in the setting of IE is reported to be up to 1.5%. We report a case of sudden death in a 22-year-old woman diagnosed with systemic lupus erythematosus who was referred to the Cardiology Center for the treatment of mitral valve incompetence due to IE. She was hemodynamically stable with antibiotic therapy and vasoactive drugs, despite severe mitral valve regurgitation. Unexpectedly, she presented cardiac arrest and died. The autopsy showed total occlusion of the left main coronary artery by septic embolus, which originated from the mitral vegetation, as the cause of death. Thus, although a rare complication, it should always be kept in mind that a coronary embolism can be a lethal complication of IE, and the possibility of surgical treatment combined with the underlying antibiotic therapy should be raised. PMID:27818954

  19. Surviving the Sudden Death of a Baby

    MedlinePlus

    ... Monument Request Information Get Involved Surviving the Sudden Death of a Baby Home Grieving Families Surviving the ... Candle on For Families Who Have Experienced the Death of a Baby The numbers are staggering. Every ...

  20. Sudden Infant Death Syndrome (SIDS) and Vaccines

    MedlinePlus

    ... this? Submit What's this? Submit Button Sudden Infant Death Syndrome (SIDS) Recommend on Facebook Tweet Share Compartir ... an international network of vaccine safety experts. SIDS deaths declined due to recommendations to put infants on ...

  1. Athletes at Risk for Sudden Cardiac Death

    ERIC Educational Resources Information Center

    Subasic, Kim

    2010-01-01

    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  2. Sudden cardiac death risk stratification.

    PubMed

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J

    2015-06-05

    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.

  3. Sudden Death in Young People--Heart Problems Often Blamed

    MedlinePlus

    Sudden death in young people: Heart problems often blamed Sudden death in young people is rare, but those at ... causes and treatments. By Mayo Clinic Staff Sudden death in people younger than 35, often due to ...

  4. A Clinical Perspective on Sudden Cardiac Death

    PubMed Central

    Gersh, Bernard J; Camm, A John

    2016-01-01

    This article presents the epidemiology, aetiology and pathophysiology of sudden cardiac death. The modern management of survivors as well as of family members of victims is discussed, as are the relevant recommendations of guidelines prepared by learned societies. PMID:28116082

  5. Sudden Arrhythmia Death Syndromes (SADS) Foundation

    MedlinePlus

    ... Family Seminar 04/29/17 Update on Inherited Arrhythmias: Recent Advancements in Therapies and Diagnosis--From 8: ... Legal Notice Privacy Policy COPYRIGHT ©2011-2016 Sudden Arrhythmia Death Syndromes Foundation 4527 South 2300 East, Suite ...

  6. Cardiac arteriovenous malformation causing sudden death.

    PubMed

    Aguilera, Beatriz; Suárez-Mier, M Paz; Argente, Trinidad

    2004-01-01

    Cardiac vascular malformations are rare. We report a subendocardial arteriovenous malformation (AVM), associated with extensive myocardial fibrosis, causing sudden death in a 25-year-old woman. To our knowledge, this is the first autopsy case reported.

  7. Sudden cardiac death – Historical perspectives

    PubMed Central

    Abhilash, S.P.; Namboodiri, Narayanan

    2014-01-01

    Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time. PMID:24568828

  8. Sudden death during arrest and phencyclidine intoxication.

    PubMed

    Pestaner, Joseph P; Southall, Pamela E

    2003-06-01

    Deaths of individuals being arrested are important and complex medicolegal cases. Conclusions regarding the cause and manner of death for such cases must take into account multiple factors that may have played a role, as well as anticipate the forensic issues that will arise. In this article, we review the deaths of 2 individuals in which phencyclidine intoxication was a factor that contributed to death during arrest. Most cases of sudden death during arrest have involved cocaine intoxication; because phencyclidine's pharmacologic properties are quite different from those of cocaine, these cases allow for comparisons to those factors that may have greater importance.

  9. Manual Snow Removal and Sudden Death.

    PubMed

    Skavić, Petar; Stemberga, Valter; Duraković, Din

    2015-06-01

    The aim was to analyze the causes of sudden death in middle-aged and elderly men during manual snow removal. During snowy winter months in Zagreb, from January 2013 to January 2014, four males aged 52, 65, 72 and 81, died suddenly while manually removing snow. They were all autopsied. All of them have suffered from arterial hypertension and coronary heart disease, and one suffered from metabolic syndrome. The cause of death in two was probable malignant ventricular arrhythmia. In the third who fell down on the icy surface, consequences were cerebral contusion and neck vertebral luxation. In the fourth who fell down from the top of a 15 m tall building during snow removal, the cause of death were multiple injuries: fractures of both clavicles, ribs and vertebrae's Th5, Th6, hematothorax, cardiac contusion, hematopericardium, thoracic aorta rupture, contusions and ruptures of both lungs, rupture of the diaphragm, liver rupture, hematoperitoneum and cerebral edema. The estimated death rate in the City of Zagreb for males aged 30-64 years is 5.44/1,000,000 inhabitants, which is less than in those aged 65-85 years (40.03/1,000,000; p = 0.2269). Sudden strenuous physical effort due to manual snow removal in two non-trained persons, who have suffered from arterial hypertension and coronary heart disease, was the cause of sudden death. Manual snow removal is an important cause of sudden death, as it is a very arduous effort in non-adapted middle-aged and elderly persons.

  10. Sudden cardiac death in the elite athlete.

    PubMed

    Del Rio-santiago, Valentín; Santiago Trinidad, Ricardo; Vicenty Rivera, Sonia

    2012-01-01

    Sudden cardiac death (SCD) is a long -recognized disease that occurs rarely in trained athletes. Most affected athletes have no symptoms before death. Many attempts have been made to detect those at risk for SCD before athletic participation. However, its overall clinical advantages remain questionable in medical literature. This article will review cardiogenic and non-cardiogenic causes of SCD as well as discuss how this entity affects those athletes older than 35 years.

  11. [EPIDEMIOLOGY OF SUDDEN CARDIAC DEATH: DATA FROM THE PARIS SUDDEN DEATH EXPERTISE CENTER REGISTRY].

    PubMed

    Jouven, Xavier; Bougouin, Wulfran; Karam, Nicole; Marijon, Eloi

    2015-09-01

    Sudden cardiac death is an unexpected cardiac arrest without obvious extra-cardiac cause. Epidemiology of sudden cardiac death has been poorly documented in France, mainly because of challenging requirement in order to capture all cases in a specific area. The Parisian registry (Sudden Death Expertise Center, European Georges Pompidou Hospital, Paris) was initiated in May 2011 and analyzed data of all sudden death in Paris and suburbs (6.6 millions inhabitants). Over 3 years, the annual incidence estimated to 50-70 per 100,000. Those occurred mainly in men (69%), with a mean age of 65 year, and at home (75%). The event was witnessed in 80% of cases, but bystander cardiopulmonary resuscitation was initiated in only half of cases. Initial cardiac rhythm was ventricular fibrillation in 25%. Survival to hospital discharge remains low (8%).

  12. Molecular diagnostics of cardiovascular diseases in sudden unexplained death.

    PubMed

    Tang, Yingying; Stahl-Herz, Jay; Sampson, Barbara A

    2014-01-01

    The most challenging type of sudden cardiac death is sudden unexplained death. The etiologies for sudden unexplained death are diverse and not necessarily confined to the cardiovascular system. Nevertheless, certain cardiovascular diseases, particularly cardiac channelopathies and cardiomyopathies, are known to play significant roles in sudden deaths. The purpose of the review is to provide autopsy pathologists with an actionable guide through illuminating the clinically relevant molecular basis of cardiac channelopathies and cardiomyopathies, as well as the changing landscape of molecular diagnostics.

  13. Sudden cardiac death athletes: a systematic review

    PubMed Central

    2010-01-01

    Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD. PMID:20682064

  14. Sudden unexpected death associated with lymphocytic thyroiditis.

    PubMed

    Vestergaard, Vibeke; Drostrup, Dorthe Høj; Thomsen, Jørgen L

    2007-04-01

    A forensic autopsy study comprising 125 cases was carried out retrospectively in order to evaluate pathological changes in the thyroid gland in different groups of death. The five groups selected consecutively were: (i) opiate addicts who died from an overdose, (ii) alcoholics who died as a result of their alcohol abuse, (iii) cases of fatal poisoning other than opiate addicts, (iv) unknown cause of death and (v) controls without prior disease. Tissue samples from the thyroid gland were cut and stained with haematoxylin and eosin and van Gieson. Histology examinations were subsequently performed blind with semiquantitative assessment of the following six parameters: (a) height of the follicular epithelium, (b) the amount of lymphocytes, (c) the presence of plasma cells, (d) hyperplastic follicular changes, (e) oxyphilic changes, and (f) fibrosis. The most striking result was the finding of extensive lymphocytic infiltration of the thyroid parenchyma in five of the 124 cases, of which four belonged in the group of 'unknown cause of death'. This discovery leads to reflections regarding lymphocytic thyroiditis as a cause of death, either by itself or in combination with other disorders. Silent (painless) thyroiditis, especially, is easily overlooked at autopsy as there are no macroscopic changes and often no prior symptoms or history of thyroid disease pointing towards this condition. Analyses of thyroid hormones are unreliable in predicting endocrine status in life. Routine microscopy of the thyroid gland is therefore advocated in cases of sudden unexpected death in order to diagnose thyroid disease, in particular silent (painless) thyroiditis.

  15. [Infant botulism and sudden infant death syndrome].

    PubMed

    Bartram, U; Singer, D

    2004-01-01

    Infant botulism represents a distinct entity of botulism. Ingestion of the ubiquitously present spores of Clostridium botulinum leads to germination of the organism and neurotoxin production in the infant intestine. Symptoms typically develop gradually in contrast to classical food botulism in which an acute onset of symptoms shortly after the ingestion of preformed toxin in a food is characteristic. Microbiologically, the diagnosis is established by identification of Clostridium botulinum organism and toxin in stool specimen. However, positive results in these tests provide only indirect evidence for the clinical relevance of the neurotoxin since asymptomatic carriers have been found. The toxin irreversibly blocks the release of acetylcholin from the motoric end plate which results in muscle weakness and paralysis. Depending on the amount of toxin produced, infant botulism exhibits a broad clinical spectrum ranging from oligosymptomatic forms to a fulminant course with acute respiratory failure within hours leading to sudden death. Unrecognized mild forms or beginning muscle weakness can be a co-factor for other risk factors of sudden infant death (SIDS). In studies analyzing infants who died from SIDS, botulism bacteria or toxin were found in up to 20 % of cases. Infant botulism therefore represents an important differential diagnosis of unexplained and inconclusive muscular hypotonia in the first year of life.

  16. Sudden unexpected death in epilepsy genetics: Molecular diagnostics and prevention

    PubMed Central

    Goldman, Alica M.; Behr, Elijah R.; Semsarian, Christopher; Bagnall, Richard D.; Sisodiya, Sanjay; Cooper, Paul N.

    2016-01-01

    Summary Epidemiologic studies clearly document the public health burden of sudden unexpected death in epilepsy (SUDEP). Clinical and experimental studies have uncovered dynamic cardiorespiratory dysfunction, both interictally and at the time of sudden death due to epilepsy. Genetic analyses in humans and in model systems have facilitated our current molecular understanding of SUDEP. Many discoveries have been informed by progress in the field of sudden cardiac death and sudden infant death syndrome. It is becoming apparent that SUDEP genomic complexity parallels that of sudden cardiac death, and that there is a pauci1ty of analytically useful postmortem material. Because many challenges remain, future progress in SUDEP research, molecular diagnostics, and prevention rests in international, collaborative, and transdisciplinary dialogue in human and experimental translational research of sudden death. PMID:26749013

  17. Sudden cardiac death in the young

    PubMed Central

    Ackerman, Michael; Atkins, Dianne L; Triedman, John K

    2016-01-01

    Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and post-mortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD victims. Institution of a national registry of SCD in the young will provide data that will help to answer these questions. PMID:26951821

  18. Escherichia coli and Sudden Infant Death Syndrome

    PubMed Central

    Bettelheim, Karl A.; Goldwater, Paul N.

    2015-01-01

    This review examines the association of strains of Escherichia coli with sudden infant death syndrome (SIDS) and the possible role these bacteria play in this enigmatic condition. The review addresses evidence for E. coli in SIDS infants, potential sources of E. coli in the environment, colonization by commensal and pathogenic strains, the variety of currently accepted pathotypes, and how these pathotypes could compromise intestinal integrity and induce inflammation. Both intestinal and extraintestinal pathotypes are compared in relation to the apparent liability in which virulence traits can be gained or lost by strains of E. coli. The way in which E. coli infections fit with current views on infant sleeping position and other SIDS risk factors is highlighted. PMID:26191064

  19. New Areas for Preventive Programing: Sudden Infant Death Syndrome.

    ERIC Educational Resources Information Center

    Lowman, Joseph

    Crisis intervention programs for persons experiencing the sudden death of family members or surviving natural disasters have been advocated as methods of primary prevention, although few have actually been implemented. A program utilizing nurses to deliver grief intervention to parents losing a baby to Sudden Infant Death Syndrome (SIDS) was…

  20. Non-locality Sudden Death in Tripartite Systems

    SciTech Connect

    Jaeger, Gregg; Ann, Kevin

    2009-03-10

    Bell non-locality sudden death is the disappearance of non-local properties in finite times under local phase noise, which decoheres states only in the infinite-time limit. We consider the relationship between decoherence, disentanglement, and Bell non-locality sudden death in bipartite and tripartite systems in specific large classes of state preparation.

  1. The Treatment of PVCs and Prevention of Sudden Cardiac Death

    PubMed Central

    Nattel, Stanley

    1991-01-01

    Premature ventricular complexes (PVCs) have traditionally been suppressed using antiarrhythmic drugs. Recent studies have failed to show that reducing the number of PVCs can prevent sudden death; moreover, treatment with some antiarrhythmic agents can increase the risk. There is a close link between the severity of ischemic heart disease and sudden death. PMID:21234088

  2. [Fever and sudden death, a reality: illustrative case report].

    PubMed

    Rodríguez-Artuza, Carlos; Osorio, Juan; Madueño, Freddy; Payares, Agustín

    2016-11-21

    The connection between fever and sudden death due to ventricular tachycardia has been usually reported in Brugada Syndrome. However the thermosensitive effects caused by fever have been recently described as a possible cause of sudden death in congenital long QT type II syndrome and in idiopathic ventricular fibrillation syndrome. We present a case where fever unmasked a congenital long QT type II syndrome.

  3. Task Force on Sudden Cardiac Death, European Society of Cardiology.

    PubMed

    Priori, S G; Aliot, E; Blømstrom-Lundqvist, C; Bossaert, L; Breithardt, G; Brugada, P; Camm, J A; Cappato, R; Cobbe, S M; Di, Mario C; Maron, B J; McKenna, W J; Pedersen, A K; Ravens, U; Schwartz, P J; Trusz-Gluza, M; Vardas, P; Wellens, H J J; Zipes, D P

    2002-01-01

    The European Society of Cardiology has convened a Task Force on Sudden Cardiac Death in order to provide a comprehensive, educational document on this important topic. The main document has been published in the European Heart Journal in August 2001. The Task Force has now summarized the most important clinical issues on sudden cardiac death and provided tables with recommendations for risk stratification and for prophylaxis of sudden cardiac death. The present recommendations are specifically intended to encourage the development and revision of national guidelines on prevention of sudden cardiac death. The common challenge for cardiologists, physicians of other medical specialties and health professionals throughout Europe is to realize the potential for sudden cardiac death prevention and to contribute to public health efforts to reduce its burden.

  4. Most deaths related to abortion occur in the developing world.

    PubMed

    Ciment, J

    1999-06-05

    A new publication of the World Health Organization, "Abortion in the Developing World," reports that 40% of the 50 million abortions performed each year are unsafe, and 90% of these medically perilous procedures occur in developing countries. Although the 30 million abortions performed annually in developing countries represent 60% of the global total, they account for 95% of abortion-related deaths. Abortion was illegal in 94% of the developing countries included in the WHO study. Unexpectedly, the proportion of women who were using contraception when they experienced an unintended pregnancy was similar in countries with strong family planning programs and those with weak or nonexistent programs.

  5. Predicting the risk of sudden cardiac death.

    PubMed

    Lerma, Claudia; Glass, Leon

    2016-05-01

    Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology.

  6. Sudden cardiac death after modified electroconvulsive therapy.

    PubMed

    Wang, Zhihui; Wang, Jiyu

    2015-10-01

    Sudden deaths associated with the use of electroconvulsive therapy are rare. In this case report a 58-year-old male with a 20-year history of bipolar disorder and no history or signs of cardiac illness died from cardiac arrest within one hour of receiving an initial session of modified electroconvulsive therapy (MECT) to treat a recurrent episode of non-psychotic mania. The patient regained consciousness and was medically stable immediately after the MECT session (which did not produce a convulsion) but deteriorated rapidly after transfer to the recovery room. It was not possible to conduct an autopsy, but the authors surmise that the most probable cause was that the use of haloperidol 17 hours prior to MECT exacerbated the cardiac effects of nonconvulsive MECT. The case highlights the need for a thorough cardiac work-up on patients being considered for MECT (possibly including assessment of cardiac enzymes in older individuals) and careful consideration of the concurrent use of antipsychotic medications and MECT.

  7. Risk reduction and sudden infant death syndrome.

    PubMed

    Gurbutt, Dawne; Gurbutt, Russell

    2007-01-01

    This article explores the concepts of 'risk' and 'risk reduction' in relation to sudden infant death syndrome (SIDS) and the implications for practice. Risk reduction is a term utilised in public health, which is usually linked to evidence-based outcomes. The Back to Sleep campaign is a high profile initiative which seeks to raise awareness of risk factors relating to SIDS and is largely credited with contributing to a significant reduction in the incidence of SIDS in the UK. Misunderstandings may occur between the terms 'risk reduction' and 'prevention' of health conditions and parents may feel that one equates to the other. There are also tensions which are inherent in defining risk in the context of SIDS. Certain measures may become 'shorthand' for a range of interventions and contributing factors. The practice of offering additional monitoring as support may reinforce a (mis)understanding about risk reduction and SIDS. There are implications for practice regarding how health professionals approach this issue, explain the guidelines and offer support.A clearer understanding of risk reduction would potentially enable bereaved parents to articulate their experiences without becoming too self critical in questioning their own consistent adherence to the accepted guidelines.

  8. [Risk stratification of sudden death in hypertrophic cardiomyopathy in 2016].

    PubMed

    Dubourg, Olivier; Charron, Philippe; Sirol, Marc; Siam-Tsieu, Valérie; Mansencal, Nicolas

    2016-10-01

    Patients with hypertrophic cardiomyopathy (HCM) are at an increased risk of death from many causes and sudden cardiac death is one of them. The study of the sudden cardiac death of patients with HCM has allowed the identification of risk factors and among them major risk factor are: family history of sudden cardiac death, the occurrence of syncope/dizziness, the existence of non-sustained ventricular tachycardia an abnormal blood pressure response during stress test, presence of severe left ventricular hypertrophy≥30mm. Risk stratification for sudden cardiac death is essential, for symptomatic or asymptomatic HCM patients. Two approaches are possible: the classical approach or risk stratification methods with major risk factors and the new approach using the risk-calculator recommended by the ESC. Both methods are not in opposition but complementary. The risk stratification in hypertrophic cardiomyopathy should be still improved to be sure that only the most high-risk patients receive an implantable cardiac defibrillator.

  9. Advanced Electrocardiographic Predictors of Sudden Death in Familial Dysautonomia

    NASA Technical Reports Server (NTRS)

    Solaimanzadeh, I.; Schlegel, T. T.; Greco, E. C.; DePalma, J. L.; Starc, V.; Marthol, H.; Tutaj, M.; Buechner, S.; Axelrod, F. B.; Hilz, M. J.

    2007-01-01

    To identify accurate predictors for the risk of sudden death in patients with familial dysautonomia (FD). Ten-minute resting high-fidelity 12-lead ECGs were obtained from 14 FD patients and 14 age/gender-matched healthy subjects. Multiple conventional and advanced ECG parameters were studied for their ability to predict sudden death in FD over a subsequent 4.5-year period, including multiple indices of linear and non-linear heart rate variability (HRV); QT variability; waveform complexity; high frequency QRS; and derived Frank-lead parameters. Four of the 14 FD patients died suddenly during the follow-up period, usually with concomitant pulmonary disorder. The presence of low vagally-mediated HRV was the ECG finding most predictive of sudden death. Concomitant left ventricular hypertrophy and other ECG abnormalities such as increased QTc and JTc intervals, spatial QRS-T angles, T-wave complexity, and QT variability were also present in FD patients, suggesting that structural heart disease is fairly common in FD. Although excessive or unopposed cardiac vagal (relative to sympathetic) activity has been postulated as a contributor to sudden death in FD, the presence of low vagally-mediated HRV was paradoxically the best predictor of sudden death. However, we suggest that low vagally-mediated HRV be construed not as a direct cause of sudden death in FD, but rather as an effect of concurrent pathological processes, especially hypoxia due to pulmonary disorders and sleep apnea, that themselves increase the risk of sudden death in FD and simultaneously diminish HRV. We speculate that adenosine may play a role in sudden death in FD, possibly independently of vagal activity, and that adenosine inhibitors such as theophylline might therefore be useful as prophylaxis in this disorder.

  10. Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith.

    PubMed

    Scorza, Fulvio A; Cavalheiro, Esper A; Costa, Jaderson Costa da

    2016-07-01

    Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP.

  11. Epidemiology of sudden cardiac death: clinical and research implications.

    PubMed

    Chugh, Sumeet S; Reinier, Kyndaron; Teodorescu, Carmen; Evanado, Audrey; Kehr, Elizabeth; Al Samara, Mershed; Mariani, Ronald; Gunson, Karen; Jui, Jonathan

    2008-01-01

    The current annual incidence of sudden cardiac death in the United States is likely to be in the range of 180,000 to 250,000 per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the United States during the second half of the 20th century. However, the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the United States and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum, and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.

  12. Genetics of sudden cardiac death in children and young athletes.

    PubMed

    Sarquella-Brugada, Georgia; Campuzano, Oscar; Iglesias, Anna; Sánchez-Malagón, Josep; Guerra-Balic, Myriam; Brugada, Josep; Brugada, Ramon

    2013-04-01

    Sudden cardiac death is a rare but socially devastating event. The most common causes of sudden cardiac death are congenital electrical disorders and structural heart diseases. The majority of these diseases have an incomplete penetrance and variable expression; therefore, patients may be unaware of their illness. In several cases, physical activity can be the trigger for sudden cardiac death as first symptom. Our purpose is to review the causes of sudden cardiac death in sportive children and young adults and its genetic background. Symptomatic individuals often receive an implantable cardioverter-defibrillator, the preventive treatment for sudden cardiac death in most of cases due to channelopathies, which can become a challenging option in young and active patients. The identification of one of these diseases in asymptomatic patients has similarly a great impact on their everyday life, especially on their ability to undertake competitive physical activities, and the requirement of prophylactic treatment. We review main causes of sudden cardiac death in relation to its genetics and diagnostic work-up

  13. Inheritance of Febrile Seizures in Sudden Unexplained Death in Toddlers

    PubMed Central

    Holm, Ingrid A.; Poduri, Annapurna; Crandall, Laura; Haas, Elisabeth; Grafe, Marjorie R.; Kinney, Hannah C.; Krous, Henry F.

    2014-01-01

    Sudden unexplained death in toddlers has been associated with febrile seizures, family history of febrile seizures, and hippocampal anomalies. We investigated the mode of inheritance for febrile seizures in these families. A three-generation pedigree was obtained from families enrolled in the San Diego Sudden Unexplained Death in Childhood Research Project, involving toddlers with sudden unexplained death, febrile seizures, and family history of febrile seizures. In our six cases, death was unwitnessed and related to sleep. The interval from last witnessed febrile seizure to death ranged from 3 weeks to 6 months. Hippocampal abnormalities were identified in one of three cases with available autopsy sections. Autosomal dominant inheritance of febrile seizures was observed in three families. A fourth demonstrated autosomal dominant inheritance with incomplete penetrance or variable expressivity. In two families, the maternal and paternal sides manifested febrile seizures. In this series, the major pattern of inheritance in toddlers with sudden unexplained death and febrile seizures was autosomal dominant. Future studies should develop markers (including genetic) to identify which patients with febrile seizures are at risk for sudden unexplained death in childhood, and to provide guidance for families and physicians. PMID:22490769

  14. Genetics of channelopathies associated with sudden cardiac death

    PubMed Central

    Campuzano, Oscar; Sarquella-Brugada, Georgia; Brugada, Ramon; Brugada, Josep

    2015-01-01

    Recent technological advances in cardiology have resulted in new guidelines for the diagnosis, treatment and prevention of diseases. Despite these improvements, sudden death remains one of the main challenges to clinicians because the majority of diseases associated with sudden cardiac death are characterized by incomplete penetrance and variable expressivity. Hence, patients may be unaware of their illness, and physical activity can be the trigger for syncope as first symptom of the disease. Most common causes of sudden cardiac death are congenital alterations and structural heart diseases, although a significant number remain unexplained after comprehensive autopsy. In these unresolved cases, channelopathies are considered the first potential cause of death. Since all these diseases are of genetic origin, family members could be at risk, despite being asymptomatic. Genetics has also benefited from technological advances, and genetic testing has been incorporated into the sudden death field, identifying the cause in clinically affected patients, asymptomatic family members and post-mortem cases without conclusive diagnosis. This review focuses on recent advances in the genetics of channelopathies associated with sudden cardiac death. PMID:26566530

  15. Contribution of opiates in sudden asthma deaths.

    PubMed

    Hlavaty, Leigh; Hansma, Patrick; Sung, LokMan

    2015-03-01

    Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner's Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests.

  16. Sickle cell trait and sudden death--bringing it home.

    PubMed Central

    Mitchell, Bruce L.

    2007-01-01

    Sickle cell trait continues to be the leading cause of sudden death for young African Americans in military basic training and civilian organized sports. The syndrome may have caused the death of up to 10 college football players since 1974 and, as recently as 2000, was suspected as the cause of death of three U.S. Army recruits. The penal military-style boot camps in the United States and the recent death of two teenagers with sickle cell trait merits renewed vigor in the education of athletic instructors, the military and the public about conditions associated with sudden death in individuals with sickle cell trait. Images Figure 1 Figure 2 PMID:17393956

  17. The costs of suicide and sudden death within an organization.

    PubMed

    Kinder, Andrew; Cooper, Cary L

    2009-05-01

    The effect of any death spreads out to many people. Deaths that occur in the workplace need to be handled with particular care given that the bereaved family as well as work colleagues will have been affected. Death by suicide or situations when an employee becomes suicidal can challenge even the most experienced manager. This article aims to raise some of the issues surrounding sudden death and suicide at work and suggests a number of ways that an organization can respond to such challenges.

  18. The Brainstem and Serotonin in the Sudden Infant Death Syndrome

    PubMed Central

    Kinney, Hannah C.; Richerson, George B.; Dymecki, Susan M.; Darnall, Robert A.; Nattie, Eugene E.

    2012-01-01

    The sudden infant death syndrome (SIDS) is the sudden death of an infant under one year of age that is typically associated with sleep and that remains unexplained after a complete autopsy and death scene investigation. A leading hypothesis about its pathogenesis is that many cases result from defects in brainstem-mediated protective responses to homeostatic stressors occurring during sleep in a critical developmental period. Here we review the evidence for the brainstem hypothesis in SIDS with a focus upon abnormalities related to the neurotransmitter serotonin in the medulla oblongata, as these are the most robust pathologic findings to date. In this context, we synthesize the human autopsy data with genetic, whole-animal, and cellular data concerning the function and development of the medullary serotonergic system. These emerging data suggest an important underlying mechanism in SIDS that may help lead to identification of infants at risk and specific interventions to prevent death. PMID:19400695

  19. Medico legal investigations into sudden sniffing deaths linked with trichloroethylene.

    PubMed

    Da Broi, Ugo; Colatutto, Antonio; Sala, Pierguido; Desinan, Lorenzo

    2015-08-01

    Sudden deaths attributed to sniffing trichloroethylene are caused by the abuse of this solvent which produces pleasant inebriating effects with rapid dissipation. In the event of repeated cycles of inhalation, a dangerous and uncontrolled systemic accumulation of trichloroethylene may occur, followed by central nervous system depression, coma and lethal cardiorespiratory arrest. Sometimes death occurs outside the hospital environment, without medical intervention or witnesses and without specific necroscopic signs. Medico legal investigations into sudden sniffing deaths associated with trichloroethylene demand careful analysis of the death scene and related circumstances, a detailed understanding of the deceased's medical history and background of substance abuse and an accurate evaluation of all autopsy and laboratory data, with close cooperation between the judiciary, coroners and toxicologists.

  20. Sudden and unexpected death between 1 and 5 years.

    PubMed Central

    Southall, D P; Stebbens, V; Shinebourne, E A

    1987-01-01

    Of a population of 9856 children followed up from birth, 9251 of whom underwent 24 hour tape recordings of electrocardiograms and abdominal wall breathing movements during early infancy, five died suddenly and unexpectedly at home at ages ranging from 16 months to 4 years. Postmortem examination, including full histological and microbiological investigations. failed to identify abnormalities ordinarily associated with death in all five cases. Two of the children were known to have had frequent cyanotic episodes and died during these events. In the three remaining cases there was no previous history of cyanotic or apnoeic episodes. The death of one of these three children was seen by his parents and the clinical features suggested that apnoea rather than a cardiac arrhythmia was the primary mechanism for his death. As in infancy, sudden and unexpected death for which no adequate cause is found at necropsy seems to constitute a major component of mortality between 1 and 5 years. PMID:3632016

  1. The brainstem and serotonin in the sudden infant death syndrome.

    PubMed

    Kinney, Hannah C; Richerson, George B; Dymecki, Susan M; Darnall, Robert A; Nattie, Eugene E

    2009-01-01

    The sudden infant death syndrome (SIDS) is the sudden death of an infant under one year of age that is typically associated with sleep and that remains unexplained after a complete autopsy and death scene investigation. A leading hypothesis about its pathogenesis is that many cases result from defects in brainstem-mediated protective responses to homeostatic stressors occurring during sleep in a critical developmental period. Here we review the evidence for the brainstem hypothesis in SIDS with a focus upon abnormalities related to the neurotransmitter serotonin in the medulla oblongata, as these are the most robust pathologic findings to date. In this context, we synthesize the human autopsy data with genetic, whole-animal, and cellular data concerning the function and development of the medullary serotonergic system. These emerging data suggest an important underlying mechanism in SIDS that may help lead to identification of infants at risk and specific interventions to prevent death.

  2. [Sudden cardiac death in individuals with normal hearts: an update].

    PubMed

    González-Melchor, Laila; Villarreal-Molina, Teresa; Iturralde-Torres, Pedro; Medeiros-Domingo, Argelia

    2014-01-01

    Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event.

  3. Extreme sacrifice: sudden cardiac death in the US Fire Service

    PubMed Central

    2013-01-01

    Firefighting is a hazardous profession which has claimed on average the lives of 105 US firefighters per year for the past decade. The leading cause of line-of-duty mortality is sudden cardiac death, which accounts for approximately 45% of all firefighter duty-related fatalities. Strenuous physical activity, emotional stress, and environmental pollutants all strain the cardiovascular system, and each can increase the risk of sudden cardiac events in susceptible individuals. Sudden cardiac death is more likely to occur during or shortly after emergency duties such as fire suppression, despite the fact that these duties comprise a relatively small proportion of firefighters' annual duties. Additionally, cardiac events are more likely to occur in firefighters who possess an excess of traditional risk factors for cardiovascular disease along with underlying atherosclerosis and/or structural heart disease. In this review, we propose a theoretical model for the interaction between underlying cardiovascular disease in firefighters and the multifactorial physiological strain of firefighting. PMID:23849605

  4. Sudden Infant Death Syndrome, FY 1983. Special Report to Congress.

    ERIC Educational Resources Information Center

    National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

    This report describes research programs focusing on the sudden infant death syndrome (SIDS) and indicates some presently available results. Specific attention is given to research on sleep apnea, respiratory control, and hypoxia, as well as to infectious disease processes and immunology. Findings of a large-scale multidisciplinary SIDS project are…

  5. Preventing Sudden Death: Cardiovascular Screening of Young Athletes.

    ERIC Educational Resources Information Center

    Ades, Philip A.

    1992-01-01

    Efficiently and inexpensively identifying athletes at risk for exercise-related sudden death is difficult. The article discusses types of cardiac disorders and outlines a practical screening method that features a cardiac history questionnaire designed to identify symptomatic athletes and those with a family history of congenital heart disease.…

  6. Detection of sudden death syndrome using a multispectral imaging sensor

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden death syndrome (SDS), caused by the fungus Fusarium solani f. sp. glycines, is a widespread mid- to late-season disease with distinctive foliar symptoms. This paper reported the development of an image analysis based method to detect SDS using a multispectral image sensor. A hue, saturation a...

  7. Defining Sudden Infant Death and Sudden Intrauterine Unexpected Death Syndromes with Regard to Anatomo-Pathological Examination

    PubMed Central

    Ottaviani, Giulia

    2016-01-01

    Crib death, or sudden infant death syndrome (SIDS), is the most frequent form of death in the first year of life, striking one baby in every 1,700–2,000. Yet, despite advances in maternal–infant care, sudden intrauterine unexplained/unexpected death syndrome (SIUDS) has a sixfold to eightfold greater incidence than that of SIDS. Frequent congenital abnormalities, likely morphological substrates for SIDS–SIUDS, were detected, mainly represented by alterations of the cardiac conduction system, such as accessory pathways and abnormal resorptive degeneration, and hypoplasia/agenesis of the vital brainstem structures. On the basis of these considerations, the new common definition of the SIDS–SIUDS complex is “The sudden death of a fetus after the 25th gestational week or infant under one year of age which is unexpected by history and remains unexplained after a thorough case investigation, including examination of the death scene, performance of a general autopsy and examination of the fetal adnexa”. Therefore, given that the general autopsy does not disclose any cause of death, a more in-depth histopathological analysis of the cardiac conduction system and autonomic nervous system by specialized pathologists is necessary. PMID:27709109

  8. Sudden unexpected death in epilepsy: Identifying risk and preventing mortality.

    PubMed

    Lhatoo, Samden; Noebels, Jeffrey; Whittemore, Vicky

    2015-11-01

    Premature death among individuals with epilepsy is higher than in the general population, and sudden unexpected death is the most common cause of this mortality. A new multisite collaborative research consortium, the Center for sudden unexpected death in epilepsy (SUDEP) Research (CSR), has received major funding from the National Institutes of Health (NIH) to examine the possible biologic mechanisms underlying this potentially preventable comorbidity and develop predictive biomarkers for interventions that could lower SUDEP incidence. This inaugural report describes the structure of the CSR, its priorities for human and experimental research, and the strategic collaborations and advanced tools under development to reduce this catastrophic outcome of epilepsy. The CSR Partners Program will work closely with committed volunteer agencies, industry, and academic institutions to accelerate and communicate these advances to the professional and lay community.

  9. Sudden death due to swimming in elderly women.

    PubMed

    Škavić, Petar; Duraković, Din

    2015-03-01

    The aim was to analyze the rate of sudden death in elderly Croatian women in comparison to elderly Croatian men, who died suddenly due to swimming. In the period from 2002 to 2011 one elderly Croatian woman and five elderly men died suddenly during swimming. In the same time, the same number of elderly foreigners died due to swimming at the Croatian Adriatic coast. One Croatian woman aged 66, who suffered of arterial hypertension with left ventricular hyper- trophy of 15 mm, diabetes mellitus and alcoholic liver cirrhosis, drowned in the sea during swimming. She was intoxi- cated with alcohol and had alcohol level in urine of 3.03 per thousand. One foreign woman, aged 82, who suffered coronary heart disease with left ventricular scar after myocardial infarction, arterial hypertension with excessive left ventricular hypertrophy of 22 mm and nephroangiosclerosis, suddenly lost conscionsness during swimming. The death rate in elderly Croatian women due to swimming reached 0.25, and the death rate in men is eight times higher: 1.97 (p = 0.0701), but the difference is not significant probably because of a small observational number.

  10. Clozapine-induced hypersensitivity myocarditis presenting as sudden cardiac death

    PubMed Central

    Balla, Sudarshan; Aggarwal, Kul

    2016-01-01

    Hypersensitivity myocarditis is a rare but serious adverse effect of clozapine, a commonly used psychiatric drug. We report the case of sudden cardiac death from clozapine-induced hypersensitivity myocarditis diagnosed at autopsy. A 54-year-old Caucasian male on clozapine therapy for bipolar disorder presented with a sudden onset of shortness of breath. Laboratory studies were significant for elevated N-terminal prohormone of brain natriuretic peptide. During his hospital stay, the patient died of sudden cardiac arrest from ventricular tachycardia. The autopsy revealed hypersensitivity myocarditis, which usually occurs in the first 4 weeks after the initiation of clozapine. A 4-week monitoring protocol, including laboratory assessment of troponin and C-reactive protein, may assist in the early diagnosis of this potentially fatal condition. PMID:28210568

  11. Cardiac Channelopathies and Sudden Death: Recent Clinical and Genetic Advances

    PubMed Central

    Fernández-Falgueras, Anna; Sarquella-Brugada, Georgia; Brugada, Josep; Brugada, Ramon; Campuzano, Oscar

    2017-01-01

    Sudden cardiac death poses a unique challenge to clinicians because it may be the only symptom of an inherited heart condition. Indeed, inherited heart diseases can cause sudden cardiac death in older and younger individuals. Two groups of familial diseases are responsible for sudden cardiac death: cardiomyopathies (mainly hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) and channelopathies (mainly long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). This review focuses on cardiac channelopathies, which are characterized by lethal arrhythmias in the structurally normal heart, incomplete penetrance, and variable expressivity. Arrhythmias in these diseases result from pathogenic variants in genes encoding cardiac ion channels or associated proteins. Due to a lack of gross structural changes in the heart, channelopathies are often considered as potential causes of death in otherwise unexplained forensic autopsies. The asymptomatic nature of channelopathies is cause for concern in family members who may be carrying genetic risk factors, making the identification of these genetic factors of significant clinical importance. PMID:28146053

  12. Sudden unexplained death among persons 1-35 years old.

    PubMed

    Morentin, Benito; Suárez-Mier, Maria Paz; Aguilera, Beatriz

    2003-08-27

    Sudden unexplained death (SUD) on children and young people is unusual, although the real magnitude is unknown. The clinical and physiopathological characteristics are poorly defined. The aim of this work is to analyse the epidemiological, clinical and pathological characteristics of SUD on children and young people. In this population observational study, all sudden non-violent deaths between 1 and 35 years occurred in Bizkaia (north Spain) from 1991 to 1998 were investigated, analysing those diagnosed as SUD. Pathological records, circumstances of death and autopsy findings were obtained. Out of 107 cases of sudden death (SD), 19 were SUD. The mortality rate of SUD was 0.43/100,000 persons per year. Five had pathological antecedents: syncopal episodes in three cases and tachycardia and ventricular extrasystoles one each. The initial symptom was sudden collapse (N=13). In four cases, a precipitating factor was identified (two physical exercise and two emotional stress). Six cases died during sleep. Minimal pathological findings in coronary arteries, myocardium or conduction system was found in nine cases. Heart weight increased (under interval of confidence of 95%) was present in 12 cases. In conclusion, the SUD is very infrequent in children and young people. However, it has great clinical significance because it affects people in good health and occurs without warning symptoms. Some of these cases can be due to cardiac arrhythmias. In deaths in bed there is a high frequency of SUD. In the future, it may be possible that abnormalities at a molecular level will be detected in some of the cases identified today as SUD.

  13. Sudden unexpected death in epilepsy: Evaluation of forensic autopsy cases.

    PubMed

    Zhuo, Luo; Zhang, Yang; Zielke, H Ronald; Levine, Barry; Zhang, Xiang; Chang, Lin; Fowler, David; Li, Ling

    2012-11-30

    Epilepsy is a common chronic neurological disorder characterized by seizures. Mortality is significantly increased in patients with epilepsy. Sudden unexpected death in epilepsy (SUDEP) is the most common seizure-related category of death. A retrospective study of forensic autopsy cases from 2007 to 2009 at the Office of the Chief Medical Examiner (OCME) yielded a total of 104 sudden unexpected deaths directly or indirectly caused by an epilepsy/seizure disorder in the State of Maryland. Of these deaths, 74 cases met a general accepted definition of SUDEP. The age of SUDEP individuals ranged from 14 to 63 with the majority of subjects in the ages between 21 and 50 years (58 cases, 78.4%). Males were slightly more likely than females to die of SUDEP (male:female=1.5:1 based on the rate). The onset age of epilepsy was documented in 47.3% of cases (35/74) based on investigation and medical records. Of the 35 cases, 12 subjects had early onset epilepsy (onset ages 1-15 years) and 20 subjects had duration of epilepsy for more than 10 years. The majority of deaths (61 of the 74 cases, 82.4%) were unwitnessed. Death scene investigation showed that 71 deaths (95.9%) occurred inside their residence with 50 subjects (70.4%) found either in bed or on the bedroom floor near the bed. Forty-three out of 74 cases (58.1%) showed neuropathological lesions. Per history, 50 subjects were reported as being on anti-epileptic drugs (AEDs). However, postmortem toxicological analysis revealed that only 26 subjects (35.1%) had detectable AEDs. Of the 74 cases, seizure disorder or epilepsy was listed as primary cause of death in 66 cases and the term of SUDEP as official cause of death in only 8 cases. This report focuses on the characteristics of death scene investigation and postmortem examination findings of SUDEP cases.

  14. Sudden Unexplained Nocturnal Death Syndrome in Central China (Hubei)

    PubMed Central

    Chen, Zhenglian; Mu, Jiao; Chen, Xinshan; Dong, Hongmei

    2016-01-01

    Abstract A retrospective study was conducted at Tongji Forensic Medical Center in Hubei (TFMCH) from 1999 to 2014. Forty-nine cases of sudden unexplained nocturnal death syndrome (SUNDS) were collected. The SUNDS rate was 1.0% in the total number of cases, in which an incidence was fluctuating over the years. Interestingly, April and January, and 3:00 to 6:00 am were the peak months and times of death. Among the decedents, farmers and migrant workers accounted for 67.3%. The syndrome predominantly attacked males in their 30s. One victim had sinus tachycardia. Thirteen victims (26.5%) were witnessed and had abnormal symptoms near death. Macroscopically, compared to sudden noncardiac deaths, the weights of brain, heart, and lungs had no statistical difference in SUNDS. Microscopically, the incidence of lung edema (45 cases, 91.8%) was significantly higher in SUNDS group than in the control group (27 cases, 55.1%). 82.9% of 35 SUNDS cases examined displayed minor histological anomalies of the cardiac conduction system (CCS), including mild or moderate fatty, fibrous or fibrofatty tissue replacement, insignificant stenosis of node artery, and punctate hemorrhage in the node area. These findings suggested that minor CCS abnormalities might be the substrates for some SUNDS deaths. Therefore, SUNDS victims might suffer ventricular fibrillation and acute cardiopulmonary failure before death. Further in-depth studies are needed to unveil the underlying mechanisms of SUNDS. PMID:26945374

  15. Sudden cardiac death secondary to antidepressant and antipsychotic drugs.

    PubMed

    Sicouri, Serge; Antzelevitch, Charles

    2008-03-01

    A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over QT prolongation and the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. Some antidepressants and antipsychotics have been linked to QT prolongation and the development of Torsade de pointes arrhythmias, whereas others have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This review examines the mechanisms and predisposing factors underlying the development of cardiac arrhythmias, and sudden cardiac death, associated with antidepressant and antipsychotic drugs in clinical use.

  16. Recommendations for sudden infant death syndrome prevention: a discussion document.

    PubMed

    Mitchell, E A

    2007-02-01

    This article reviews the evidence for the current UK Department of Health recommendations for prevention of sudden infant death syndrome (SIDS) and suggests other factors that should be considered. The wording of the Department of Health recommendations for SIDS prevention has changed over the past 6 years, but the specific recommendations are largely consistent with the scientific evidence. The emphasis on thermal and illness factors and immunisation could be reduced. Bed sharing and sharing the parental bedroom should be given more emphasis. Two major recommendations need to be discussed in greater detail: (1) breast feeding and (2) pacifier use. Meta-analyses or reviews looking at each risk factor or a combination of risk factors are required. Further, it is recommended that a committee is established that reviews the recommendations and publishes the evidence that leads to these recommendations, as is done by the American Academy of Pediatrics Taskforce on Sudden Infant Death Syndrome.

  17. Melatonin concentrations in the sudden infant death syndrome

    NASA Technical Reports Server (NTRS)

    Sturner, W. Q.; Lynch, H. J.; Deng, M. H.; Gleason, R. E.; Wurtman, R. J.

    1990-01-01

    The melatonin levels in various body fluids of the sudden infant death syndrome (SIDS) infants are compared with those of infants of comparable age who died of other causes to examine a possible relationship between pineal function and SIDS. After adjusting for age differences, cerebrospinal fluid melatonin levels are found to be significantly lower in the SIDS infants. It is suggested that diminished melatonin production may be characteristic of SIDS and could represent an impairment in the maturation of physiologic circadian organization.

  18. Clinical management and prevention of sudden cardiac death.

    PubMed

    Yousuf, Omair; Chrispin, Jonathan; Tomaselli, Gordon F; Berger, Ronald D

    2015-06-05

    Despite the revolutionary advancements in the past 3 decades in the treatment of ventricular tachyarrhythmias with device-based therapy, sudden cardiac death (SCD) remains an enormous public health burden. Survivors of SCD are generally at high risk for recurrent events. The clinical management of such patients requires a multidisciplinary approach from postresuscitative care to a thorough cardiovascular investigation in an attempt to identify the underlying substrate, with potential to eliminate or modify the triggers through catheter ablation and ultimately an implantable cardioverter-defibrillator (ICD) for prompt treatment of recurrences in those at risk. Early recognition of low left ventricular ejection fraction as a strong predictor of death and association of ventricular arrhythmias with sudden death led to significant investigation with antiarrhythmic drugs. The lack of efficacy and the proarrhythmic effects of drugs catalyzed the development and investigation of the ICD through several major clinical trials that proved the efficacy of ICD as a bedrock tool to detect and promptly treat life-threatening arrhythmias. The ICD therapy is routinely used for primary prevention of SCD in patients with cardiomyopathy and high risk inherited arrhythmic conditions and secondary prevention in survivors of sudden cardiac arrest. This compendium will review the clinical management of those surviving SCD and discuss landmark studies of antiarrhythmic drugs, ICD, and cardiac resynchronization therapy in the primary and secondary prevention of SCD.

  19. Commotio cordis: an underappreciated cause of sudden death in athletes.

    PubMed

    Lateef, F

    2000-10-01

    Over the last few years, the recognised cardiovascular risks of sporting activities have been extended to include cardiac arrest resulting from low-energy precordial chest impact produced by projectiles (e.g. baseball) or bodily contact, in the young, healthy and active athlete [also known as commotio cordis (CC)]. However, case reports of CC in European medical literature can be traced back for at least 130 years. CC accounts for a small, but important, subset of sudden death during sporting activities. It is a devastating electrophysiological event in the young athlete, and one which has generated considerable concern, both in the medical profession as well as in the public. The mechanism of sudden death appears to be caused by ventricular fibrillation, which occurs when the chest impact is delivered within a narrow, electrically vulnerable portion of the cardiac cycle, that is, during repolarisation, just before the peak of the T wave. Resuscitation of these victims is possible with prompt cardiopulmonary resuscitation and defibrillation. Preventive measures, such as the use of age-appropriate safety baseballs and suitably designed chest wall protection, may reduce the risk of sudden death and, thus, make the athletic field a safer place for young athletes.

  20. Monte Carlo Simulation of Sudden Death Bearing Testing

    NASA Technical Reports Server (NTRS)

    Vlcek, Brian L.; Hendricks, Robert C.; Zaretsky, Erwin V.

    2003-01-01

    Monte Carlo simulations combined with sudden death testing were used to compare resultant bearing lives to the calculated hearing life and the cumulative test time and calendar time relative to sequential and censored sequential testing. A total of 30 960 virtual 50-mm bore deep-groove ball bearings were evaluated in 33 different sudden death test configurations comprising 36, 72, and 144 bearings each. Variations in both life and Weibull slope were a function of the number of bearings failed independent of the test method used and not the total number of bearings tested. Variation in L10 life as a function of number of bearings failed were similar to variations in lift obtained from sequentially failed real bearings and from Monte Carlo (virtual) testing of entire populations. Reductions up to 40 percent in bearing test time and calendar time can be achieved by testing to failure or the L(sub 50) life and terminating all testing when the last of the predetermined bearing failures has occurred. Sudden death testing is not a more efficient method to reduce bearing test time or calendar time when compared to censored sequential testing.

  1. [Newborn sleep positioners and sudden infant death syndrome risk].

    PubMed

    Rossato, Norma Elena

    2013-01-01

    The rate of sudden infant death decreased after the publication of the first guidelines regarding infant sleep position and safe environment in 1992. From 2005 onwards, infant deaths by suffocation, choking or entrapment have increased. Some of them were associated with wedges, positioning devices, and bumper pads. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising, but there is a lack of control over this. We emphasize the important role of health professionals in disseminating the recommendation for a safe infant sleep environment.

  2. Sudden infant death syndrome: risk factor profiles for distinct subgroups.

    PubMed

    Kohlendorfer, U; Kiechl, S; Sperl, W

    1998-05-15

    The authors investigated risk profiles of sudden infant death syndrome (SIDS) as a function of age at death. A case-control study carried out in the Tyrol region of Austria enrolled 99 infants who died of SIDS between 1984 and 1994 and 136 randomly selected controls. Early and late SIDS (< 120 days of age vs. > or = 120 days) were defined according to the clear-cut bimodal age-at-death distribution. Inadequate antenatal care, low parental social and educational level, and the prone sleeping position were risk conditions that applied to both early and late SIDS. A marked seasonal variation (winter preponderance) was the most outstanding feature of late SIDS. A gestational age of < 37 weeks (odds ratio (OR) = 8.4, 95% confidence interval (CI) 2.6-26.0), repeated episodes of apnea (OR = 5.7, 95% CI 1.2-27.0), low birth weight (< 2,500 g) (OR = 3.4, 95% CI 1.1-11.0), a family history of sudden infant death (OR = 2.9, 95% CI 1.1-7.5), and maternal smoking during pregnancy (OR = 2.2, 95% CI 1.0-4.5) were associated with early SIDS. This study identified two distinct subgroups of SIDS infants characterized by different risk conditions and ages at death. These results underline a multiple-cause hypothesis for SIDS etiology which involves a genetic predisposition, immaturity in the first months of life, and environmental factors acting at various ages.

  3. Sudden infant deaths and seasonality in Tasmania, 1970-1976.

    PubMed

    McGlashan, N D; Grice, A C

    1983-01-01

    Analyses of monthly minimum temperatures and daily minimum temperatures show that significantly more Sudden Infant Deaths and 'pneumonitis' deaths occur in colder conditions in southern Tasmania. Low minimum monthly and low minimum daily temperatures 'explain' part of the observed winter seasonal peak of deaths. However, a sharp change of temperature over 24 hours, either upwards or downwards, is associated with fewer deaths than occurred when little or no change of temperature had been experienced. Utilising the additional data of the Tasmania-wide series it is shown that the winter seasonal effect is especially evident in infants over 3 months of age compared with those aged only 0-3 months, in whom seasonal variation did not occur.

  4. Early repolarization, acute emotional stress and sudden death.

    PubMed

    Palmiere, Cristian; Lesta, Maria del Mar; Vanhaebost, Jessica; Mangin, Patrice; Augsburger, Marc; Vogt, Pierre

    2014-05-01

    We herein report the case of a 36-year-old man who died suddenly after a fight with another man. Forensic investigations included unenhanced computed tomography, postmortem angiography, autopsy, histology, neuropathology, toxicology, and biochemistry and allowed a traumatic cause of death to be excluded. An electrocardiogram recorded some years prior to death revealed the presence of an early repolarization pattern. Based on the results of all investigations, the cause of death was determined to be cardiac arrhythmia and cardiac arrest during an emotionally stressful event associated with physical assault. Direct third party involvement, however, was excluded, and the manner of death was listed as natural. The case was not pursued any further by the public prosecutor.

  5. Cardiac disease and risk of sudden death in the young: the burden of the phenomenon.

    PubMed

    Fishbein, Michael C

    2010-01-01

    Sudden cardiovascular death is a rare but catastrophic event in young men and women throughout the world. Sudden death is difficult to study. Factors that need elucidation are (1) the definition of sudden death; (2) diagnosis of the cause of sudden death; (3) the true incidence of sudden death, and (4) age and gender of individuals being studied. The "burden" of sudden death is far-reaching and involves medical, emotional, and economic burdens on the family members at risk, the entire family of the victim, and society in general. The pathologist trying to evaluate a case of sudden death also has a burden to make the correct diagnosis, especially since the cause of the sudden death may determine risk to the victim's family members. Sudden death is difficult to prevent since it may be the first and last manifestation of the cardiovascular disease. Also, paradoxically, the greatest number of deaths occurs in "low-risk" groups. The most common causes of cardiovascular deaths in the young are cardiomyopathy, coronary anomaly, obstructive coronary artery disease, myocarditis, valvular disease, channelopathy, and aortic disease leading to dissection or rupture. Many sudden deaths in the young occur during or shortly after exercise. Appropriate pre-participation screening of competitive athletes can reduce the incidence of sudden cardiovascular death in the young. Which measures to try to prevent these rare deaths are indicated and/or cost effective is a matter of discussion and controversy.

  6. Sudden birth versus sudden death of entanglement for the extended Werner-like state in a dissipative environment

    NASA Astrophysics Data System (ADS)

    Shan, Chuan-Jia; Chen, Tao; Liu, Ji-Bing; Cheng, Wei-Wen; Liu, Tang-Kun; Huang, Yan-Xia; Li, Hong

    2010-06-01

    In this paper, we investigate the dynamical behaviour of entanglement in terms of concurrence in a bipartite system subjected to an external magnetic field under the action of dissipative environments in the extended Werner-like initial state. The interesting phenomenon of entanglement sudden death as well as sudden birth appears during the evolution process. We analyse in detail the effect of the purity of the initial entangled state of two qubits via Heisenberg XY interaction on the apparition time of entanglement sudden death and entanglement sudden birth. Furthermore, the conditions on the conversion of entanglement sudden death and entanglement sudden birth can be generalized when the initial entangled state is not pure. In particular, a critical purity of the initial mixed entangled state exists, above which entanglement sudden birth vanishes while entanglement sudden death appears. It is also noticed that stable entanglement, which is independent of different initial states of the qubits (pure or mixed state), occurs even in the presence of decoherence. These results arising from the combination of the extended Werner-like initial state and dissipative environments suggest an approach to control and enhance the entanglement even after purity induced sudden birth, death and revival.

  7. The Spectrum of Epidemiology Underlying Sudden Cardiac Death

    PubMed Central

    Hayashi, Meiso; Shimizu, Wataru; Albert, Christine M.

    2015-01-01

    Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15–20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who suffer a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly due to inherited disorders. Coronary heart disease (CHD) is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. Over the past three decades, declines in SCD rates have not been as steep as for other causes of CHD deaths, and there is a growing fraction of SCDs not due to CHD and/or ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition prior to death. Multifaceted preventative approaches, which address risk factors in seemingly low risk and known high-risk populations will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies. PMID:26044246

  8. Mutations in Calmodulin Cause Ventricular Tachycardia and Sudden Cardiac Death

    PubMed Central

    Nyegaard, Mette; Overgaard, Michael T.; Søndergaard, Mads T.; Vranas, Marta; Behr, Elijah R.; Hildebrandt, Lasse L.; Lund, Jacob; Hedley, Paula L.; Camm, A. John; Wettrell, Göran; Fosdal, Inger; Christiansen, Michael; Børglum, Anders D.

    2012-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating inherited disorder characterized by episodic syncope and/or sudden cardiac arrest during exercise or acute emotion in individuals without structural cardiac abnormalities. Although rare, CPVT is suspected to cause a substantial part of sudden cardiac deaths in young individuals. Mutations in RYR2, encoding the cardiac sarcoplasmic calcium channel, have been identified as causative in approximately half of all dominantly inherited CPVT cases. Applying a genome-wide linkage analysis in a large Swedish family with a severe dominantly inherited form of CPVT-like arrhythmias, we mapped the disease locus to chromosome 14q31-32. Sequencing CALM1 encoding calmodulin revealed a heterozygous missense mutation (c.161A>T [p.Asn53Ile]) segregating with the disease. A second, de novo, missense mutation (c.293A>G [p.Asn97Ser]) was subsequently identified in an individual of Iraqi origin; this individual was diagnosed with CPVT from a screening of 61 arrhythmia samples with no identified RYR2 mutations. Both CALM1 substitutions demonstrated compromised calcium binding, and p.Asn97Ser displayed an aberrant interaction with the RYR2 calmodulin-binding-domain peptide at low calcium concentrations. We conclude that calmodulin mutations can cause severe cardiac arrhythmia and that the calmodulin genes are candidates for genetic screening of individual cases and families with idiopathic ventricular tachycardia and unexplained sudden cardiac death. PMID:23040497

  9. Reporting a sudden death due to accidental gasoline inhalation.

    PubMed

    Martínez, María Antonia; Ballesteros, Salomé; Alcaraz, Rafael

    2012-02-10

    The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes.

  10. Sudden Death of Cardiac Origin and Psychotropic Drugs

    PubMed Central

    Timour, Quadiri; Frassati, Dominique; Descotes, Jacques; Chevalier, Philippe; Christé, Georges; Chahine, Mohamed

    2012-01-01

    Mortality rate is high in psychiatric patients versus general population. An important cause of this increased mortality is sudden cardiac death (SCD) as a major side-effect of psychotropic drugs. These SCDs generally result from arrhythmias occurring when the posology is high and may attain a toxic threshold but also at dosages within therapeutic range, in the presence of risk factors. There are three kinds of risk factors: physiological (e.g., low cardiac rate of sportsmen), physiopathological (e.g., hepatic insufficiency, hypothyroidism) and “therapeutic” (due to interactions between psychotropic drugs and other medicines). Association of pharmacological agents may increase the likelihood of SCDs either by (i) a pharmacokinetic mechanism (e.g., increased torsadogenic potential of a psychotropic drug when its destruction and/or elimination are compromised) or (ii) a pharmacodynamical mechanism (e.g., mutual potentiation of proarrhythmic properties of two drugs). In addition, some psychotropic drugs may induce sudden death in cases of pre-existing congenital cardiopathies such as (i) congenital long QT syndrome, predisposing to torsade de pointes that eventually cause syncope and sudden death. (ii) A Brugada syndrome, that may directly cause ventricular fibrillation due to reduced sodium current through Nav1.5 channels. Moreover, psychotropic drugs may be a direct cause of cardiac lesions also leading to SCD. This is the case, for example, of phenothiazines responsible for ischemic coronaropathies and of clozapine that is involved in the occurrence of myocarditis. The aims of this work are to delineate: (i) the risk of SCD related to the use of psychotropic drugs; (ii) mechanisms involved in the occurrence of such SCD; (iii) preventive actions of psychotropic drugs side effects, on the basis of the knowledge of patient-specific risk factors, documented from clinical history, ionic balance, and ECG investigation by the psychiatrist. PMID:22590457

  11. Risk factor profile for sudden cardiac death during mountain hiking.

    PubMed

    Burtscher, M; Pachinger, O; Schocke, M F H; Ulmer, H

    2007-07-01

    Mountain hiking is associated with a death rate of about 4 deaths per 100,000 hikers annually. About 50 % of all fatalities during mountain hiking are sudden cardiac deaths (SCDs). But there are only few data available regarding risk factors and triggers associated with SCD during mountain hiking. Thus, a case-control analysis between persons who died suddenly during mountain hiking and randomly selected controls was carried out. Risk factor profiles of 179 males over the age of 34 who suffered SCD during mountain hiking were compared to those of 537 matched controls. Hikers who died suddenly during mountain hiking were much more likely to have had a prior MI (17% vs. 0.9%; p < 0.001), known coronary artery disease (CAD) without prior MI (17 % vs. 4%; p < 0.001), diabetes (6% vs. 1 %; p < 0.001), hypercholesterolemia (54 % vs. 20%; p < 0.001), and were less engaged in regular mountain sports activities (31% vs. 58%; p < 0.001) compared to hikers from the control group. Based on the reported relationship between traditional risk factors and coronary plaque morphology, acute plaque rupture with thrombus formation and subsequent lethal arrhythmias may be assumed to be a dominant mechanism precipitating SCD during hiking. In contrast, in skiers especially non-occlusive plaques may precipitate ischemia leading to an imbalance between oxygen demand and supply and subsequent lethal arrhythmias. As preventive measures recommended to hikers at risk, adaptation to regular mountain sports activities by an adequate training program and pharmacological interventions, e.g. lipid lowering drugs, aspirin, and beta-blockers, should be considered.

  12. [Sudden cardiac death during exercise in the elder persons].

    PubMed

    Kawamura, Tsuyoshi

    2005-07-01

    Sudden cardiac death during exercise is consequent on the myocardial infarction which is caused by acute coronary occlusion, triggered by the rupture of unstable plaque due to temporary exercise hypertension in the hyper-coagulable conditions induced by dehydration and increased sympathetic activity. Fortunately, most cases were witnessed by audience and could be saved the life with AED. The elder persons should have medical checks in which the coronary risk factors are evaluated before aerobic exercise. Mild exercise such as spinal stretch walking is recommended to the elder persons with multiple coronary risk factors.

  13. Mechanisms of Sudden Cardiac Death: Oxidants and Metabolism

    PubMed Central

    Yang, Kai-Chien; Kyle, John W.; Makielski, Jonathan C.; Dudley, Samuel C.

    2015-01-01

    Ventricular arrhythmia is the leading cause of sudden cardiac death (SCD). Deranged cardiac metabolism and abnormal redox state during cardiac diseases foment arrhythmogenic substrates through direct or indirect modulation of cardiac ion channel/transporter function. This review presents current evidence on the mechanisms linking metabolic derangement and excessive oxidative stress to ion channel/transporter dysfunction that predisposes to ventricular arrhythmias and SCD. As conventional anti-arrhythmic agents aiming at ion channels have proven challenging to use, targeting arrhythmogenic metabolic changes and redox imbalance may provide novel therapeutics to treat or prevent life-threatening arrhythmias and SCD. PMID:26044249

  14. Ebstein's Anomaly, Left Ventricular Noncompaction, and Sudden Cardiac Death

    PubMed Central

    McGee, Michael; Warner, Luke; Collins, Nicholas

    2015-01-01

    Ebstein's anomaly is a congenital disorder characterized by apical displacement of the septal leaflet of the tricuspid valve. Ebstein's anomaly may be seen in association with other cardiac conditions, including patent foramen ovale, atrial septal defect, and left ventricular noncompaction (LVNC). LVNC is characterized by increased trabeculation within the left ventricular apex. Echocardiography is often used to diagnose LVNC; however, magnetic resonance (MR) imaging offers superior characterization of the myocardium. We report a case of sudden cardiac death in a patient with Ebstein's anomaly with unrecognized LVNC noted on post mortem examination with screening documenting the presence of LVNC in one of the patient's twin sons. PMID:26240764

  15. Nonlinear dynamics, fractals, cardiac physiology and sudden death

    NASA Technical Reports Server (NTRS)

    Goldberger, Ary L.

    1987-01-01

    The authors propose a diametrically opposite viewpoint to the generally accepted tendency of equating healthy function with order and disease with chaos. With regard to the question of sudden cardiac death and chaos, it is suggested that certain features of dynamical chaos related to fractal structure and fractal dynamics may be important organizing principles in normal physiology and that certain pathologies, including ventricular fibrillation, represent a class of 'pathological periodicities'. Some laboratory work bearing on the relation of nonlinear analysis to physiological and pathophysiological data is briefly reviewed, with tentative theories and models described in reference to the mechanism of ventricular fibrillation.

  16. Sudden Cardiovascular Death Associated with Supplement Use in the Young

    DTIC Science & Technology

    2008-01-01

    926 cases of possible Ma Huang toxicity  37 patients with stroke, myocardial infarction, or sudden cardiac death  In Denmark,  ephedrine /caffiene...70 1%).  Diet Fuel, Ripped Fuel, VigorPlex, Xtreme Lean, etc.  Clinical or toxicologic  ephedrine  or  phenylpropanolamine – 28 (58.3%)  Negative

  17. Exercise-Related Sudden Death: Risks and Causes (Part 1 of 2).

    ERIC Educational Resources Information Center

    Van Camp, Steven P.

    1988-01-01

    The causes of exercise-related sudden death are discussed. Multiple structural cardiovascular diseases are the primary cause of death in athletes under 30; severe coronary artery disease is the culprit in deaths of those over 30. These diseases and the mechanisms of sudden death, as well as preventive measures, are detailed. (JL)

  18. Sudden infant death syndrome in Japan 1995-1998.

    PubMed

    Fujita, T

    2002-09-14

    This study examined the effects of birth characteristics, which reported on birth certificates, on sudden infant death syndrome (SIDS) based on vital statistics between 1995 and 1998 in Japan. One thousand eight hundred and fifty-nine cases of SIDS and 4,787,537 live births were analyzed. The mortality rate from SIDS was 0.388 SIDS deaths per 1000 live births. Based on multivariate analysis using Poisson regression model, risk factors associated with significantly increased SIDS rates included low birth weight, being a male infant, young maternal age, late birth in multiparity, maternal stillbirth experience, residential region of Kyusyu, Tokai or Hokuriku, and employment status as "unemployed or unknown". However, there was no significant difference between single and multiple birth groups after adjusting other characteristics. A decreasing postnatal age of death was observed as birth weight increased. However, there was no difference in postconceptional age of death between birth weight groups. Preterm infants died of SIDS at a later postnatal age than term infants, but there appeared to be little difference in postconceptional age of death amongst preterm infants. This association between birth characteristics and SIDS were consistent with other studies from western countries, suggesting that recommendations for SIDS in western countries are also applicable for Japan.

  19. A possible explanation of sudden infant death syndrome (SIDS).

    PubMed

    Christos, G A; Christos, J A

    1993-09-01

    Research into (lucid) dreaming has shown that the images of a dream are supported by the corresponding body actions, utilizing those muscles which remain active during dreaming. We suggest that Sudden Infant Death Syndrome (SIDS) or Cot Death may be a result of an infant dreaming about its life as a fetus. In the course of that dream, since a fetus does not breathe in the usual sense, the infant may cease to breathe and die. Our hypothesis is consistent with the known facts about SIDS, including social factors such as sleeping position and climatic variation. We suggest that the risk of SIDS can be reduced by making the environment of the infant, as much as possible, unlike that of the womb.

  20. Air pollution and sudden infant death syndrome: a literature review.

    PubMed

    Tong, Shilu; Colditz, Paul

    2004-09-01

    Although the rate of sudden infant death syndrome (SIDS) has been reduced with the 'Back to Sleep' campaign, SIDS is still a common cause of death in infancy. A range of environmental factors may interact to contribute to the adverse health conditions conducive to SIDS. Nine studies have evaluated the association between exposure to air pollution and the incidence of SIDS. The available evidence is inadequate to come to any conclusion about a relationship between air pollution and SIDS, although the body of evidence appears to suggest that air pollution (especially particles and some gaseous pollutants) may play a certain role in the occurrence of SIDS. We suggest that future studies should focus on the research design, role of indoor air quality and the effect of smaller particles, particularly those in the ultrafine range.

  1. Sudden infant death syndrome and early family interpersonal relationships.

    PubMed

    Lindsay, J S

    1999-04-01

    The medical profession are concerned with diseases or disorders, their diagnoses, and the appropriate treatment of their patients. The relevant processes involve interpersonal relationships in physical examinations, associated with the conventional social ritual courtesies. There are only two certainties--birth and death--with areas of probabilities and uncertainties in between. One such uncertainty is the sudden death of an infant in its first year. After the obstetrical birth processes, the specific health of the neonate involves the paediatrician. His skill and modern technical resources have enabled numbers of the prematurely born to survive. Has the modern neonate evolved over the centuries to have some needs that must be worked out between mother and her baby? To attribute hands-on experiences to genes takes away four holding hands from what they feel, the eyeball movements and what they see, the noses and what they smell, and the breast milk for the energy to move the muscles no longer in floating weightlessness.

  2. Seasonal relationship of sudden infant death syndrome and environmental pollutants

    SciTech Connect

    Hoppenbrouwers, T.; Calub, M.; Arakawa, K.; Hodgman, J.E.

    1981-06-01

    Evidence that chronic hypoxia precedes death from sudden infant death syndrome (SIDS) is mounting. Prolonged exposure to moderate levels of pollutants could be a contributing factor to hypoxia. Levels of carbon monoxide (CO), sulfur dioxide (SO/sub 2/), nitrogen dioxide (NO/sub 2/) and hydrocarbons (HC) are highest in the winter when incidence of SIDS is increased. SIDS cases in Los Angeles County were correlated with daily mean levels of these pollutants, temperature, barometric pressure and monthly lead levels with the aid of time series analyses. Peaks in CO, SO/sub 2/, NO/sub 2/, HC and lead preceded the seasonal increase in SIDS by seven weeks. Theoretical considerations, such as the hypoxia-inducing effects of CO, support the hypothesis that this temporal relation has functional significance. The role of pollution levels as a predisposing factor in risk for SIDS cannot be summarily dismissed.

  3. Sudden death of the young with cardiovascular diseases.

    PubMed

    Nakazawa, M; Takao, A; Niwa, K; Momma, K; Ando, M

    1983-05-01

    Sudden death due to cardiovascular diseases was studied in 142 children who died suddenly during the period from 1969 to 1981. The age-distribution analysis showed that death occurred most frequently in infancy and it decreased with age. The subjects were divided into 7 groups, of which the hypoxemic group, consisting of 45 cases (32%), was the largest, followed by the congestive heart failure (CHF) group (33 cases, 23%), the primary endomyocardial disease (PMD)-coronary heart disease (CorHD) group (21 cases, 15%), the postoperative group (18 cases, 13%), the pulmonary vascular obstruction group (17 cases, 12%), the arrhythmia group of 3 cases and the miscellaneous group of the remaining cases. In the hypoxemic, CHF and arrhythmia groups, the majority of the cases were infants, while in the other groups the cases were distributed among all age groups. The relative incidence of each group showed that non-surgical and inoperable cases and postoperative cases increased with age and this increase has occurred in the last few years. This change has been brought about by the recent advances in medical and surgical treatments for infants with congenital heart diseases. It is hoped that in the future the number of cases which are too late for treatment will decrease further.

  4. Sudden death due to metronidazole/ethanol interaction.

    PubMed

    Cina, S J; Russell, R A; Conradi, S E

    1996-12-01

    Metronidazole (Flagyl), a commonly prescribed antimicrobial agent, can produce a reaction similar to that of disulfiram (Antabuse) when administered to patients drinking ethanol. This drug/chemical interaction results in accumulation of acetaldehyde in the blood. Acetaldehyde is hepatotoxic, cardiotoxic, and arrythmogenic; no lethal serum acetaldehyde level has been established. Sudden death has been reported in patients taking disulfiram while using ethanol; no fatalities have been reported due to ethanol/ metronidazole interactions. Described is a case of a 31-year-old woman who died moments after an assault by a male companion, during which he inflicted minor physical trauma to her upper arm. Toxicologic analysis yielded elevated concentrations of serum ethanol (162 mg/d), acetaldehyde (4.6 mg/d), and metronidazole (0.42 mg/L). The cause of death was reported to be cardiac dysrhythmia due to acetaldehyde toxicity due to an ethanol/ metronidazole interaction. Autonomic stress associated with the assault is likely to have contributed to this woman's death. The mechanism of death is examined.

  5. Liberalized abortion in Oregon: effects on fertility, prematurity, fetal death, and infant death.

    PubMed

    Quick, J D

    1978-10-01

    An analysis of Oregon Vital Statistics data from 1965 to 1975 was conducted to assess the impact of Oregon's 1969 abortion legislation, which substantially increased the number of reported medically induced abortions. This increase was associated with a slight increase in the age-adjusted 1970 fertility rate and there was no decrease in births to women in the age groups obtaining proportionately the most abortions. A significant and persistent 11 per cent reduction in premature births to women over age 20 (p less than .001) and a 22 per cent reduction in spontaneous fetal deaths (p less than .05) were associated with liberalized abortion. Decreases in neonatal and postneonatal infant mortality were observed, but were indistinguishable from an ongoing trend toward improved infant health. A gradual 25 per cent decline in the age-adjusted fertility rate occurred between 1969 and 1975, but the increase in the number of reported abortions could account for only one-fourth of this decrease. A seven-fold increase in the use of family planning clinics between 1970 and 1973 and more liberalized laws regarding provision of family planning service appeared to account for a much higher proportion of the decreased fertility than did liberalized abortion.

  6. Mechanically induced sudden death in chest wall impact (commotio cordis).

    PubMed

    Link, Mark S

    2003-01-01

    Sudden death due to nonpenetrating chest wall impact in the absence of injury to the ribs, sternum and heart is known as commotio cordis. Although once thought rare, an increasing number of these events have been reported. Indeed, a significant percentage of deaths on the athletic field are due to chest wall impact. Commotio cordis is most frequently observed in young individuals (age 4-18 years), but may also occur in adults. Sudden death is instantaneous or preceded by several seconds of lightheadedness after the chest wall blow. Victims are most often found in ventricular fibrillation, and successful resuscitation is more difficult than expected given the young age, excellent health of the victims, and the absence of structural heart disease. Autopsy examination is notable for the lack of any significant cardiac or thoracic abnormalities. In an experimental model of commotio cordis utilizing anesthetized juvenile swine, ventricular fibrillation can be produced by a 30 mph baseball strike if the strike occurred during the vulnerable period of repolarization, on the upslope of the T-wave. Energy of the impact object was also found to be a critical variable with 40 mph baseballs more likely to cause ventricular fibrillation than velocities less or greater than 40 mph. In addition, more rigid impact objects and blows directly over the center of the chest were more likely to cause ventricular fibrillation. Peak left ventricular pressure generated by the chest wall blow correlated with the risk of ventricular fibrillation. Activation of the K(+)(ATP) channel is a likely cause of the ventricular fibrillation produced by chest wall blows. Successful resuscitation is attainable with early defibrillation.

  7. Asplenia as a cause of sudden unexpected death in childhood.

    PubMed

    Kanthan, R; Moyana, T; Nyssen, J

    1999-03-01

    Sudden unexpected death in childhood is rare. The commonest causes of such deaths are a result of fulminating infections of the respiratory or nervous systems. Other causes include unsuspected congenital abnormalities of the heart, acute metabolic disorders, and rarities such as internal hemorrhages and pulmonary thrombosis. Recognition of children with congenital asplenia who are otherwise normal but have an increased susceptibility to overwhelming sepsis is extremely difficult. We reviewed 1763 autopsy files from our institution over 5 years (1990-1995), of which 293 were classified as pediatric cases. The vast majority of the cases were stillbirths and deaths within the first year of life as a result of complex congenital anomalies. Four cases of asplenia were identified in our entire series, 3 of which were of the congenital syndromal variety and 1 of which was a case of isolated sporadic congenital asplenia. All 4 cases of asplenia were analyzed in detail with respect to autopsy findings and cause of death. Severe complex cardiac malformations were present in the congenital syndromal asplenia patients; these other malformations contributed significantly to their death. In this report, we discuss in detail the autopsy findings in a previously healthy 4-year-old girl who presented with a brief 8-hour history of being unwell and died within 4 hours of admission into the hospital. She had sporadic, isolated congenital asplenia complicated by high-grade type 6B pneumococcemia and acute bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). Previously healthy children who clinically deteriorate very rapidly should have a blood smear done as part of their clinical workup. The detection of Howell-Jolly bodies on a peripheral blood smear can be an indicator of asplenia, and this diagnosis can be confirmed by medical imaging of the abdomen. Such steps may aid in the aggressive management of isolated congenital asplenia and thereby avert untimely death.

  8. Sudden cardiac death: a nationwide cohort study among the young.

    PubMed

    Risgaard, Bjarke

    2016-12-01

    Sudden cardiac death (SCD) is a tragic event affecting millions of individuals worldwide. Although several studies have investigated the epidemiology of SCD, these studies may have been affected by reporting and referral biases, which are reflected in the very different incidence rates and causes of deaths that have previously been reported. Among SCD victims aged < 36 years, inherited cardiac diseases are well known to play an important role. However, the extent to which inherited cardiac diseases also play a role in SCD victims aged < 50 years has not been completely described. Additionally, SCD in children is of particular interest. These deaths are often described as a part of the deaths of young adolescents up to 40 years of age, and the focus has recently shifted towards the prevention of these deaths. The SCD incidence rate among patients with psychiatric disease has also gained significant attention. Finally, the incidence rate of sports-related sudden cardiac death (SrSCD) has been thoroughly investigated in young competitive athletes. However, whether competitive athletes are at increased risk for SrSCD compared with non-competitive athletes remains unknown. These data should be available prior to discussing optimal screening strategies for (competitive) athletes. In this thesis, we investigated the SCD burden in Danes aged 1-49 years between 2007 and 2009. By using the unique Danish death certificates, autopsy reports, discharge summaries, and registries, we included all deaths in a nationwide setting. We described the incidence rates and causes of death, and we performed a sub-group analysis of SCD in children (1-18 years, 2000-2006). Furthermore, we described the SCD burden in competitive and non-competitive athletes and investigated how often SCD occurred in patients with previous psychiatric disease. SCD has an incidence rate of 8.6 (95% confidence interval (CI) 8.0-9.2) per 100,000 person-years in persons aged 1-49 years. We found a steep increase

  9. Unsuspected cardiac lesions associated with sudden unexpected perioperative death.

    PubMed

    Tabib, A; Loire, R; Miras, A; Thivolet-Bejui, F; Timour, Q; Bui-Xuan, B; Malicier, D

    2000-04-01

    The retrospective analysis of 1700 forensic autopsies over 17 years (1981-97) following unexpected sudden cardiac death revealed a group of 50 cases that could have been related to surgery and/or anaesthesia. Patients were young with no history of cardiac disease. Surgery was performed for uncomplicated disorders, all classified as ASA 1. Cardiac arrest took place at induction of anaesthesia in 16% of cases, during surgery in 64% and at the end of surgery in 20%. Investigation and expertise reports ordered by the public prosecutor revealed none of the typical causes of death usually associated with surgery or anaesthesia. Pathological examination showed cardiac lesions in 47 cases: arrhythmogenic right ventricular cardiomyopathy in 18 cases, coronary artery disease in 10 cases, cardiomyopathy in eight cases, structural abnormalities of the His bundle in nine cases, mitral valve prolapse in one case, and acute myocarditis in one case. Identification of the cause of death of patients at low risk may provide major relief to the family of the patient and the medical staff.

  10. Sudden cardiac death owing to pseudoxanthoma elasticum: a case report.

    PubMed

    Nolte, K B

    2000-08-01

    A 26-year-old woman collapsed and died suddenly while dancing. Autopsy findings included the cutaneous lesions of pseudoxanthoma elasticum (PXE), a rare genetic disease with autosomal dominant and recessive inheritance patterns. Pathologic findings of PXE (degenerated elastic fibers) were seen in the stenotic epicardial coronary arteries, the intramyocardial arterioles, the subendocardium, the mitral valve, and the blood vessels of other viscera. The mitral valve was slightly myxoid. Intramyocardial arteriolar involvement has not been previously described in PXE. The other cardiac findings have only been described in a few cases. Although mitral valve prolapse in PXE has been shown echocardiographically, it is unclear whether or not the mitral valve findings in this case represent the substrate for this condition. It is important that autopsy pathologists search carefully for the pathognomonic skin lesions of PXE in cases of sudden death associated with coronary disease, mitral valve prolapse, or endocardial lesions. Recognition of this disease is essential for proper genetic counseling of surviving family members.

  11. Heavy caffeine intake in pregnancy and sudden infant death syndrome

    PubMed Central

    Ford, R; Schluter, P; Mitchell, E; Taylor, B; Scragg, R; Stewart, A; the, N; OSMOND, C.

    1998-01-01

    AIMS—To examine the association between maternal caffeine consumption during pregnancy and the risk of sudden infant death syndrome (SIDS).
METHODS—A nationwide case-control study surveying parents of 393 SIDS victims and parents of 1592 control infants. Caffeine consumption in each of the first and third trimesters was estimated by questionnaire. Heavy caffeine intake was defined as 400 mg/day or more (equivalent to four or more cups of coffee per day).
RESULTS—Infants whose mothers had heavy caffeine consumption throughout their pregnancy had a significantly increased risk for SIDS (odds ratio 1.65; 95% confidence interval 1.15 to 2.35) after adjusting for likely confounding factors.
CONCLUSION—Caffeine intake has been associated with fetal harm and now SIDS. Reducing heavy caffeine intake during pregnancy could be another way to lessen the risk of SIDS. This needs confirmation by others.

 PMID:9534669

  12. Psychophysiological factors in ventricular arrhythmias and sudden cardiac death.

    PubMed

    Hatton, D C; Gilden, E R; Edwards, M E; Cutler, J; Kron, J; McAnulty, J H

    1989-01-01

    Plasma catecholamine levels were measured preceding programmed electrophysiological studies of patients who had survived a ventricular tachyarrhythmia episode. Psychological assessments of desire for control, locus of control and behavior pattern were obtained. Psychophysiological variables were analysed with respect to the severity of arrhythmias induced by the electrophysiological procedure. Analysis of data from 17 subjects showed desire for control was significantly higher in those with induced sustained arrhythmias than in those in which nonsustained arrhythmias were induced. No relationship was found between behavior pattern and arrhythmia severity or plasma catecholamine levels. There was a significant interaction between desire for control and behavior pattern with respect to epinephrine level. The findings indicate that psychological factors such as desire for control may be associated with potentially lethal arrhythmias and implicated in sudden cardiac death.

  13. Sudden infant death syndrome prevention: a model program for NICUs.

    PubMed

    McMullen, Sherri L; Lipke, Bethann; LeMura, Catherine

    2009-01-01

    Health care providers' opinions can influence how parents place their infant to sleep. Neonatal nurses can improve how they teach and model safe infant sleep practices to parents. To increase neonatal nurses' knowledge, a sudden infant death syndrome (SIDS) prevention program was implemented. Program components included a computerized teaching tool, a crib card, sleep sacks, and discharge instructions. Initial program evaluation showed that 98 percent of infants slept supine and 93 percent slept in sleep sacks in open cribs. However, nurses continued to swaddle some infants with blankets to improve thermoregulation. To increase nursing compliance in modeling safe infant sleep practices, Halo SleepSack Swaddles were provided for nurses to use in place of a blanket to regulate infant temperature. Recent data show that 100 percent of infants in open cribs are now sleeping supine wearing a Halo Swaddle or a traditional Halo SleepSack. This model program can easily be replicated to enhance neonatal nurses' knowledge about SIDS prevention.

  14. Pathogenesis of sudden death following water immersion (immersion syndrome)

    NASA Technical Reports Server (NTRS)

    Buhring, M.; Spies, H. F.

    1981-01-01

    Sympathetic activity under cold stress is investigated. Predominantly vagal cardio-depressive reflexes are discussed besides currently known mechanisms of sudden death after water immersion. Pronounced circulatory centralization in diving animals as well as following exposure in cold water indicates additional sympathetic activity. In cold water baths of 15 C, measurements indicate an increase in plasma catecholamine levels by more than 300 percent. This may lead to cardiac arrhythmias by the following mechanisms: cold water essentially induces sinus bradycardia; brady-and tachycardiarrhythmias may supervene as secondary complications; sinusbradycardia may be enhanced by sympathetic hypertonus. Furthermore, ectopic dysrhythmias are liable to be induced by the strictly sympathetic innervation of the ventricle. Myocardial ischemia following a rise in peripheral blood pressure constitutes another arrhythmogenic factor. Some of these reactions are enhanced by alcohol intoxication.

  15. Sudden cardiac death in low- and middle-income countries.

    PubMed

    Vedanthan, Rajesh; Fuster, Valentin; Fischer, Avi

    2012-12-01

    Cardiovascular disease, and the incidence of sudden cardiac death (SCD), will increase significantly in low- and middle-income countries (LMIC). Thus, SCD threatens to become a global public health problem. We present a summary of the current research that has investigated the epidemiology of SCD in LMIC. Few studies of SCD in LMIC exist, and they are of variable methodological quality. Risk factors for SCD are described, taking into account recent global burden of disease and risk factor statistics. We describe 1 proposal for a community-based, prospective, multiple-source methodology for SCD monitoring and surveillance that can be implemented in LMIC. Further research into the epidemiology of SCD in LMIC, using standardized methodology, would allow investigators and policy makers to determine the regions, communities, and individuals most at need for SCD prevention. Focusing on SCD and its prevention in LMIC should be a priority for the global health community.

  16. Endogenous alcohol production by intestinal fermentation in sudden infant death.

    PubMed

    Geertinger, P; Bodenhoff, J; Helweg-Larsen, K; Lund, A

    1982-01-01

    In some cases of sudden infant death syndrome (SIDS) the intestinal flora was found to be dominated by Candida albicans. Microbiologic investigations of the various organs showed the occasional presence of different Candida species, but not in the form of massive growth as in sepsis. There is no basis to assume that the activity of yeasts, first of all of Candida albicans, is a contributory factor in the occurrence of SIDS. Candida albicans was shown to produce alcohol from glucose at a rate of maximally 1 mg of alcohol per gram of intestinal content per hour. It is concluded that the intestinal production of alcohol in vivo from cases showing a Candida albicans dominated intestinal flora will not be able to surpass the normal alcohol metabolizing capacity of the liver. Thus, measurable concentrations of alcohol in the blood from such cases cannot be expected.

  17. Cardiac potassium channel dysfunction in sudden infant death syndrome.

    PubMed

    Rhodes, Troy E; Abraham, Robert L; Welch, Richard C; Vanoye, Carlos G; Crotti, Lia; Arnestad, Marianne; Insolia, Roberto; Pedrazzini, Matteo; Ferrandi, Chiara; Vege, Ashild; Rognum, Torleiv; Roden, Dan M; Schwartz, Peter J; George, Alfred L

    2008-03-01

    Life-threatening arrhythmias have been suspected as one cause of the sudden infant death syndrome (SIDS), and this hypothesis is supported by the observation that mutations in arrhythmia susceptibility genes occur in 5-10% of cases. However, the functional consequences of cardiac potassium channel gene mutations associated with SIDS and how these alleles might mechanistically predispose to sudden death are unknown. To address these questions, we studied four missense KCNH2 (encoding HERG) variants, one compound KCNH2 genotype, and a missense KCNQ1 mutation all previously identified in Norwegian SIDS cases. Three of the six variants exhibited functional impairments while three were biophysically similar to wild-type channels (KCNH2 variants V279M, R885C, and S1040G). When co-expressed with WT-HERG, R273Q and K897T/R954C generated currents resembling the rapid component of the cardiac delayed rectifier current (I(Kr)) but with significantly diminished amplitude. Action potential modeling demonstrated that this level of functional impairment was sufficient to evoke increased action potential duration and pause-dependent early afterdepolarizations. By contrast, KCNQ1-I274V causes a gain-of-function in I(Ks) characterized by increased current density, faster activation, and slower deactivation leading to accumulation of instantaneous current upon repeated stimulation. Action potential simulations using a Markov model of heterozygous I274V-I(Ks) incorporated into the Luo-Rudy (LRd) ventricular cell model demonstrated marked rate-dependent shortening of action potential duration predicting a short QT phenotype. Our results indicate that certain potassium channel mutations associated with SIDS confer overt functional defects consistent with either LQTS or SQTS, and further emphasize the role of congenital arrhythmia susceptibility in this syndrome.

  18. Registry of Malignant Arrhythmias and Sudden Cardiac Death - Influence of Diagnostics and Interventions

    ClinicalTrials.gov

    2016-11-30

    Ventricular Tachycardia; Ventricular Fibrillation; Sudden Cardiac Death; Coronary Angiography; Electrophysiologic Testing (EP); Catheter Ablation; Percutaneous Coronary Intervention (PCI); Internal Cardioverter Defibrillator (ICD)

  19. Melatonin concentrations in the sudden infant death syndrome

    NASA Technical Reports Server (NTRS)

    Sturner, W. Q.; Lynch, H. J.; Deng, M. H.; Gleason, R. E.; Wurtman, R. J.

    1990-01-01

    To examine a possible relationship between pineal function and the sudden infant death syndrome (SIDS), samples of whole blood, ventricular cerebrospinal fluid (CSF) and/or vitreous humor (VH) were obtained at autopsy from 68 infants (45 male, 23 female) whose deaths were attributed to either SIDS (n = 32, 0.5-5.0 months of age; mean plus or minus S.E.M., 2.6 plus or minus 0.2 months) or other causes (non-SIDS, n = 36, 0.3-8.0 months of age 4.3 plus or minus 0.3 months). The melatonin concentrations were measured by radioimmunoassay. A significant correlation was observed for melatonin levels in different body fluids from the same individual. After adjusting for age differences, CSF melatonin levels were significantly lower among the SIDS infants (91 plus or minus 29 pmol/l; n = 32) than among those dying from other causes (180 plus or minus 27; n = 35, P less than 0.05). A similar, but non-significant trend was also noted in blood (97 plus or minus 23, n = 30 vs. 144 plus or minus 22 pmol/l, n = 33) and vitreous humor (68 plus or minus 21, n = 10 vs. 81 plus or minus 17 pmol/l, n = 15). These differences do not appear to be explainable in terms of the interval between death and autopsy, gender, premortem infection, or therapeutic measures instituted prior to death. Diminished melatonin production may be characteristic of SIDS and could represent an impairment in the maturation of physiologic circadian organization.

  20. The epidemiology of non-traumatic prehospital sudden death in Split-Dalmatia County.

    PubMed

    Aljinović, Jure; Novak, Katarina; Mirić, Lina; Grandić, Leo; Kunac, Nenad; Pisac, Valdi Pesutić

    2013-12-01

    The aim of this study was to determine epidemiology of non-traumatic prehospital sudden adult deaths in Split-Dalmatia County from 2000 to 2005. The following information were collected from autopsy reports in the archives of University Hospital Split: gender of deceased, birth date, date of death, location of death, immediate cause of death, previously diagnosed diseases that might lead to terminal outcome. There were 160 non-traumatic prehospital sudden adult deaths in the observed period, with 104 (65%) male and 56 (35%) female autopsies performed. Diseases of cardiovascular system were the main cause of death, responsible for 95 (59.37%) sudden deaths, followed by diseases of respiratory system (14.37%) and central nervous system (8.12%). The most frequent cause of non-traumatic sudden death was myocardial infarction, found in 50 cases. July and September were the months of the most frequent occurrence of sudden death. In this study it was confirmed that sudden death incidence increases with age, with almost half of all deaths occurring in people between ages of 61-80. The result that a fifth of all sudden deaths occurred in people aged 51-60 is troubling and potentially preventable. The most frequent location of death was deceased's place of residence (N = 29), followed by the ambulance vehicle (N = 17). In conclusion, this is the first publication describing the incidence of prehospital sudden non-traumatic adult death in Split-Dalmatia County. Causes of sudden death and its incidence are in accordance with World Health Organization's information on general causes of death in Croatia and Western Europe.

  1. Sudden death in a patient with idiopathic scoliosis.

    PubMed

    Satoh, Fumiko; Fujita, Masaki Q; Seto, Yoshihisa; Tsuboi, Akio; Takeichi, Sanae

    2006-01-01

    We report an autopsy case of sudden death in a 36-year-old craftsman with idiopathic scoliosis. The doctor identified his scoliosis at the age of thirteen, and he was under medical care for three years until he stopped consulting the doctor. He collapsed while walking at the station and was sent to an emergency room in cardiopulmonary arrest state, where he was declared dead in spite of more than an hour of CPR. Numbers of petechiae were seen on the bilateral palpebral conjunctivae and the lips were cyanotic. There were no particular injuries except for small abrasions observed on the face. The back showed right rib hump owing to midthoracic scoliosis (with 73 degrees of Cobb's angle) and right hemithorax was deformed showing an appearance of pectus excavatum in the front. The volume of the right thoracic cavity was significantly decreased. In the right lung, there was extensive stromal fibrosis, leaving almost no normal alveolar structures, and medial hypertrophy of pulmonary arteriolar walls. Hypertrophy of the right heart ventricle due to these pulmonary changes and the congestion of other organs suggested that the cause of death in this case was cor pulmonale due to pulmonary hypertension. This was a rare case of fatal outcome of advanced idiopathic scoliosis without medical care in spite of early detection through mass screening.

  2. Tissue and Animal Models of Sudden Cardiac Death

    PubMed Central

    Sallam, Karim; Li, Yingxin; Sager, Philip T.; Houser, Steven R.; Wu, Joseph C.

    2015-01-01

    Sudden Cardiac Death (SCD) is a common cause of death in patients with structural heart disease, genetic mutations or acquired disorders affecting cardiac ion channels. A wide range of platforms exist to model and study disorders associated with SCD. Human clinical studies are cumbersome and are thwarted by the extent of investigation that can be performed on human subjects. Animal models are limited by their degree of homology to human cardiac electrophysiology including ion channel expression. Most commonly used cellular models are cellular transfection models, which are able to mimic the expression of a single ion channel offering incomplete insight into changes of the action potential profile. Induced pluripotent stem cell derived Cardiomyocytes (iPSC-CMs) resemble, but are not identical, to adult human cardiomyocytes, and provide a new platform for studying arrhythmic disorders leading to SCD. A variety of platforms exist to phenotype cellular models including conventional and automated patch clamp, multi-electrode array, and computational modeling. iPSC-CMs have been used to study Long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy and other hereditary cardiac disorders. Although iPSC-CMs are distinct from adult cardiomyocytes, they provide a robust platform to advance the science and clinical care of SCD. PMID:26044252

  3. Sudden infant death syndrome: review for the obstetric care provider.

    PubMed

    Van Nguyen, Julie My; Abenhaim, Haim A

    2013-10-01

    Sudden infant death syndrome (SIDS) is the leading cause of death among infants aged 1 to 12 months. In this article, we review risk factors that may predispose infants to increased vulnerability. Maternal characteristics, including nonmodifiable and modifiable factors, antenatal medical conditions, labor and delivery events, and infant characteristics, are reviewed, with the purpose of helping obstetric care providers target risk reduction efforts. We have reviewed over 85 case-control, retrospective, and prospective cohort studies published between 1975 and 2011. Major modifiable risk factors include maternal and paternal smoking, drug use, alcohol use, and insufficient prenatal care. Infants at increased risk include males, premature infants, infants of low birth weight or growth-restricted infants, and infants in multiple gestations. By targeting modifiable and nonmodifiable risk factors, it may be possible to decrease the incidence of SIDS. Efforts should be put on decreasing high-risk behaviors and encouraging sufficient antenatal follow-up. In view of recent increases in ethnic and social disparity with SIDS, it is essential that risk reduction guidelines, which have recently been expanded by the American Association of Pediatrics, be explained in a culturally sensitive manner.

  4. Exploring the Discussion of Risk of Sudden Cardiac Death.

    PubMed

    Wiley, Kristin Anne; Demo, Erin M; Walker, Peggy; Shuler, C Osborne

    2016-02-01

    Sudden arrhythmic death syndrome (SADS), where death is secondary to cardiac arrhythmia, is associated with several cardiac ion channelopathies, including long QT syndrome and Brugada syndrome, as well as cardiomyopathies such as hypertrophic cardiomyopathy and dilated cardiomyopathy. Many of these conditions often present in childhood or adolescence. This study investigates how diagnoses of cardiac diseases associated with SADS are communicated within families. A questionnaire was distributed through cardiac disease-focused support groups and organizations. Data from 114 parents who have a child with a SADS condition were used for analysis. Based on the responses, parents explained the risk of SADS in a straightforward manner and related the risk to the importance of compliance with the prescribed treatment. Participants also found it difficult to determine and enforce lifestyle modifications, manage individuals' emotional reactions, convey the seriousness of the information without scaring their children, and discuss the risk of SADS during these conversations. Concerns regarding disease progression, length and quality of life, and treatment failures were also expressed. Healthcare providers, the Internet, other affected people, visual aids, and personal experience were all reported to be helpful for facilitating these discussions. Services and resources requested by participants included children's support groups, a counselor or psychologist, and child-oriented materials. Increased understanding of how families discuss children's diagnosis of SADS conditions will equip healthcare providers with the information to address parental concerns and help facilitate meaningful and informative discussions within families.

  5. [Sudden death of a young man as late sequelae complicating a pediatric disease: About a case].

    PubMed

    Pierry, Clémence; Franchet, Camille; Tuchtan-Torrents, Lucile; Macon, Céline; Torrents, Julia; Capuani, Caroline; Piercecchi-Marti, Marie-Dominique

    2017-04-01

    In France, sudden death is responsible every year for 40,000 deaths. The most frequent etiology is cardiac disease. Atheromatous-related pathology is the most common etiology beyond 35, but cardiomyopathies and channelopathies are responsible for a significant number of deaths in young adults. Some acquired disorders can also cause sudden cardiac death. We report the case of a 17-year-old man who died suddenly after sport. Autopsy and pathological study found multiple giant coronary aneurysms. Thrombosis and fibrous scar of myocardial ischemic events were observed. These lesions were in favor of late sequelae of Kawasaki disease. Kawasaki disease is a rare but not exceptional cause of sudden cardiac death in young adults. In the lack of known clinical history, some aspects, even not specific, should evoke this diagnosis. Even in front of apparent good clinical tolerance, these sequelae require appropriate follow-up because of a significant risk of sudden death.

  6. [Awareness of death and interpersonal relations in induced abortion].

    PubMed

    Petersen, P

    1987-01-01

    So far no research has been carried out into the way in which women come to terms with abortion. There are four levels of experience. First, normal psychological experience, with feelings of guilt, reproach, stability, indifference; deeper awareness is suppressed with the aid of forms of defense such as scientific objectivism, positivism, and reductionism. This level is sociopsychologically well documented. Second, breakthrough of destructive deep awareness, with chaos and panic, revulsion and hate-this level is being researched by psychoanalytic methods. Third, acceptance of existential reality, experiencing guilt at having been party to killing a child. Fourth, responsibility and a feeling of guilt toward the dead child; it is here that the interhuman relationship is fulfilled, because the mental image of the child becomes like and independent being. Only at this point does full awareness of death occur. "He who knows the invisible, which has no material substance, but nevertheless an effect, is a physician."

  7. Cystatin C and Sudden Cardiac Death Risk in the Elderly

    PubMed Central

    Deo, Rajat; Sotoodehnia, Nona; Katz, Ronit; Sarnak, Mark J.; Fried, Linda F.; Chonchol, Michel; Kestenbaum, Bryan; Psaty, Bruce M.; Siscovick, David S.; Shlipak, Michael G.

    2010-01-01

    Background Recent studies have demonstrated an association between moderate kidney dysfunction and sudden cardiac death in people with cardiovascular disease. Methods and Results The study was a longitudinal analysis among 4465 participants from the Cardiovascular Health Study without prevalent cardiovascular disease at baseline. Cystatin C and creatinine were measured from baseline sera. SCD was defined as a sudden pulseless condition from a cardiac origin in a previously stable individual that occurred out of the hospital or in the emergency room. The association between cystatin C tertiles and SCD was determined with multivariate Cox proportional hazards. A similar analysis compared SCD incidence across creatinine-based eGFR tertiles. Over a median follow-up of 11.2 years, 91 adjudicated SCD events occurred. The annual incidence of SCD events increased across cystatin C tertiles: 10 events per 10,000 person years in tertile 1, 25 events per 10,000 person years in tertile 2 and 32 events per 10,000 person years in the highest cystatin C tertile. These associations persisted after multivariate adjustment: [HR = 2.72, 95% CI (1.44–5.16) in tertile 2 and HR = 2.67, 95% CI (1.33–5.35) in tertile 3]. After multivariate adjustment, the rate of SCD also increased in a linear distribution across creatinine-based eGFR tertiles: 15 events per 10,000 person years in tertile 1, 22 events per 10,000 person years in tertile 2 and 27 events per 10,000 person years in tertile 3. No significant associations, however, remained between creatinine-based eGFR and SCD after multivariable adjustment. Conclusion Impaired kidney function, as measured by cystatin C, has an independent association with SCD risk among elderly persons without clinical cardiovascular disease. PMID:20233980

  8. Primary prophylaxis of sudden death in hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and dilated cardiomyopathy.

    PubMed

    Klein, George J; Krahn, Andrew D; Skanes, Allan C; Yee, Raymond; Gula, Lorne J

    2005-09-01

    We present an evidence-based overview of primary prevention of sudden cardiac death. Several recent studies have provided important data regarding pharmacologic and device-based therapy for patients with conditions that confer high risk for sudden death. A rational approach to these therapies, with emphasis on implanted cardiovertor defibrillators, is discussed.

  9. Environmental risk factors for sudden infant death syndrome in Japan.

    PubMed

    Hirabayashi, Masako; Yoshinaga, Masao; Nomura, Yuichi; Ushinohama, Hiroya; Sato, Seiichi; Tauchi, Nobuo; Horigome, Hitoshi; Takahashi, Hideto; Sumitomo, Naokata; Shiraishi, Hirohiko; Nagashima, Masami

    2016-12-01

    While the prevalence of sudden infant death syndrome (SIDS) has decreased worldwide, this decline has plateaued recently. Strategies are needed to resume the constant decrease of SIDS in Japan. A prospective electrocardiographic screening program for infants was performed between July 2010 and March 2011. Parents of 4319 infants were asked about environmental factors related to SIDS through questionnaires at a one-month medical checkup and one year. Parental awareness of prone position, smoke exposure, and breast feeding as environmental factors were 81.4 %, 69.0 %, and 47.8 %, respectively. The prevalence of laying infants exclusively in a supine position was 96.7 %. At the one-month medical checkup, smoking prevalence was 41.7 % in fathers and 2.1 % in mothers. Maternal smoking prevalence was significantly increased at one year after (p < 0.001). Multivariate regression analysis showed that risk factors for new or continued maternal smoking habits were maternal smoking habits at one month (p < 0.001), paternal smoking habits one year later (p < 0.001), and younger maternal age (p = 0.02).

  10. Cardiac ion channel gene mutations in sudden infant death syndrome.

    PubMed

    Otagiri, Tesshu; Kijima, Kazuki; Osawa, Motoki; Ishii, Kuniaki; Makita, Naomasa; Matoba, Ryoji; Umetsu, Kazuo; Hayasaka, Kiyoshi

    2008-11-01

    Sudden infant death syndrome (SIDS) is multifactorial and may result from the interaction of a number of environmental, genetic, and developmental factors. We studied three major genes causing long QT syndrome in 42 Japanese SIDS victims and found five mutations, KCNQ1-K598R, KCNH2-T895M, SCN5A-F532C, SCN5A-G1084S, and SCN5A-F1705S, in four cases; one case had both KCNH2-T895M and SCN5A-G1084S. All mutations were novel except for SCN5A-F532C, which was previously detected in an arrhythmic patient. Heterologous expression study revealed significant changes in channel properties of KCNH2-T895M, SCN5A-G1084S, and SCN5A-F1705S, but did not in KCNQ1-K598R and SCN5A-F532C. Our data suggests that nearly 10% of SIDS victims in Japan have mutations of the cardiac ion channel genes similar to in other countries.

  11. Observations of paternal response to sudden unanticipated infant death.

    PubMed

    Mandell, F; McAnulty, E; Reece, R M

    1980-02-01

    Support provided to families experiencing the loss of an infant to sudden infant death syndrome has focused on the description of maternal bonding and the consequences to the mother. However fathers also develop significant relationships with their infants, and their responses to the unanticipated loss of their children may be different than those of mothers. In this study 28 fathers who lost infants to SIDS appeared to have identifiable patterns of behavior which were more peculiar to men: (1) the necessity to "keep busy" with increased work; (2) feelings of diminished self-worth; (3) self-blame because of lack of "care" involvement; and (4) a limited ability to ask for help. That men should be stoic and less emotional and that one need not be concerned with the reactions of fathers appears to be a reflection of societal attitudes. However, these paternal behaviors, which emerge at a time of crisis and which obstruct full expression of grief, may unwittingly be promoted by medical and health care providers who are anxious to help fathers fulfill societal expectations of masculine strength.

  12. HERG block, QT liability and sudden cardiac death.

    PubMed

    Brown, Arthur M

    2005-01-01

    Non-cardiac drugs may prolong action potential duration (APD) and QT leading to Torsade de Pointes (TdP) and sudden cardiac death. TdP is rare and QT is used as a surrogate marker in the clinic. For non-cardiac drugs, APD/QT liability is always associated with a reduction in hERG current produced by either direct channel block or inhibition of trafficking. hERG and APD liabilities correlate better when APDs are measured in rabbit versus canine Purkinje fibres. hERG and APD/QT liabilities may be dissociated when hERG block is offset by block of calcium or sodium currents. hERG liability may be placed in context by calculating a safety margin (SM) from the IC50 for inhibition of hERG current measured by patch clamp divided by the effective therapeutic plasma concentration of the drug. The SM is uncertain because literature values for IC50 may vary by 50-fold and small differences in plasma protein binding have large effects. With quality control, the IC50 95% confidence limits vary less than twofold. Ideally, hERG liability should be determined during lead optimization. Patch damp has insufficient throughput for this purpose. A novel high-throughput screen has been developed to detect drugs that block hERG directly and/or inhibit hERG trafficking.

  13. Cardiac arrhythmias and sudden unexpected death in epilepsy (SUDEP).

    PubMed

    Velagapudi, Poonam; Turagam, Mohit; Laurence, Thomas; Kocheril, Abraham

    2012-03-01

    Sudden unexpected death in epilepsy (SUDEP) is a major clinical problem in epilepsy patients in the United States, especially those with chronic, uncontrolled epilepsy. Several pathophysiological events contributing to SUDEP include cardiac arrhythmias, respiratory dysfunction, and dysregulation of systemic or cerebral circulation. There is a significant body of literature suggesting the prominent role of cardiac arrhythmias in the pathogenesis of SUDEP. There is evidence to say that long-standing epilepsy can cause physiological and anatomical autonomic instability resulting in life-threatening arrhythmias. Tachyarrhythmias, bradyarrhythmias, and asystole are commonly seen during ictal, interictal, and postictal phase in epilepsy patients. It is unclear if these rhythm disturbances need attention as some of them may be just benign findings. Evidence regarding prolonged cardiovascular monitoring or the benefit of pacemaker/defibrillator implantation for primary or secondary prevention in epilepsy patients is limited. Awareness regarding pathophysiology, cardiac effects, and management options of SUDEP will become useful in guiding more individualized treatment in the near future. (PACE 2011; 1-8).

  14. Temporal Epidemiology of Sudden Oak Death in Oregon.

    PubMed

    Peterson, Ebba K; Hansen, Everett M; Kanaskie, Alan

    2015-07-01

    An effort to eradicate Phytophthora ramorum, causal agent of sudden oak death, has been underway since its discovery in Oregon forests. Using an information-theoretical approach, we sought to model yearly variation in the size of newly infested areas and dispersal distance. Maximum dispersal distances were best modeled by spring and winter precipitation 2 years before detection, and infestation size the year prior. Infestation size was best modeled by infestation size and spring precipitation the year prior. In our interpretation, there is a 2-year delay between the introduction of inoculum and onset of mortality for a majority of sites. The year-long gap in between allows ample time for the production of inoculum contributing to the spread of P. ramorum. This is supported by epidemic development following changes in eradication protocols precipitated by an outbreak in 2011, attributable to a 2009 treatment delay and an uncharacteristically wet spring in 2010. Posteradication, we have observed an increase in the total area of new outbreaks and increased frequency in dispersal distances greater than 4 km. Although the eradication program has not eliminated P. ramorum from Oregon forests, it has likely moderated this epidemic, emphasizing the need for prompt treatment of future invasive forest pathogens.

  15. Role of risk stratification and genetics in sudden cardiac death.

    PubMed

    Rai, Vikrant; Agrawal, Devendra K

    2017-03-01

    Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.

  16. Adaptive management of Sudden Oak Death in California woodlands

    NASA Astrophysics Data System (ADS)

    Garbelotto, M.

    2009-04-01

    Sudden Oak Death is an emergent disease caused by the exotic pathogen Phytophthora ramorum. This newly described Phytophthora is also responsible for a disease of ornamental plants, and multiple lines of evidence indicate its introduction in North America is linked to the trade of infected ornamental plants. P. ramorum is predominantly aerially transmitted, but a soil and water phases, not unlike other forest Phytophthoras are also present. One striking feature of the epidemiology of the disease is that the largest amounts of infectious aerial sporangia are produced on bay laurel leaves, while oaks appear to be non-infectious. Our strategy to deal with the disease has been multiple and involves the following aspects: 1)- Understand the mode of introduction of the pathogen, and monitor potential new escapes in the wild; 2)- Understand factors linked to the reproductive and spread potential, e.g. seasonalpatterns in the life cycle of the pathogen and distance of spread; 3)- Define the relationship between ecological stand characteristics and severity of the disease, inclusive of predictive modeling; 4)- Qualify precise pathways for infection; 5)- Reduce infection rates by modifying known infection pathways; 6)- Change stands characteristics to make them less favorable to the spread of the disease, e.g. by selective thinnings; 7)- Protect individual trees and some populations of the highly susceptible tanoak using phosphonate chemical treatments. Because our knowledge of the epidemiology and biology of the disease is still rather limited, recommendations are expected to change in time, as our understanding of the disease improves.

  17. Sudden death in epilepsy: Insights from the last 25 years.

    PubMed

    Jones, Lliwen A; Thomas, Rhys H

    2017-01-01

    Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with refractory epilepsy, and as such has been a major research focus over the last 25 years. The earliest SUDEP research papers were published in Seizure, as have scores of SUDEP papers since. In this review we discuss the efforts to try and describe the pathophysiological basis of SUDEP, the drive to discover the clinical risk factors that increase the likelihood of SUDEP, and the motivation to increase awareness of SUDEP. These three areas are the prime factors that, when answered, will allow us to better mitigate against SUDEP and help individuals monitor their personal risk. The field has benefited from strong definitions, multinational collaboration, the use of cutting edge genetic analysis, and ensuring that bereaved families are able to take part in research when this is appropriate. Clearly there is much that we do not know and yet, has any area of epilepsy research come so far in the last 25 years?

  18. Sudden unexpected death in epilepsy: from the lab to the clinic setting.

    PubMed

    Terra, Vera C; Cysneiros, Roberta; Cavalheiro, Esper A; Scorza, Fulvio A

    2013-03-01

    Sudden unexpected death in epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death in a patient with epilepsy. Sudden unexpected death in epilepsy is probably the most common cause of epilepsy-related deaths. Many predisposing and initiating factors may coexist and contribute to SUDEP, but the mechanisms are poorly understood. Cardiac and respiratory deregulation seems to have a major role in SUDEP. Here, we review several advances in understanding the mechanisms involved in SUDEP.

  19. Sudden unexpected death in epileptics following sudden, intense, increases in geomagnetic activity: Prevalence of effect and potential mechanisms

    NASA Astrophysics Data System (ADS)

    Persinger, M. A.; Psych, C.

    1995-12-01

    Abrupt, intense increases in global geomagnetic activity during the local night may precipitate a significant proportion of sudden unexpected (or unexplained) deaths (SUD) in epileptics. Over a 2-year period SUD in healthy chronic epileptic rats occurred when the average daily geomagnetic activity exceeded 50 nT (nanoTesla) and suddenly began during local night. Other experiments demonstrated that epileptic rats displayed more spontaneous seizures per night if there had been sudden increases in geomagnetic activity. Analyses of previously published data indicated that the number of SUDs/month in a population of human epileptics was positively associated with the number of days/month when the average geomagnetic activity exceeded 50 nT. The results support the hypothesis that suppression of the nocturnal concentrations of the endogenous anticonvulsant melatonin by sudden increases in geomagnetic activity may encourage fatal cardiac arrhythmias by uncoupling the insular/amygdaloid-paraventricular hypothalamic-solitary nucleus pathways.

  20. Hippocampal Formation Maldevelopment and Sudden Unexpected Death across the Pediatric Age Spectrum.

    PubMed

    Kinney, Hannah C; Poduri, Annapurna H; Cryan, Jane B; Haynes, Robin L; Teot, Lisa; Sleeper, Lynn A; Holm, Ingrid A; Berry, Gerald T; Prabhu, Sanjay P; Warfield, Simon K; Brownstein, Catherine; Abram, Harry S; Kruer, Michael; Kemp, Walter L; Hargitai, Beata; Gastrang, Joanne; Mena, Othon J; Haas, Elisabeth A; Dastjerdi, Roya; Armstrong, Dawna D; Goldstein, Richard D

    2016-10-01

    Sudden infant death syndrome (SIDS) and sudden unexplained death in childhood (SUDC) are defined as sudden death in a child remaining unexplained despite autopsy and death scene investigation. They are distinguished from each other by age criteria, i.e. with SIDS under 1 year and SUDC over 1 year. Our separate studies of SIDS and SUDC provide evidence of shared hippocampal abnormalities, specifically focal dentate bilamination, a lesion classically associated with temporal lobe epilepsy, across the 2 groups. In this study, we characterized the clinicopathologic features in a retrospective case series of 32 children with sudden death and hippocampal formation (HF) maldevelopment. The greatest frequency of deaths was between 3 weeks and 3 years (81%, 26/32). Dentate anomalies were found across the pediatric age spectrum, supporting a common vulnerability that defies the 1-year age cutoff between SIDS and SUDC. Twelve cases (38%) had seizures, including 7 only with febrile seizures. Subicular anomalies were found in cases over 1 year of age and were associated with increased risk of febrile seizures. Sudden death associated with HF maldevelopment reflects a complex interaction of intrinsic and extrinsic factors that lead to death at different pediatric ages, and may be analogous to sudden unexplained death in epilepsy.

  1. State of the art in forensic investigation of sudden cardiac death.

    PubMed

    Oliva, Antonio; Brugada, Ramon; D'Aloja, Ernesto; Boschi, Ilaria; Partemi, Sara; Brugada, Josep; Pascali, Vincenzo L

    2011-03-01

    The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death. Many of the causes of sudden death are due to genetic heart disorders, which can lead to both structural (eg, hypertrophic cardiomyopathy) and arrhythmogenic abnormalities (eg, familial long QT syndrome, Brugada syndrome). Most commonly, sudden cardiac death can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a great challenge to the forensic pathologist involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counselor, and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological, and social complexities observed in families in which there has been a young sudden cardiac death. The present study will address the spectrum of structural substrates of cardiac sudden death with particular emphasis given to the possible role of forensic molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability.

  2. Peripheral arterial chemoreceptors and sudden infant death syndrome.

    PubMed

    Gauda, Estelle B; Cristofalo, Elizabeth; Nunez, Jeanne

    2007-07-01

    Sudden infant death syndrome (SIDS) is the major cause of death in infants between 1 month and 1 year of age. Two particular concerns are that (1) premature or low birth weight (<2500-g) infants have a 2- to 40-fold greater risk of dying of SIDS (depending on the sleep position) than infants born at term and of normal birth weight, and that (2) the proportion of premature infants dying of SIDS has increased from 12 to 34% between 1988 and 2003. Hypo- and hypersensitivity of peripheral arterial chemoreceptors (PACs) may be one biological mechanism that could help to explain the epidemiological association between the increased incidence of SIDS in formerly premature infants. Because premature infants are often exposed to the extremes of oxygen stress during early postnatal development, they are more likely to have a maladaptive response of PACs later in their lives. As the first line of defense that mediates an increase in ventilation to a hypoxic challenge during wakefulness and sleep, PACs also mediate arousal responses during sleep in response to an asphyxial event that is often associated with upper airway obstruction. In most mammalian species, PACs are not fully developed at birth and thus are vulnerable to plasticity-induced changes mediated by environmental exposures such as the extremes of oxygen tension. Hypoxic or hyperoxic exposure during early postnatal development can lead to hyposensitive or hypersensitive PAC responses later in life. Although baseline chemoreceptor activity may not be the cause of an initial hypoxic or asphyxial event, the level of peripheral chemoreceptor drive does modulate the (1) time to arousal, (2) resumption of airflow during airway obstruction, (3) escape behaviors during rebreathing, and (4) cardiorespiratory responses that result from activation of the laryngeal chemoreflex. The laryngeal chemoreflex can be stimulated by reflux of gastric contents above the upper esophageal sphincter, or an increase in nasopharyngeal

  3. Sudden cardiac death and the potential role of beta-adrenoceptor-blocking drugs.

    PubMed Central

    Rajman, I.; Kendall, M. J.

    1993-01-01

    Sudden cardiac death is a major health problem in the industrially developed countries. The risk of sudden cardiac death may be reduced by early detection of coronary heart disease, elimination of the risk factors, treatment of the ischaemia in patients known to have coronary heart disease and suppression of ventricular arrhythmias. Of all the therapeutic measures currently available to reduce the risk of sudden cardiac death, beta-adrenoceptor-blocking drugs (beta blockers) appear to be the most effective. In this paper their actions are reviewed and evidence for their efficacy is presented. PMID:7907178

  4. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    MedlinePlus

    ... Trials Links Related Topics Arrhythmia Automated External Defibrillator Coronary Heart Disease Heart Failure Long QT Syndrome Send a link ... First Sudden Cardiac Arrest If you have severe coronary heart disease (CHD), you're at increased risk for SCA. ...

  5. Teaching Child Care Providers to Reduce the Risk of SIDS (Sudden Infant Death Syndrome)

    ERIC Educational Resources Information Center

    Byington, Teresa; Martin, Sally; Reilly, Jackie; Weigel, Dan

    2011-01-01

    Keeping children safe and healthy is one of the main concerns of parents and child care providers. SIDS (Sudden Infant Death Syndrome) is the leading cause of death in infants 1 month to 12 months of age. Over 2,000 infants die from SIDS every year in the United States, and almost 15% of these deaths occur in child care settings. A targeted…

  6. Brainstem Serotonergic Deficiency in Sudden Infant Death Syndrome

    PubMed Central

    Duncan, Jhodie R.; Paterson, David S.; Hoffman, Jill M.; Mokler, David J.; Borenstein, Natalia S.; Belliveau, Richard A.; Krous, Henry F.; Haas, Elisabeth A.; Stanley, Christina; Nattie, Eugene E.; Trachtenberg, Felicia L.; Kinney, Hannah C.

    2011-01-01

    Context Sudden infant death syndrome (SIDS) is postulated to result from abnormalities in brainstem control of autonomic function and breathing during a critical developmental period. Abnormalities of serotonin (5-hydroxytryptamine [5-HT]) receptor binding in regions of the medulla oblongata involved in this control have been reported in infants dying from SIDS. Objective To test the hypothesis that 5-HT receptor abnormalities in infants dying from SIDS are associated with decreased tissue levels of 5-HT, its key biosynthetic enzyme (tryptophan hydroxylase [TPH2]), or both. Design, Setting, and Participants Autopsy study conducted to analyze levels of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA); levels of TPH2; and 5-HT1A receptor binding. The data set was accrued between 2004 and 2008 and consisted of 41 infants dying from SIDS (cases), 7 infants with acute death from known causes (controls), and 5 hospitalized infants with chronic hypoxia-ischemia. Main Outcome Measures Serotonin and metabolite tissue levels in the raphé obscurus and paragigantocellularis lateralis (PGCL); TPH2 levels in the raphé obscurus; and 5-HT1A binding density in 5 medullary nuclei that contain 5-HT neurons and 5 medullary nuclei that receive 5-HT projections. Results Serotonin levels were 26% lower in SIDS cases (n = 35) compared with age-adjusted controls (n = 5) in the raphé obscurus (55.4 [95% confidence interval {CI}, 47.2–63.6] vs 75.5 [95% CI, 54.2–96.8] pmol/mg protein, P = .05) and the PGCL (31.4 [95% CI, 23.7–39.0] vs 40.0 [95% CI, 20.1–60.0] pmol/mg protein, P = .04). There was no evidence of excessive 5-HT degradation assessed by 5-HIAA levels, 5-HIAA:5-HT ratio, or both. In the raphé obscurus, TPH2 levels were 22% lower in the SIDS cases (n = 34) compared with controls (n = 5) (151.2% of standard [95% CI, 137.5%–165.0%] vs 193.9% [95% CI, 158.6%–229.2%], P = .03). 5-HT1A receptor binding was 29% to 55% lower in 3 medullary nuclei that receive 5

  7. Abortion

    MedlinePlus

    An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most healthcare providers advise counseling.

  8. Authorised access web portal for Italiandata bank on sudden unexpected perinatal and infant death.

    PubMed

    Ottaviani, Giulia; Perlasca, Paolo; Mesiti, Marco; Ferrari, Luca; Lavezzi, Anna M

    2017-03-15

    Sudden infant death syndrome (SIDS) is common during the first year of life and affects 0.40every 1,000 births (1). Stillbirths are seven times more common than SIDS; in 40-80% of cases remain unexplained and are categorised as sudden intrauterine unexpected death syndrome (2).In 2006 Italy passed legislation that fetuses, and infants, from 25 weeks of gestation to one postnatal year, that died suddenly and unexpectedly should be sent to the University of Milan, Italy, for an in-depth diagnostic post-mortem with parental permission (3). This article is protected by copyright. All rights reserved.

  9. Discordance in investigator-reported and adjudicated sudden death in TIOSPIR

    PubMed Central

    Kowey, Peter R.; Austen, George; Mueller, Achim; Metzdorf, Norbert; Fowler, Andy; McGarvey, Lorcan P.

    2017-01-01

    Accurate and consistent determination of cause of death is challenging in chronic obstructive pulmonary disease (COPD) patients. TIOSPIR (N=17 135) compared the safety and efficacy of tiotropium Respimat 5/2.5 µg with HandiHaler 18 µg in COPD patients. All-cause mortality was a primary end-point. A mortality adjudication committee (MAC) assessed all deaths. We aimed to investigate causes of discordance in investigator-reported and MAC-adjudicated causes of death and their impact on results, especially cardiac and sudden death. The MAC provided independent, blinded assessment of investigator-reported deaths (n=1302) and assigned underlying cause of death. Discordance between causes of death was assessed descriptively (shift tables). There was agreement between investigator-reported and MAC-adjudicated deaths in 69.4% of cases at the system organ class level. Differences were mainly observed for cardiac deaths (16.4% investigator, 5.1% MAC) and deaths assigned to general disorders including sudden death (17.4% investigator, 24.6% MAC). Reasons for discrepancies included investigator attribution to the immediate (e.g. myocardial infarction (MI)) over the underlying cause of death (e.g. COPD) and insufficient information for a definitive cause. Cause-specific mortality varies in COPD, depending on the method of assignment. Sudden death, witnessed and unwitnessed, is common in COPD and often attributed to MI without supporting evidence. PMID:28344980

  10. Is sudden death random or is it in the weather?

    PubMed

    Bierton, Christopher; Cashman, Kara; Langlois, Neil E I

    2013-03-01

    It has been suggested that the weather may promote some types of death; this study sought to determine if types of death in the region around Adelaide, South Australia, occur in non-random clusters and in relationship to the weather. A Poisson model was used to determine if the occurrence of types of death were random. An exploratory analysis was performed for each death type to see if there was a relationship to weather variables using data supplied by the Bureau of Meteorology. Cases examined at Forensic Science South Australia from 1 January 2008 to 31 December 2009 were reviewed. It was ascertained that cardiovascular deaths were distributed non-randomly; there was statistical evidence to suggest that deaths from ischemic heart disease, pulmonary embolus and drug toxicity had non-random occurrence. Maximum temperatures and increases in temperatures correlated with deaths from natural causes, cardiovascular disease, ischemic heart disease and pulmonary thromboembolus; lower hours of sunlight were statistically significant for deaths due to pulmonary thromboembolus. The distribution pattern of deaths resulting from motor vehicle collision did not fit the Poisson (random) model with variation through the week also being present. Non-random clusters of deaths do occur and weather events, such as increase in temperature, are associated with some types of death. However, analysis indicates that the weather is not responsible for all clustering. With regards to motor vehicle collision deaths temporal variation may be related to social factors, such as holiday periods. Further investigation may assist with health resource planning.

  11. The Costs of Suicide and Sudden Death within an Organization

    ERIC Educational Resources Information Center

    Kinder, Andrew; Cooper, Cary L.

    2009-01-01

    The effect of any death spreads out to many people. Deaths that occur in the workplace need to be handled with particular care given that the bereaved family as well as work colleagues will have been affected. Death by suicide or situations when an employee becomes suicidal can challenge even the most experienced manager. This article aims to…

  12. Ignored Disease or Diagnostic Dustbin? Sudden Infant Death Syndrome in the British Context

    PubMed Central

    Ferguson, Angus H.

    2015-01-01

    Sudden Infant Death Syndrome (SIDS) was defined in 1969 and incorporated into the International Classification of Diseases a decade later. To advocates of SIDS as a diagnosis, medical interest in sudden infant death was long overdue. However, the definition of SIDS lacked positive diagnostic criteria, provoking some to view it as a ‘diagnostic dustbin’ for the disposal of problematic cases where cause of death was unclear. This paper examines the development of medical interest in sudden infant death in Britain during the middle decades of the twentieth century. It highlights the importance of recognising the historicity of SIDS as a diagnosis facilitated by changes in law and medicine over the course of the nineteenth and twentieth centuries. It suggests that SIDS provides a definitive case study of the medicalisation of life and death, and a unique example of an officially recognised disease that had no symptoms, signs, pathology or patients. PMID:26217070

  13. Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study

    PubMed Central

    Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J

    2014-01-01

    Objective To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Design Case distribution study (case series with survey information on referent exposures). Setting United States law enforcement. Participants Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Main outcome measures Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. Results 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Conclusions Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law

  14. Progressive Primary Pulmonary Tuberculosis Presenting as the Sudden Unexpected Death in Infancy: A Case Report

    PubMed Central

    Dempers, Johan; Sens, Mary Ann; Wadee, Shabbir Ahmed; Kinney, Hannah C.; Odendaal, Hein J.; Wright, Colleen A.

    2010-01-01

    The classification of an unexpected infant death as the sudden infant death syndrome (SIDS) depends upon a complete autopsy and death scene investigation to exclude known causes of death. Here we report the death of a four-month-old infant in a tuberculosis endemic area that presented as a sudden unexpected death in infancy (SUDI) with no apparent explanation based on the death scene characteristics. The autopsy, however, revealed progressive primary pulmonary tuberculosis with intrathoracic adenopathy, compression of the tracheobronchial tree and miliary lesions in the liver. This case underscores the clinical difficulties in the diagnosis of infantile tuberculosis, as well as the possibility of sudden death as part of its protean manifestations. The pathology and clinical progression of tuberculosis in infants differs from older children and adults due to the immature immune response in infants. This case dramatically highlights the need for complete autopsies in all sudden and unexpected infant deaths, as well as the public health issues in a sentinel infant tuberculosis diagnosis. PMID:20705406

  15. Abortion.

    PubMed

    1993-05-01

    The Alan Guttmacher Institute's State Reproductive Health Monitor "Legislative Proposals and Actions" provides US legislative information on abortion. The listing contains information on pending bills: the state, the identifying legislative number, the sponsor, the committee, the date the bill was introduced, a description of the bill, and when available the bill's status. The bills cover: 1) clinic licensing, e.g., requiring outpatient health care facilities in which abortions are performed, to have malpractice liability insurance; 2) comprehensive statues, which require parental notification before minor may obtain abortions, mandate abortion counseling to all women 24 hours before the abortion can be performed and prohibit disciplining or discharging a state employee for refusing to provide abortion counseling; 3) fetal personhood and rights, e.g. providing that life is vested in each person at fertilization; 4) fetal research and remains; 5) gender of fetus, which regulate abortions relative to sex selection in pregnancies; 6) harassment regulation; 7) informed consent and waiting periods detailing the risks and alternatives to abortion, and the 24-hour waiting period; 8) insurance coverage, e.g., eliminating language banning the coverage of abortions for state workers, and prohibiting disclosure by a health insurance carrier to the employer of a claimant that the claimant had a surgical abortion; 9) legality of abortion, urging Congress to reject he Freedom of Choice Act; 10) parental consent and notification; 11) postviability requirements; 12) public funding; 13) reporting requirements; 14) reproductive rights, and 15) spousal and paternal consent and notification.

  16. Sudden infant death syndrome caused by cardiac arrhythmias: only a matter of genes encoding ion channels?

    PubMed

    Sarquella-Brugada, Georgia; Campuzano, Oscar; Cesar, Sergi; Iglesias, Anna; Fernandez, Anna; Brugada, Josep; Brugada, Ramon

    2016-03-01

    Sudden infant death syndrome is the unexpected demise of a child younger than 1 year of age which remains unexplained after a complete autopsy investigation. Usually, it occurs during sleep, in males, and during the first 12 weeks of life. The pathophysiological mechanism underlying the death is unknown, and the lethal episode is considered multifactorial. However, in cases without a conclusive post-mortem diagnosis, suspicious of cardiac arrhythmias may also be considered as a cause of death, especially in families suffering from any cardiac disease associated with sudden cardiac death. Here, we review current understanding of sudden infant death, focusing on genetic causes leading to lethal cardiac arrhythmias, considering both genes encoding ion channels as well as structural proteins due to recent association of channelopathies and desmosomal genes. We support a comprehensive analysis of all genes associated with sudden cardiac death in families suffering of infant death. It allows the identification of the most plausible cause of death but also of family members at risk, providing cardiologists with essential data to adopt therapeutic preventive measures in families affected with this lethal entity.

  17. Cigarette Smoking as a Risk Factor for Sudden Infant Death Syndrome: A Population-Based Study.

    ERIC Educational Resources Information Center

    Haglund, Bengt; Cnattingius, Sven

    1990-01-01

    Examines risk factors for sudden infant death syndrome based on Swedish births between 1983 and 1985. Results indicate that maternal smoking doubles the risk of infant death, and infants of smokers also died sooner. The more the mother smoked the more likely her infant was to die. (JS)

  18. Sports and Marfan Syndrome: Awareness and Early Diagnosis Can Prevent Sudden Death.

    ERIC Educational Resources Information Center

    Salim, Mubadda A.; Alpert, Bruce S.

    2001-01-01

    Physicians who work with athletes play an important role in preventing sudden death related to physical activity in people who have Marfan syndrome. Flagging those who have the physical stigmata and listening for certain cardiac auscultation sounds are early diagnostic keys that can help prevent deaths. People with Marfan syndrome should be…

  19. National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports

    PubMed Central

    Casa, Douglas J.; Guskiewicz, Kevin M.; Anderson, Scott A.; Courson, Ronald W.; Heck, Jonathan F.; Jimenez, Carolyn C.; McDermott, Brendon P.; Miller, Michael G.; Stearns, Rebecca L.; Swartz, Erik E.; Walsh, Katie M.

    2012-01-01

    Objective: To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports. Background: Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes. Recommendations: These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care. PMID:22488236

  20. Hypertrophic Cardiomyopathy: Practical Steps for Preventing Sudden Death.

    ERIC Educational Resources Information Center

    Maron, Barry J.

    2002-01-01

    Hypertrophic cardiomyopathy (HCM) is a rare cause of death among athletes, with deaths occurring in young, apparently healthy people. Differentiating HCM from conditioning hypertrophy is challenging. Routine detection involves family history, physical examination, electrocardiography, and echocardiography. Keys to differential diagnosis include…

  1. Primary Prevention of Sudden Cardiac Death in Adults with Transposition of the Great Arteries: A Review of Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Cedars, Ari M.

    2015-01-01

    Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue. PMID:26413012

  2. Sudden unexpected infant deaths associated with car seats.

    PubMed

    Bamber, Andrew R; Pryce, Jeremy; Ashworth, Michael T; Sebire, Neil J

    2014-06-01

    The purpose of this study was to investigate the frequency, circumstances, demographics, and causes of death of infants dying while seated in car safety seats. A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period was undertaken to identify any infant deaths (aged <1 year), in whom death occurred while seated in a car safety seat. Fourteen car seat-associated deaths were identified from a total of 1,465 coronial infant autopsies (0.96 %). Four involved infants were being appropriately transported in the car seat, all of whom had a medical underlying cause of death (one infection and three congenital heart disease). The majority (10 cases; 70 %) occurred while car seats were being inappropriately used, outside of the car, including as an alternative to a cot or high-chair. Five of these infants died of explained causes, but four deaths remained unexplained after autopsy, and in one no cause of death was available. There were no cases of previously healthy infants dying unexpectedly in a car seat when it was being used appropriately, and in this series there were no cases of traumatic death associated with car seats, either during road traffic accidents, or from falling or being suspended from a car seat. Infant deaths in car seats are rare. These data support the recommendation that car seats be used only for transport and not as alternatives for cots or high-chairs. More research is required to investigate the effect of travel in car seats on infants with underlying conditions. There appears to be no increased risk of unexpected deaths of healthy infants transported appropriately in car seats.

  3. Ependymal alterations in sudden intrauterine unexplained death and sudden infant death syndrome: possible primary consequence of prenatal exposure to cigarette smoking

    PubMed Central

    2010-01-01

    Background The ependyma, the lining providing a protective barrier and filtration system separating brain parenchyma from cerebrospinal fluid, is still inadequately understood in humans. In this study we aimed to define, by morphological and immunohistochemical methods, the sequence of developmental steps of the human ependyma in the brainstem (ventricular ependyma) and thoracic spinal cord (central canal ependyma) of a large sample of fetal and infant death victims, aged from 17 gestational weeks to 8 postnatal months. Additionally, we investigated a possible link between alterations of this structure, sudden unexplained fetal and infant death and maternal smoking. Results Our results demonstrate that in early fetal life the human ependyma shows a pseudostratified cytoarchitecture including many tanycytes and ciliated cells together with numerous apoptotic and reactive astrocytes in the subependymal layer. The ependyma is fully differentiated, with a monolayer of uniform cells, after 32 to 34 gestational weeks. We observed a wide spectrum of ependymal pathological changes in sudden death victims, such as desquamation, clusters of ependymal cells in the subventricular zone, radial glial cells, and the unusual presence of neurons within and over the ependymal lining. These alterations were significantly related to maternal smoking in pregnancy. Conclusions We conclude that in smoking mothers, nicotine and its derivatives easily reach the cerebrospinal fluid in the fetus, immediately causing ependymal damage. Consequently, we suggest that the ependyma should be examined in-depth first in victims of sudden fetal or infant death with mothers who smoke. PMID:20642831

  4. Sudden unexpected non-violent death between 1 and 19 years in north Spain

    PubMed Central

    Morentin, B.; Aguilera, B.; Garamendi, P. M.; Suarez-Mier, M

    2000-01-01

    AIMS—To study the epidemiological, clinical, and pathological characteristics of sudden unexpected non-violent deaths between 1and 19years.
METHODS—Population based observational study of all sudden unexpected non-violent deaths between 1 and 19 years, from 1990 to 1997,in a north Spain county (Bizkaia). In each case, clinical information and circumstances of death were obtained and a complete forensic autopsy was performed.
RESULTS—There were 34 sudden unexpected non-violent deaths. The mortality rate was 1.7 per 100 000 persons per year (representing 9% of the mortality rate of all non-violent deaths). In 10 cases the cause of death was cardiac, in 13 cases extracardiac, and 11 cases were unexplained. In 17 cases there were no pathological antecedents and in nine cases death occurred in patients with known disorders. Syncopes prior to death were present in five cases. Exercise related deaths occurred in seven cases (mainly associated with cardiac causes). Eight cases were "death in bed".

 PMID:10833176

  5. QT prolongation and sudden cardiac death in patients with alcoholic liver disease

    SciTech Connect

    Day, C.P.; James, O.F.W. . Dept. of Medicine); Butler, T.J. . Dept. of Medical Statistics); Campbell, R.W.F. . Dept. of Academic Cardiology)

    1993-06-05

    Cardiovascular death is the most important cause of mortality in alcoholics, yet alcohol may protect against ischemic heart disease. This could be explained if deaths were a consequence of alcohol-related arrhythmias rather than of coronary atheroma. In many conditions, abnormalities of the QT interval are markers of arrhythmia and for risk of sudden death. The authors examined the relation between QT intervals and mortality in patients with alcoholic liver disease.

  6. Preventing sudden cardiac death in athletes: in search of evidence-based, cost-effective screening.

    PubMed

    Angelini, Paolo; Vidovich, Mladen I; Lawless, Christine E; Elayda, Macarthur A; Lopez, J Alberto; Wolf, Dwayne; Willerson, James T

    2013-01-01

    Sudden cardiac death in athletes is a recurrent phenomenon at sporting events and during training. Recent studies have associated sudden cardiac death with such cardiovascular conditions as coronary artery anomalies, cardiomyopathies, and electrocardiographic abnormalities, most of which are screenable with modern imaging techniques. We recently inaugurated the Center for Coronary Artery Anomalies at the Texas Heart Institute, which is dedicated to preventing sudden cardiac death in the young and investigating coronary artery anomalies. There, we are conducting 2 cross-sectional studies intended to firmly establish and quantify, in a large group of individuals from a general population, risk factors for sudden cardiac death that arise from specific cardiovascular conditions. In a pilot screening study, we are using a brief, focused clinical questionnaire, electrocardiography, and a simplified novel cardiovascular magnetic resonance screening protocol in approximately 10,000 unselected 11- to 15-year-old children. Concurrently, we are prospectively studying the prevalence of these same conditions, their severity, and their relation to exercise and mode of death in approximately 6,500 consecutive necropsy cases referred to a large forensic center. Eventually, we hope to use our findings to develop a more efficient method of preventing sudden cardiac death in athletes. We believe that these studies will help quantify sudden cardiac death risk factors and the relevance of associated physical activities--crucial information in evaluating the feasibility and affordability of cardiovascular magnetic resonance-based screening. We discuss the rationale for and methods of this long-term endeavor, in advance of reporting the results.

  7. Sudden death at the end of the Mesozoic

    USGS Publications Warehouse

    Emiliani, C.; Kraus, E.B.; Shoemaker, E.M.

    1981-01-01

    A paleoecological analysis of the fossil record before and after the Cretaceous/Tertiary boundary indicates that the widespread extinctions and biological stresses around the boundary are best explained in terms of a sudden, significant, but short temperature rise. L. Alvarez and co-authors, having found an enrichment in iridium at the same boundary, postulated that it was associated with the impact of an extraterrestrial body. If this body struck the ocean, the water injected into the atmosphere may have led to a transient increase in the global surface temperature. This temperature pulse may have been primarily responsible for the effects observed in the biosphere. The pattern of extinction of higher plant species suggests that splash down occurred in the northern Pacific-Bering Sea area. ?? 1981.

  8. Expert opinion and controversies in musculoskeletal and sports medicine: preventing sudden cardiac death in young athletes.

    PubMed

    Rao, Ashwin L; Standaert, Christopher J; Drezner, Jonathan A; Herring, Stanley A

    2010-06-01

    Sudden cardiac death in young athletes has become a highly visible public health concern. Over the past 2 decades, unexplained or premature deaths of numerous athletes at the youth, collegiate, and professional levels have garnered extensive media coverage and stimulated a discussion centered on prevention of such tragic events. A number of issues related to the prevention and management of sudden cardiac arrest on the playing field are currently debated in the medical literature, including the true incidence of sudden death in the young athletic population, the adequacy of the preparticipation physical evaluation, and the emergency response and effectiveness of secondary prevention strategies such as use of automated external defibrillators in the athletic setting. Clinicians who care for competitive athletes and/or cover youth sporting events must be aware of the benefits and limitations of different preparticipation screening programs to identify at-risk athletes, and they must be prepared to respond to life-threatening emergencies during athletic participation.

  9. Alternative research funding to improve clinical outcomes: model of prediction and prevention of sudden cardiac death.

    PubMed

    Myerburg, Robert J; Ullmann, Steven G

    2015-04-01

    Although identification and management of cardiovascular risk markers have provided important population risk insights and public health benefits, individual risk prediction remains challenging. Using sudden cardiac death risk as a base case, the complex epidemiology of sudden cardiac death risk and the substantial new funding required to study individual risk are explored. Complex epidemiology derives from the multiple subgroups having different denominators and risk profiles, while funding limitations emerge from saturation of conventional sources of research funding without foreseeable opportunities for increases. A resolution to this problem would have to emerge from new sources of funding targeted to individual risk prediction. In this analysis, we explore the possibility of a research funding strategy that would offer business incentives to the insurance industries, while providing support for unresolved research goals. The model is developed for the case of sudden cardiac death risk, but the concept is applicable to other areas of the medical enterprise.

  10. Risk Stratification for Sudden Cardiac Death In Patients With Non-ischemic Dilated Cardiomyopathy

    PubMed Central

    Shekha, Karthik; Ghosh, Joydeep; Thekkoott, Deepak; Greenberg, Yisachar

    2005-01-01

    Non ischemic dilated cardiomyopathy (NIDCM) is a disorder of myocardium. It has varying etiologies. Albeit the varying etiologies of this heart muscle disorder, it presents with symptoms of heart failure, and rarely as sudden cardiac death (SCD). Manifestations of this disorder are in many ways similar to its counterpart, ischemic dilated cardiomyopathy (IDCM). A proportion of patients with NIDCM carries a grave prognosis and is prone to sudden cardiac death from sustained ventricular arrhythmias. Identification of this subgroup of patients who carry the risk of sudden cardiac death despite adequate medical management is a challenge .Yet another method is a blanket treatment of patients with this disorder with anti arrhythmic medications or anti tachyarrhythmia devices like implantable cardioverter defibrillators (ICD). However this modality of treatment could be a costly exercise even for affluent economies. In this review we try to analyze the existing data of risk stratification of NIDCM and its clinical implications in practice. PMID:16943952

  11. Stratification of the Risk of Sudden Death in Nonischemic Heart Failure

    PubMed Central

    Pimentel, Maurício; Zimerman, Leandro Ioschpe; Rohde, Luis Eduardo

    2014-01-01

    Despite significant therapeutic advancements, heart failure remains a highly prevalent clinical condition associated with significant morbidity and mortality. In 30%-40% patients, the etiology of heart failure is nonischemic. The implantable cardioverter-defibrillator (ICD) is capable of preventing sudden death and decreasing total mortality in patients with nonischemic heart failure. However, a significant number of patients receiving ICD do not receive any kind of therapy during follow-up. Moreover, considering the situation in Brazil and several other countries, ICD cannot be implanted in all patients with nonischemic heart failure. Therefore, there is an urgent need to identify patients at an increased risk of sudden death because these would benefit more than patients at a lower risk, despite the presence of heart failure in both risk groups. In this study, the authors review the primary available methods for the stratification of the risk of sudden death in patients with nonischemic heart failure. PMID:25352509

  12. Natural and Undetermined Sudden Death: Value of Post-Mortem Genetic Investigation

    PubMed Central

    Fernández-Falgueras, Anna; Sarquella-Brugada, Georgia; Cesar, Sergi; Mademont, Irene; Mates, Jesus; Pérez-Serra, Alexandra; Coll, Monica; Pico, Ferran; Iglesias, Anna; Tirón, Coloma; Allegue, Catarina; Carro, Esther; Gallego, María Ángeles; Ferrer-Costa, Carles; Hospital, Anna; Bardalet, Narcís; Borondo, Juan Carlos; Vingut, Albert; Arbelo, Elena; Brugada, Josep; Castellà, Josep; Medallo, Jordi; Brugada, Ramon

    2016-01-01

    Background Sudden unexplained death may be the first manifestation of an unknown inherited cardiac disease. Current genetic technologies may enable the unraveling of an etiology and the identification of relatives at risk. The aim of our study was to define the etiology of natural deaths, younger than 50 years of age, and to investigate whether genetic defects associated with cardiac diseases could provide a potential etiology for the unexplained cases. Methods and Findings Our cohort included a total of 789 consecutive cases (77.19% males) <50 years old (average 38.6±12.2 years old) who died suddenly from non-violent causes. A comprehensive autopsy was performed according to current forensic guidelines. During autopsy a cause of death was identified in most cases (81.1%), mainly due to cardiac alterations (56.87%). In unexplained cases, genetic analysis of the main genes associated with sudden cardiac death was performed using Next Generation Sequencing technology. Genetic analysis was performed in suspected inherited diseases (cardiomyopathy) and in unexplained death, with identification of potentially pathogenic variants in nearly 50% and 40% of samples, respectively. Conclusions Cardiac disease is the most important cause of sudden death, especially after the age of 40. Close to 10% of cases may remain unexplained after a complete autopsy investigation. Molecular autopsy may provide an explanation for a significant part of these unexplained cases. Identification of genetic variations enables genetic counseling and undertaking of preventive measures in relatives at risk. PMID:27930701

  13. [Abortion].

    PubMed

    Dourlen-rollier, A M

    1971-01-01

    The historical and current (1969) abortion laws in France as well as those in other Western countries are analyzed. France has had a series of punitive abortion codes since the Napoleonic Code of 1810 prescribing solitary confinement for the woman. The reforms of 1920 and 1923 made provocation of abortion or contraceptional propaganda a "crime" (felony), later a "delit" (misdemeanor), called for trial before magistr ate instead of jury, but resulted in only about 200 convictions a year. The decree of 1939 extended the misdemeanor to women who aborted even if they were not pregnant, and provided for professional licenses such as that of surgeon or pharmacist to be suspended. The law of 1942 made abortion a social crime and increased the maximum penalty to capital punishment, which was exercised in 2 cases. About 4000 per year were convicted from 1942-1944. Now the law still applies to all who intend to abort, whether or not pregnant or successful, but punishemnt is limited to 1-5 years imprisonment, and 72,000 francs fine, or suspension of medical practice for 5 years. About 500 have been convicted per year. Since 1955 legal abortion has been available (to about 130 women over 4 years) if it is the only means to save the woman's life. Although pregnancy tests are controlled, the population desregards the law by resorting to clandestine abortion. The wealthy travel to Switzerland (where 68% of legal abortions are done on French women) or to England. Numbers are estimated by the French government at 250,000-300,000 per year, or 1 for every 2 live births, but by hospital statistics at 400,000-1,000,000 per year. The rest of the review covers abortion laws in Scandinavian, Central European, and individual US states as of 1969.

  14. Sudden death of a young woman attributed to diabetic ketoacidosis.

    PubMed

    Rosenbloom, Arlan L

    2013-11-01

    A young woman's death at home was attributed to new onset diabetic ketoacidosis with subsequent litigation supported by several expert consultants, despite a history and postmortem findings inconsistent with this diagnosis. More thorough tissue study of the heart and analysis of the circumstances led to a credible explanation of the entire scenario.

  15. Sudden Cardiac Death of a Body Packer Due to Cocaine Cardiotoxicity

    PubMed Central

    Pramanik, Parthasarathi; Vidua, Raghvendra Kumar

    2016-01-01

    This article presents a case of sudden cardiac death due to the effects of cocaine concealed in the body of a male drug smuggler in his 40s, a so-called body packer. A total of 57 body packets filled with cocaine powder were discovered in his body cavities. The detailed autopsy examination, including histopathology and toxicology findings, is discussed with the aim of describing the mechanism of cocaine intoxication in the body packer and an analysis of cocaine-induced cardiotoxicity and sudden death. PMID:27932899

  16. Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager.

    PubMed

    Hlavaty, Leigh; Diaz, Francisco; Sung, LokMan

    2015-09-01

    Takayasu arteritis is a rare disease that expresses chronic, large vessel inflammation. The etiology remains unclear and its presentation depends on the affected arteries. With coronary artery involvement, manifestations range from chest pain and shortness of breath to sudden death. We report a case of a 15-year-old white girl who presented with syncope immediately before passing. On autopsy, all 3 major coronary arteries grossly contained multiple proximal lesions that were consistent with Takayasu arteritis, microscopically. Takayasu arteritis solely affecting multiple coronary arteries is exceedingly rare. This report discusses the significance of coronary involvement in Takayasu arteritis at autopsy and sudden death.

  17. Sudden death of a child due to pyogenic bacterial myocarditis.

    PubMed

    Sikary, Asit K; Mridha, Asit R; Behera, Chittaranjan

    2016-01-01

    Bacterial myocarditis is an uncommon condition and only a few fatal cases in adults are reported in the scientific literature. Death from acute bacterial myocarditis in children is extremely rare. We report an unusual case of fatal bacterial myocarditis in a seven-year-old girl, who had a history of cough for a month and fever for two days. She was given symptomatic treatment by a local physician without suspecting her clinical condition. Her condition rapidly deteriorated and she was brought in dead to the hospital. Autopsy revealed pyogenic bacterial myocarditis associated with bilateral lobar pneumonia caused by Gram-positive cocci. Death from bacterial myocarditis can be prevented by early diagnosis and appropriate antibiotics.

  18. A 51-year-old man with sudden unexpected death.

    PubMed

    Donelan, Kent J; Randall, Brad B; Newby, Paul E

    2009-01-01

    We report an unusual case of a 51-year-old man who died suddenly and was found to have an intraventricular and subarachnoid hemorrhage secondary to acute hemorrhage within a choroid plexus xanthogranuloma. This is a highly unusual source of bleeding and to our knowledge has not been previously described in the literature. The man was discovered deceased on the bathroom floor of his home and an autopsy was ordered by the county coroner. Examination of the brain showed diffuse subarachnoid blood accumulation over the base of the brain in a symmetric distribution. A large amount of subarachnoid blood was especially noted near the brainstem at the level of the fourth ventricle foramina. Sections of the lateral left ventricle showed acute non-organizing hemorrhage within the ventricle and adjacent choroid plexus. Microscopically, a nodular focus seen grossly in the left lateral ventricle revealed marked chronic xanthogranulomatous inflammation with extensive cholesterol clefts, foreign body reaction, and focal calcifications. A periphery of normal choroid plexus was identified around the nodule. There was evidence of both recent and remote hemorrhage.

  19. Sudden death due to the atrioventricular node contusion

    PubMed Central

    Li, Wenhe; Zhang, Lin; Liang, Yue; Tong, Fang; Zhou, Yiwu

    2017-01-01

    Abstract Introduction: Atrioventricular node (AVN) contusion usually results in cardiogenic shock and arrhythmia and is a rare but fatal condition. The condition is difficult to diagnose and easily overlooked because it develops rapidly and is asymptomatic. We here report 3 cases that demonstrate blunt chest impact and hemorrhages of the posterior atrioventricular junction, eventually result in death. Clinical Findings: Autopsy and histological examination were performed on all cases. External inspection revealed bruises in the hearts and fractures in the sternum and ribs. However, histological examinations were conclusive and showed cardiac contusion on the surface of the posterior atrioventricular junction of the individuals, and the death was due to the AVN contusion. The position of the AVN on the heart surface is determined by detailed examinations via an autopsy and microscopic, both of which are critical in the certification of cause of death. Conclusion: The report is intended to raise our understanding and make forensic pathologists aware of the surface of the posterior atrioventricular junction. PMID:28072704

  20. Sudden or unnatural deaths involving anabolic-androgenic steroids.

    PubMed

    Darke, Shane; Torok, Michelle; Duflou, Johan

    2014-07-01

    Anabolic-androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995-2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable.

  1. Infant dreaming and fetal memory: a possible explanation of sudden infant death syndrome.

    PubMed

    Christos, G A

    1995-04-01

    During rapid-eye-movement sleep, when we dream, the brain is thought to be processing stored memory. The memory of a newborn infant is dominated by its fetal experience, and the infant is likely to dream about its life in the womb. Research with lucid (or conscious) dreaming has shown that dream images are supported by the corresponding body actions, using those muscles which remain active during rapid-eye-movement sleep. We suggest that sudden infant death syndrome or cot death may be a result of an infant dreaming about its life (or memory) as a fetus. In the course of that dream, since a fetus does not breathe (in the usual sense) the infant may cease to breathe and may die. This simple hypothesis is consistent with all of the known facts about sudden infant death syndrome (pathological and epidemiological), such as the age at death curve (the observed exponential decay and possibly the peak at 2-3 months), the higher risk with the prone sleeping position (but not excluding the supine position), and the observed climatic variation (seasonal and regional) in the incidence of sudden infant death syndrome. Many of these well-established facts have no other known explanation and other theories can generally only account for a few of the known facts about sudden infant death syndrome. Our hypothesis is also supported by recent findings that, as a group, sudden infant death syndrome infants have a higher proportion of rapid-eye-movement sleep, and also that they have an average higher heart rate (corresponding to possible fetal dreams) but only during rapid-eye-movement sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Seasonality, but not prevalence of sudden infant death syndrome varies by region in mainland Britain.

    PubMed

    Douglas, A S; Helms, P J; Jolliffe, I T

    1999-01-01

    This study aimed to investigate whether seasonal variation in day length contributed to winter/summer variation in sudden infant death syndrome (SIDS) at different latitudes in mainland Britain. Over 11 yrs 13,973 deaths were studied. Using appropriate analytic techniques a sine curve was fitted to monthly rates with the amplitude indicating magnitude of seasonal change. The rate of SIDS per 1,000 live births was the same (1.73) in the north as in the south. The amplitude was a quarter less in the north (41.3%) than in the south (54.2%) (p<0.001). While annual rates did not differ, the within year distribution did. The findings for seasonality of SIDS births were similar (amplitudes: north 213%, south 32.3%). Correlations were made between SIDS amplitude and individual environmental factors, particularly temperature and day length. These complex issues, while reported briefly, do not allow firm conclusions. In the north the winter day length is shorter, sunshine hours are less and temperature is lower, but the winter increment in SIDS is less. The extent of seasonal variation of sudden infant death syndrome is greater in the south as compared with the colder, darker north but this has no effect on sudden infant death syndrome rates. Changing photoperiod by latitude, amongst other environmental influences, may hold clues to the aetiology of sudden infant death syndrome.

  3. Arrhythmia Management in the Elderly-Implanted Cardioverter Defibrillators and Prevention of Sudden Death.

    PubMed

    Manian, Usha; Gula, Lorne J

    2016-09-01

    We present an overview of arrhythmia management in elderly patients as it pertains to implantable cardioverter defibrillator (ICD) therapy and prevention of sudden death. Treatment of arrhythmia in elderly patients is fraught with challenges pertaining to goals of care and patient frailty. With an ever increasing amount of technology available, realistic expectations of therapy need to balance quality and quantity of life. The ICD is an important treatment option for selected patients at risk of ventricular arrhythmia and sudden cardiac death. However, the incidence of sudden death as a percentage of all-cause mortality decreases with age. Studies have reported that 20% of elderly patients might die within 1 year of an episode of life-threatening ventricular arrhythmia, but most because of nonarrhythmic causes. This illustrates the 'sudden cardiac death paradox,' with a great proportion of death in elderly patients, even those at risk for ventricular arrhythmias, attributable to medical conditions that cannot be addressed by an ICD. We discuss current practices in ICD therapy in elderly patients, existing evidence from registries and clinical trials, approaches to risk stratification, and important ethical considerations. Although the decision on whether ICD insertion is appropriate in the elderly population remains an area of uncertainty from an evidence-based and ethical perspective, we offer insight on potential clinical and research strategies for this growing population.

  4. Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases.

    PubMed

    Li, Yang; Li, Ling; Mu, Hong-Shu; Fan, Shuan-Liang; He, Fang-Gang; Wang, Zhen-Yuan

    2015-09-01

    Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female=6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.

  5. Factors associated with sudden death of individuals requiring restraint for excited delirium.

    PubMed

    Stratton, S J; Rogers, C; Brickett, K; Gruzinski, G

    2001-05-01

    The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eighteen cases of such deaths witnessed by emergency medical service (EMS) personnel are reported. The 18 cases reported were restrained with the wrists and ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% of the sudden death cases. Associated with all sudden death cases was struggle by the victim with forced restraint and cessation of struggling with labored or agonal breathing immediately before cardiopulmonary arrest. Also associated was stimulant drug use (78%), chronic disease (56%), and obesity (56%). The primary cardiac arrest rhythm of ventricular tachycardia was found in 1 of 13 victims with confirmed initial cardiac rhythms, with none found in ventricular fibrillation. Our findings indicate that unexpected sudden death when excited delirium victims are restrained in the out-of-hospital setting is not infrequent and can be associated with multiple predictable but usually uncontrollable factors.

  6. Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants

    PubMed Central

    Randall, Bradley B.; Paterson, David S.; Haas, Elisabeth A.; Broadbelt, Kevin G.; Duncan, Jhodie R.; Mena, Othon J.; Krous, Henry F.; Trachtenberg, Felicia L.

    2013-01-01

    OBJECTIVE: Sudden and unexplained death is a leading cause of infant mortality. Certain characteristics of the sleep environment increase the risk for sleep-related sudden and unexplained infant death. These characteristics have the potential to generate asphyxial conditions. We tested the hypothesis that infants may be exposed to differing degrees of asphyxia in sleep environments, such that vulnerable infants with a severe underlying brainstem deficiency in serotonergic, γ-aminobutyric acid-ergic, or 14-3-3 transduction proteins succumb even without asphyxial triggers (eg, supine), whereas infants with intermediate or borderline brainstem deficiencies require asphyxial stressors to precipitate death. METHODS: We classified cases of sudden infant death into categories relative to a “potential asphyxia” schema in a cohort autopsied at the San Diego County Medical Examiner’s Office. Controls were infants who died with known causes of death established at autopsy. Analysis of covariance tested for differences between groups. RESULTS: Medullary neurochemical abnormalities were present in both infants dying suddenly in circumstances consistent with asphyxia and infants dying suddenly without obvious asphyxia-generating circumstances. There were no differences in the mean neurochemical measures between these 2 groups, although mean measures were both significantly lower (P < .05) than those of controls dying of known causes. CONCLUSIONS: We found no direct relationship between the presence of potentially asphyxia conditions in the sleep environment and brainstem abnormalities in infants dying suddenly and unexpectedly. Brainstem abnormalities were associated with both asphyxia-generating and non–asphyxia generating conditions. Heeding safe sleep messages is essential for all infants, especially given our current inability to detect underlying vulnerabilities. PMID:24218471

  7. Unexpected Death of a Child with Complex Febrile Seizures—Pathophysiology Similar to Sudden Unexpected Death in Epilepsy?

    PubMed Central

    Dlouhy, Brian J.; Ciliberto, Michael A.; Cifra, Christina L.; Kirby, Patricia A.; Shrock, Devin L.; Nashelsky, Marcus; Richerson, George B.

    2017-01-01

    Febrile seizures are usually considered relatively benign. Although some cases of sudden unexplained death in childhood have a history of febrile seizures, no documented case of febrile seizure-induced death has been reported. Here, we describe a child with complex febrile seizures who died suddenly and unexpectedly after a suspected seizure while in bed at night during the beginning phases of sleep. She was resuscitated and pronounced brain dead 2 days later at our regional medical center. Autopsy revealed multiorgan effects of hypoperfusion and did not reveal an underlying (precipitating) disease, injury, or toxicological cause of death. Although a seizure was not witnessed, it was suspected as the underlying cause of death based on the medical examiner and forensic pathologist (author Marcus Nashelsky) investigation, the post-resuscitation clinical findings, and multiple aspects of the clinical history. The child had a history of complex febrile seizures that had previously caused apnea and oxygen desaturation. She had two febrile seizures earlier on the same day of the fatal event. Interestingly, her mother also experienced a febrile seizure as a child, which led to respiratory arrest requiring cardiorespiratory resuscitation. This case suggests that in a child with complex febrile seizures, a seizure can induce death in a manner that is consistent with the majority of cases of sudden unexpected death in epilepsy (SUDEP). Further work is needed to better understand how and why certain individuals, with a history of epilepsy or not, die suddenly and unexpectedly from seizures. This will only occur through better understanding of the pathophysiologic mechanisms underlying epileptic and febrile seizures and death from seizures including SUDEP. PMID:28203222

  8. Sudden death caused by 1,1-difluoroethane inhalation.

    PubMed

    Xiong, Zhenggang; Avella, Joseph; Wetli, Charles V

    2004-05-01

    A 20-year-old man was found dead on the floor next to a computer, with a nearly full can of "CRC Duster" dust remover located next to the deceased on the floor, and an empty can of the same product on the computer desk. Toxicologic evaluation using either gas chromatography/mass spectrometry (GC/MS) or gas chromatography/flame ionization detector (GC/FID) method identified the active ingredient 1,1-difluoroethane (Freon 152a) in all tissues analyzed. Tissue distribution studies revealed highest concentration in central blood, lung, and liver. It is believed that the 1,1-difluoroethane inhalation was the cause of death.

  9. Diagnostic exercise: hemolysis and sudden death in lambs.

    PubMed

    Giannitti, F; Rioseco, M Macias; García, J P; Beingesser, J; Woods, L W; Puschner, B; Uzal, F A

    2014-05-01

    Within a 24-hour period, 7 out of 200 three- to four-week-old pastured Katahdin lambs died after showing clinical signs of hemoglobinuria, red-tinged feces, weakness, and recumbency. One of the lambs that was examined clinically before natural death also had abdominal pain, trembling, tachycardia, and severe anemia with a packed cell volume of 4%. Pathologic findings included icterus, hemoglobinuric nephrosis, dark red urine, pulmonary edema, hydrothorax, splenomegaly, and acute centrilobular to midzonal hepatocellular degeneration and necrosis with cholestasis. The differential diagnoses and diagnostic workup to achieve the diagnosis are briefly discussed.

  10. Sudden unexpected death under acute influence of cannabis.

    PubMed

    Hartung, Benno; Kauferstein, Silke; Ritz-Timme, Stefanie; Daldrup, Thomas

    2014-04-01

    The acute toxicity of cannabinoids is said to be low and there is little public awareness of the potentially hazardous cardiovascular effects of cannabis, e.g. marked increase in heart rate or supine blood pressure. We describe the cases of two young, putative healthy men who died unexpectedly under the acute influence of cannabinoids. To our knowledge, these are the first cases of suspected fatal cannabis intoxications where full postmortem investigations, including autopsy, toxicological, histological, immunohistochemical and genetical examinations, were carried out. The results of these examinations are presented. After exclusion of other causes of death we assume that the young men experienced fatal cardiovascular complications evoked by smoking cannabis.

  11. Abortion.

    PubMed

    Somerville, A C

    1977-08-24

    A survey of 886 adults over 16 was conducted regarding abortion in Papanui, New Zealand. Only 7.79% thought a person should never have an abortion under any circumstances, 16.70% thought the decision to have an abortion should be decided by a panel of two doctors, a social worker, and a statutory committee set up by the government. 44.4% thought the decision should be between a woman and the doctor of her choice. 20.54% thought the decision should be made solely by the woman concerned. The respondants had thought about the question. Other surveys in different electorates reflected similar views. It is hoped that people's opinions will influence legislators to enact more liberal abortion laws.

  12. Fetal Alcohol Syndrome in Sudden Unexpected Death in Infancy: A Case Report in Medicolegal Autopsy.

    PubMed

    Tangsermkijsakul, Aphinan

    2016-03-01

    Fetal alcohol spectrum disorder is a range of birth defects associated with prenatal alcohol exposure. Fetal alcohol syndrome (FAS) is the most serious form of fetal alcohol spectrum disorder. Infants with FAS are prone to death because of various physical abnormalities. Consequently, infants with FAS may be presented in the medicolegal investigation as a form of sudden unexpected death in infancy. The author reported a 6-month-old male infant who was found dead at home. The history of maternal ethanol consumption during pregnancy was obtained. The infant was diagnosed with FAS at the autopsy because he was presented with postnatal growth retardation, multiple facial abnormalities, and abnormal brain structures, which met the criteria of FAS. The cause of death was severe aspiration pneumonia. The purposes of this case report are to show an uncommon manifestation of sudden unexpected death in infancy case for the forensic pathologists and to emphasize on the national healthcare problem.

  13. Relation of Taser (electrical stun gun) deployment to increase in in-custody sudden deaths.

    PubMed

    Lee, Byron K; Vittinghoff, Eric; Whiteman, Dean; Park, Minna; Lau, Linda L; Tseng, Zian H

    2009-03-15

    Despite controversy concerning their safety, use of electrical stun guns (Tasers) by law enforcement agencies is increasing. We examined the effect of Taser deployment on rates of (1) in-custody sudden deaths in the absence of lethal force, (2) lethal force (firearm) deaths, and (3) officer injuries (OIs) requiring emergency room visits. Under the Public Records Act and the Freedom of Information Act, 126 police and sheriff departments from California cities were mailed surveys requesting rates of each of the outcomes of interest for each of the 5 years preceding Taser deployment through the 5 years after deployment. To control for population size and crime rates, we used total annual arrests per city as reported to the Department of Justice. Fifty cities provided predeployment and postdeployment data on in-custody sudden death, 21 cities reported firearm deaths, and 4 cities reported OIs. The rate of in-custody sudden death increased 6.4-fold (95% confidence interval 3.2-12.8, p = 0.006) and the rate of firearm death increased 2.3-fold (95% confidence interval 1.3-4.0, p = 0.003) in the in the first full year after Taser deployment compared with the average rate in the 5 years before deployment. In years 2 to 5 after deployment, rates of the 2 events decreased to predeployment levels. We observed no significant change in the rate of serious OIs after Taser deployment. In conclusion, although considered by some a safer alternative to firearms, Taser deployment was associated with a substantial increase in in-custody sudden deaths in the early deployment period, with no decrease in firearm deaths or serious OIs.

  14. Spatial and temporal analysis of populations of the Sudden Oak Death pathogen in Oregon forests

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden oak death caused by the oomycete Phytophthora ramorum was first discovered in California towards the end of the 20th century and subsequently emerged on tanoak forests in Oregon before its first detection in 2001 by aerial surveys. The Oregon Department of Forestry has since monitored the epi...

  15. Thyroid gland and cerebella lesions: New risk factors for sudden cardiac death in schizophrenia?

    PubMed

    Scorza, Fulvio A; Cavalheiro, Esper A; de Albuquerque, Marly; de Albuquerque, Juliana; Cysneiros, Roberta M; Terra, Vera C; Arida, Ricardo M

    2011-02-01

    People with schizophrenia show a two to threefold increased risk to die prematurely than those without schizophrenia. Patients' life style, suicide, premature development of cardiovascular disease, high prevalence of metabolic syndrome and sudden cardiac death are well-known causes of the excess mortality. The exact pathophysiological cause of sudden death in schizophrenia is unknown, but it is likely that cardiac arrhythmia and respiratory abnormalities play potential role. Some antipsychotics may be associated with cardiovascular adverse events (e.g., QT interval prolongation) and lesions in specific brain regions, such as cerebella may be associated with respiratory abnormalities, suggesting that metabolic and brain dysfunction could lead to sudden cardiac death in patients with schizophrenia. However, exact knowledge regarding the association of these findings and schizophrenia is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease and cerebella progressive atrophy has been observed in patients with schizophrenia, we propose in this paper that subclinical thyroid dysfunction and cerebella volume loss could be considered as new risk factor for sudden cardiac death in schizophrenia.

  16. Exercise-Related Sudden Death: Cardiovascular Evaluation of Exercisers (Part 2 of 2).

    ERIC Educational Resources Information Center

    Van Camp, Steven P.

    1988-01-01

    A primary goal of the cardiovascular evaluation of exercisers is to identify conditions that carry the risk of exercise-related sudden death. These conditions, which are found in a careful evaluation of the patient, are identifed and described in detail. (Author/JL)

  17. Spontaneous haemothorax: a cause of sudden death in von Recklinghausen's disease.

    PubMed Central

    Griffiths, A. P.; White, J.; Dawson, A.

    1998-01-01

    Vasculopathy is a relatively frequent but poorly recognised manifestation of von Recklinghausen's neurofibromatosis. One of its more dramatic presentations is as spontaneous haemothorax. Clinicians and pathologists should be aware of this syndrome as a cause of sudden death in patients with neurofibromatosis. Images Figure 1 Figure 2 PMID:10197217

  18. Sudden Cardiac Death in Children and Adolescents: Can We Prevent It?

    ERIC Educational Resources Information Center

    Berger, Stuart

    2001-01-01

    Sudden cardiac death (SCD) can occur at any age in apparently healthy people. Early identification and intervention are essential. This article examines SCD in children and adolescents, explaining: who is at risk; the importance of training school personnel for SCD emergencies and having automated external defibrillators (AED) within the schools;…

  19. Athletic Training Educators' Pedagogical Strategies for Preparing Students to Address Sudden Death in Sport

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Pagnotta, Kelly D.; Salvatore, Anthony C.; Casa, Douglas J.

    2013-01-01

    Context: Educational training programs both impart knowledge and allow students to practice skills to gain clinical competence. Objective: Understand the educational training provided to athletic training students regarding sudden death in sport beyond exertional heat stroke. Design: An exploratory, qualitative study using telephone interviews and…

  20. Infant Temperament Characteristics Related to Sudden Infant Death Syndrome and Its Risk Factors

    ERIC Educational Resources Information Center

    Kelmanson, Igor A.

    2006-01-01

    Three major components have been repeatedly implicated for the origin(s) of sudden infant death syndrome (SIDS): system, minor sickness and surroundings. All these factors also frame infant temperament, and therefore it seems logical to suppose that the babies who either succumb to or are at risk of SIDS may present with certain behavioral…

  1. Risk Factors of Sudden Infant Death Syndrome and Risk Factors for Sleep Disturbances

    ERIC Educational Resources Information Center

    Kelmanson, Igor A.

    2011-01-01

    Relationship between major risk factors of sudden infant death syndrome (SIDS) and sleep disorders in the infants is the subject of review and discussion. Improper micro-environmental characteristics (especially poor environmental organisation and lack of developmental stimulation), pre-term delivery and/or infant low birth weight, prone sleep…

  2. CAP2 in cardiac conduction, sudden cardiac death and eye development.

    PubMed

    Field, Jeffrey; Ye, Diana Z; Shinde, Manasi; Liu, Fang; Schillinger, Kurt J; Lu, MinMin; Wang, Tao; Skettini, Michelle; Xiong, Yao; Brice, Angela K; Chung, Daniel C; Patel, Vickas V

    2015-11-30

    Sudden cardiac death kills 180,000 to 450,000 Americans annually, predominantly males. A locus that confers a risk for sudden cardiac death, cardiac conduction disease, and a newly described developmental disorder (6p22 syndrome) is located at 6p22. One gene at 6p22 is CAP2, which encodes a cytoskeletal protein that regulates actin dynamics. To determine the role of CAP2 in vivo, we generated knockout (KO) mice. cap2(-)/cap2(-) males were underrepresented at weaning and ~70% died by 12 weeks of age, but cap2(-)/cap2(-) females survived at close to the expected levels and lived normal life spans. CAP2 knockouts resembled patients with 6p22 syndrome in that mice were smaller and they developed microphthalmia and cardiac disease. The cardiac disease included cardiac conduction disease (CCD) and, after six months of age, dilated cardiomyopathy (DCM), most noticeably in the males. To address the mechanisms underlying these phenotypes, we used Cre-mediated recombination to knock out CAP2 in cardiomyocytes. We found that the mice developed CCD, leading to sudden cardiac death from complete heart block, but no longer developed DCM or the other phenotypes, including sex bias. These studies establish a direct role for CAP2 and actin dynamics in sudden cardiac death and cardiac conduction disease.

  3. CAP2 in cardiac conduction, sudden cardiac death and eye development

    PubMed Central

    Field, Jeffrey; Ye, Diana Z.; Shinde, Manasi; Liu, Fang; Schillinger, Kurt J.; Lu, MinMin; Wang, Tao; Skettini, Michelle; Xiong, Yao; Brice, Angela K.; Chung, Daniel C.; Patel, Vickas V.

    2015-01-01

    Sudden cardiac death kills 180,000 to 450,000 Americans annually, predominantly males. A locus that confers a risk for sudden cardiac death, cardiac conduction disease, and a newly described developmental disorder (6p22 syndrome) is located at 6p22. One gene at 6p22 is CAP2, which encodes a cytoskeletal protein that regulates actin dynamics. To determine the role of CAP2 in vivo, we generated knockout (KO) mice. cap2−/cap2− males were underrepresented at weaning and ~70% died by 12 weeks of age, but cap2−/cap2− females survived at close to the expected levels and lived normal life spans. CAP2 knockouts resembled patients with 6p22 syndrome in that mice were smaller and they developed microphthalmia and cardiac disease. The cardiac disease included cardiac conduction disease (CCD) and, after six months of age, dilated cardiomyopathy (DCM), most noticeably in the males. To address the mechanisms underlying these phenotypes, we used Cre-mediated recombination to knock out CAP2 in cardiomyocytes. We found that the mice developed CCD, leading to sudden cardiac death from complete heart block, but no longer developed DCM or the other phenotypes, including sex bias. These studies establish a direct role for CAP2 and actin dynamics in sudden cardiac death and cardiac conduction disease. PMID:26616005

  4. Iodine-123-metaiodobenzylguanidine scintigraphy in risk stratification of sudden death in heart failure.

    PubMed

    Martins da Silva, Marta Inês; Vidigal Ferreira, Maria João; Morão Moreira, Ana Paula

    2013-06-01

    Metaiodobenzylguanidine (MIBG) is a false neurotransmitter noradrenaline analogue that is taken up by the 'uptake 1' transporter mechanism in the cell membrane of presynaptic adrenergic neurons and accumulates in catecholamine storage vesicles. Since it is practically unmetabolized, it can be labeled with a radioisotope (iodine-123) in scintigraphic exams to noninvasively assess the functional status of the sympathetic innervation of organs with a significant adrenergic component, including the heart. Studies of its application in nuclear cardiology appear to confirm its value in the assessment of conditions such as coronary artery disease, heart failure, arrhythmias and sudden death. Heart failure is a global problem, with an estimated prevalence of 2% in developed countries. Sudden cardiac death is the main cause of its high mortality. The autonomic nervous system dysfunction, including sympathetic hyperactivity, that accompanies chronic heart failure is associated with progressive myocardial remodeling, declining left ventricular function and worsening symptoms, and contributes to the development of ventricular arrhythmias and sudden death. Since 123I-MIBG cardiac scintigraphy can detect changes in the cardiac adrenergic system, there is considerable interest in its role in obtaining diagnostic and prognostic information in patients with heart failure. In this article we present a literature review on the use of 123I-MIBG scintigraphy for risk stratification of sudden death in patients with heart failure.

  5. A method for determining the severity of Sudden Death Syndrome in soybeans

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden death syndrome (SDS), caused by the fungus Fusarium virguliforme, is a widespread mid- to late- season soybean disease with distinctive foliar symptoms that in some extreme cases may cause nearly 100% yield loss. This article reports on the development of an image analysis method to quantify ...

  6. Cardiovascular Risk Factors in Primary Relatives of Sudden Cardiac Death Victims

    DTIC Science & Technology

    1991-01-01

    hypertriglyceridemia and hypertension as risk factors in relatives of sudden death victims. The sample for both studies will be the same. 5 Chapter II The...student, Nicole Pashek, who will examine upper body obesity, glucose intolerance, hypertriglyceridemia , and hypertension as cardiovascular risk factors

  7. Greenhouse Inoculation Methods for Evaluating Resistance of Soybean to Sudden Death Syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden death syndrome (SDS) caused by the soil borne fungus Fusarium solani f. sp. glycines (FSG) (syn. Fusarium virguliforme Akoi, O’Donnell, Homma and Lattanzi), is a major disease in soybean [Glycine max (L.) Merr.]. Selection for SDS resistance in the field is difficult because of the impact of ...

  8. First Report of Sexual Reproduction by the Soybean Sudden Death Syndrome Pathogen Fusarium tucumaniae in Nature

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Of the four fusaria that have been shown to cause soybean sudden death syndrome (SDS), field surveys indicate that Fusarium tucumaniae is the most important and genetically diverse SDS pathogen in Argentina. Although none of the SDS fusaria have been shown to produce perithecia in nature, a heteroth...

  9. Genome-wide association mapping of quantitative resistance to sudden death syndrome in soybean

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden death syndrome (SDS) is a serious threat to soybean production that can be controlled by host plant resistance. To dissect the genetic architecture of quantitative resistance to the disease in soybean, two independent association panels of soybean elite cultivar, consisting of 392 and 300 uni...

  10. Standardizing the Nomenclature for Clonal Lineages of the Sudden Oak Death Pathogen, Phytophthora ramorum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Phytophthora ramorum, the causal agent of sudden oak death and ramorum blight, is known to exist as three distinct clonal lineages based on a range of molecular marker systems. However, in the recent literature there exists no consensus on naming of lineages. Here we name clonal lineages of P. ramor...

  11. Arrhythmias, Sudden Cardiac Death and incapacitation of pilots

    PubMed Central

    Mantziari, L; Styliadis, C; Kourtidou-Papadeli, C; Styliadis, I

    2008-01-01

    Inflight medical emergencies occur at a rate of 20 to 100 per million passengers, with a death rate of 0.1 to 1 per million. Cardiac, neurologic, and respiratory complaints comprise the more serious emergencies, as defined by aircraft diversion or use of ground-based medical assistance. In this paper, we review changes seen in the resting electrocardiogram in normal individuals exposed to high altitude, alongside important implications for patients with heart diseases in high altitude exposures and the possible effects of high altitude to permanent cardiac pacemakers. Arrhythmias in pilots and public safety are revisited together with the guidelines of the Joint Aviation Requirements (JAR) in Europe. The situation of Military flights is also discussed. Physicians ought to become knowledgeable about the specific medical job standards for their patients when asked to render opinions regarding fitness to fly. A database must be established to obtain prospective data that defines the risk of accidents in patients who are or were being treated for arrhythmias. Current guidelines could then be updated and revised as appropriate. PMID:19050752

  12. Leaky RyR2 channels unleash a brainstem spreading depolarization mechanism of sudden cardiac death

    PubMed Central

    Aiba, Isamu; Wehrens, Xander H. T.; Noebels, Jeffrey L.

    2016-01-01

    Cardiorespiratory failure is the most common cause of sudden unexplained death in epilepsy (SUDEP). Genetic autopsies have detected “leaky” gain-of-function mutations in the ryanodine receptor-2 (RyR2) gene in both SUDEP and sudden cardiac death cases linked to catecholaminergic polymorphic ventricular tachycardia that feature lethal cardiac arrhythmias without structural abnormality. Here we find that a human leaky RyR2 mutation, R176Q (RQ), alters neurotransmitter release probability in mice and significantly lowers the threshold for spreading depolarization (SD) in dorsal medulla, leading to cardiorespiratory collapse. Rare episodes of sinus bradycardia, spontaneous seizure, and sudden death were detected in RQ/+ mutant mice in vivo; however, when provoked, cortical seizures frequently led to apneas, brainstem SD, cardiorespiratory failure, and death. In vitro studies revealed that the RQ mutation selectively strengthened excitatory, but not inhibitory, synapses and facilitated SD in both the neocortex as well as brainstem dorsal medulla autonomic microcircuits. These data link defects in neuronal intracellular calcium homeostasis to the vulnerability of central autonomic brainstem pathways to hypoxic stress and implicate brainstem SD as a previously unrecognized site and mechanism contributing to premature death in individuals with leaky RYR2 mutations. PMID:27482086

  13. Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

    PubMed Central

    Sowers, Levi P.; Massey, Cory A.; Gehlbach, Brian K.; Granner, Mark A.; Richerson, George B.

    2015-01-01

    Sudden unexplained death in epilepsy (SUDEP) is the cause of premature death of up to 17% of all patients with epilepsy and as many as 50% with chronic refractory epilepsy. However, SUDEP is not widely recognized to exist. The etiology of SUDEP remains unclear, but growing evidence points to peri-ictal respiratory, cardiac, or autonomic nervous system dysfunction. How seizures affect these systems remains uncertain. Here we focus on respiratory mechanisms believed to underlie SUDEP. We highlight clinical evidence that indicates peri-ictal hypoxemia occurs in a large percentage of patients due to central apnea, and identify the proposed anatomical regions of the brain governing these responses. In addition, we discuss animal models used to study peri-ictal respiratory depression. We highlight the role 5-HT neurons play in respiratory control, chemoreception, and arousal. Finally, we discuss the evidence that 5-HT deficits contribute to SUDEP and sudden infant death syndrome and the striking similarities between the two. PMID:23707877

  14. Idiopathic Infantile Arterial Calcification: A Rare Cause of Sudden Unexpected Death in Childhood

    PubMed Central

    Guimarães, Susana; Lopes, José Manuel; Oliveira, José Bessa; Santos, Agostinho

    2010-01-01

    Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC) is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis) were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death. PMID:21151691

  15. Sudden fetal death due to dualism of the sino-atrial node.

    PubMed

    Pusiol, Teresa; Roncati, Luca; Lavezzi, Anna Maria; Taddei, Fabrizio; Piscioli, Francesco; Ottaviani, Giulia

    2016-01-01

    First, we report a sudden fetal death at 33(+3)weeks due to sino-atrial node dualism. The female stillborn was delivered by induced labor. The postmortem examination of the cardiac conduction system revealed a dualism of the sino-atrial node, associated with fragmentation of the atrio-ventricular node and His bundle. These abnormalities of the cardiac conduction system represent the morphological substrate for the development of malignant arrhythmias. In particular, the dualism of the sino-atrial node can cause the dissociation of the longitudinal nodal impulse into two distinct ways of different pulse generation, resulting in supraventricular tachyarrhythmias. This observation suggests new avenues of research on the pathogenesis of the sudden unexpected fetal death. Moreover, our findings confirm the need for an accurate postmortem examination, including serial sectioning of the cardiac conduction system, in every case of unexplained fetal death, following standardized autoptic protocols.

  16. Next-Generation Sequencing in Post-mortem Genetic Testing of Young Sudden Cardiac Death Cases

    PubMed Central

    Lahrouchi, Najim; Behr, Elijah R.; Bezzina, Connie R.

    2016-01-01

    Sudden cardiac death (SCD) in the young (<40 years) occurs in the setting of a variety of rare inherited cardiac disorders and is a disastrous event for family members. Establishing the cause of SCD is important as it permits the pre-symptomatic identification of relatives at risk of SCD. Sudden arrhythmic death syndrome (SADS) is defined as SCD in the setting of negative autopsy findings and toxicological analysis. In such cases, reaching a diagnosis is even more challenging and post-mortem genetic testing can crucially contribute to the identification of the underlying cause of death. In this review, we will discuss the current achievements of “the molecular autopsy” in young SADS cases and provide an overview of key challenges in assessing pathogenicity (i.e., causality) of genetic variants identified through next-generation sequencing. PMID:27303672

  17. Sudden Cardiac Death in a Case of Non-Dominant Coronary Artery Obstruction Without Depressed Left Ventricular Function

    PubMed Central

    Chen, Hung Yi

    2013-01-01

    Acute myocardial infarction complicated with lethal cardiac arrhythmia remains the major cause of sudden death. The possible clinical presentation leading to lethal ventricular arrhythmia has been demonstrated but the data are limited. The previous study revealed no significant correlation between sudden cardiac death and the location of coronary obstruction site. And the possible mechanism of sudden cardiac death in non-dominant coronary artery obstruction is unclear. We presented a case of acute myocardial infarction with mid left circumflex artery occlusion complicated with new onset atrial fibrillation initially. The rhythm degenerated into ventricular fibrillation immediately and sudden cardiac death occurred. After resuscitation, he received coronary angioplasty, and the rhythm recovered to sinus after the occluded coronary artery reopened. We thick new onset atrial fibrillation could be a potential risk factor leading to sudden death in acute myocardial infarction with obstruction of non-dominant coronary artery. Control of ventricular rate and early restoration of sinus rhythm may be potential benefit.

  18. [Medico-legal investigation of Sudden Infant Death Syndrome (SIDS): differential diagnosis between natural and unnatural death].

    PubMed

    Ventura, F; Portunato, F; Celesti, R

    2010-04-01

    The sudden infant death syndrome (SIDS) is the sudden dead of every infant or small child (usually within the first year of life). It is an unexpected event, according to the anamnesis of the subject, and the necroscopic examination of the event does not allow to demonstrate with success the proper cause of death. The careful forensic medical appraisal of the death scene and the clinician and anamnestic data, together with the anatomoistopatologic findings, are essential elements to make a correct diagnosis and discriminate between natural and violent causes of death, even if with remarkable interpretative difficulties. Only in rare cases (with variable statistical data), in spite of the scrupulous application of the surveying protocol, it is not possible to define the exact cause of the death. In these cases, generally characterized by an unspecific anossic anatomopathologic picture, the accepted diagnosis of death is exactly that of SIDS, reasoning by elimination. The study of the phenomenon must be based on a multidisciplinary approach, in which the legal surgeon's cooperation with other specialists, such as the anatomopathologist and the pediatrician, plays an important role.

  19. Sudden unexpected death in epilepsy or voodoo heart: analysis of heart/brain connections.

    PubMed

    Moghimi, Narges; Lhatoo, Samden D

    2013-12-01

    Sudden unexpected death in epilepsy (SUDEP) affects up to 5000 patients a year in the United States alone. The exact pathophysiologic processes of are unknown. Profound autonomic dysregulation driving cardiac and respiratory dysfunction is likely. Available evidence from monitored deaths suggests that fatal tachyarrhythmias are not primarily responsible although near deaths due to ventricular arrhythmias have been reported. Genetic "neuro-cardiac" channelopathies affecting brain function, central respiratory processes, and cardiac rhythm have been hypothesized. These, as well as serotonergic mechanisms affecting brainstem homeostasis of cardiac and respiratory function are important areas of current and future SUDEP research.

  20. Sudden death after intravenous administration of a perflutren contrast agent: a case of pseudocomplication?

    PubMed

    Mahjoub, Haïfa; Roméo, Philippe; Leung, Tack-Ki; Burelle, Denis; Cartier, Raymond; Basmadjian, Arsène J

    2009-06-01

    Perflutren cardiac ultrasound agents improve diagnostic accuracy in patients whose imaging is technically difficult. This report describes a case of sudden death approximately 5 minutes after the intravenous administration of 0.5 mL of perflutren contrast agent (Definity) during transthoracic echocardiography with suboptimal baseline images performed 10 days after coronary artery bypass graft surgery because of hypotension and tachycardia in a 73-year-old patient with severe left ventricular systolic dysfunction. Autopsy did not reveal a clear direct relationship between perflutren and death. This is the first reported case of death related temporally to an echocardiographic contrast agent occurring in Canada and could represent a case of pseudocomplication.

  1. [Sudden Cardiac Death of Young Persons: Risk Factors, Causes, Morphological Equivalents].

    PubMed

    Shilova, M A; Mamedov, M N

    2015-01-01

    The article contains literature review on the problem of causes of sudden cardiac death (SCD) among young people as well as results of author's own retrospective study of deaths of persons before 39 years based on forensic autopsies performed during 10 year period. The study of structure and dynamics of causes of death, its risk factors and the role of connective tissue dysplasia in development of terminal symptomocomlexes allowed to establish that main mechanism of SCD in young people was arrhythmogenic developing as a response to provoking factors--physical effort, psychoemotional stress, consumption of light alcoholic beverages.

  2. Infant Botulism Acquired from Household Dust Presenting as Sudden Infant Death Syndrome

    PubMed Central

    Nevas, Mari; Lindström, Miia; Virtanen, Antti; Hielm, Sebastian; Kuusi, Markku; Arnon, Stephen S.; Vuori, Erkki; Korkeala, Hannu

    2005-01-01

    Clostridium botulinum type B was detected by multiplex PCR in the intestinal contents of a suddenly deceased 11-week-old infant and in vacuum cleaner dust from the patient's household. C. botulinum was also isolated from the deceased infant's intestinal contents and from the household dust. The genetic similarity of the two isolates was demonstrated by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, thereby confirming that dust may act as a vehicle for infant botulism that results in sudden death. PMID:15635031

  3. Infant botulism acquired from household dust presenting as sudden infant death syndrome.

    PubMed

    Nevas, Mari; Lindström, Miia; Virtanen, Antti; Hielm, Sebastian; Kuusi, Markku; Arnon, Stephen S; Vuori, Erkki; Korkeala, Hannu

    2005-01-01

    Clostridium botulinum type B was detected by multiplex PCR in the intestinal contents of a suddenly deceased 11-week-old infant and in vacuum cleaner dust from the patient's household. C. botulinum was also isolated from the deceased infant's intestinal contents and from the household dust. The genetic similarity of the two isolates was demonstrated by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, thereby confirming that dust may act as a vehicle for infant botulism that results in sudden death.

  4. Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics

    PubMed Central

    Roohi, Fereydoon; Gropen, Toby; Kula, Roger W.

    2014-01-01

    Background: Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and SUD in CM1 and the possibility that the adverse effects of opiate analgesics likely were the leading cause of death in our patient. Case Description: In this review, we present a 29-year-old male with worsening headache secondary to previously diagnosed CM1. The patient died suddenly and unexpectedly after administration of common and therapeutic doses of narcotic analgesics for the management of pain. Conclusion: The mechanism(s) of acute neurological deterioration and sudden death in patients with CM1 remains poorly understood. We believe the rapid fatal deterioration in our patient following administration of opioids suggests that this category of medication may cause sudden unexpected “neurogenic” cardiac death in CM1 patients by inducing sleep-related breathing difficulties and associated hypercapnia. Hypercapnia by further increasing intracranial pressure can result in a sudden pressure-induced decompensation of the cardiopulmonary control centers in the brain stem and cause instantaneous cardiorespiratory arrest. PMID:24778905

  5. [Abortion].

    PubMed

    Nunes, J P

    1998-01-01

    Abortion is the interruption of a dynamic process in a final and irreversible form. The legalization of abortion is applied to human ontogenesis, that is, the development of the human being. However, the embryo that is growing in the uterus is not a human being because a human being is a complex organism with differentiated systems, its own identity and intrinsic autonomy in its process of development. There are basically four levels of the analysis of the problem of abortion: 1) fundamental emotional arguments; 2) profound ignorance of technical and scientific facts; 3) rational positions obfuscated by the dramatic intensity of everyday situations; and 4) the conjunction of deliberated position where culpability is avoided with solidarity for all subjects of the process with a socially oriented view. The phenomenon of abortion from an epidemiological point of view summons the facts with which it is associated: poverty, illiteracy, shortage or lack of community health resources, absence of centers for adolescents, degradation of the environment, and precariousness of employment.

  6. Occurrence of specific environmental risk factors in brain tissues of sudden infant death and sudden intrauterine unexpected death victims assessed with gas chromatography-tandem mass spectrometry.

    PubMed

    Termopoli, Veronica; Famiglini, Giorgio; Palma, Pierangela; Magrini, Laura; Cappiello, Achille

    2015-03-01

    Sudden infant death syndrome (SIDS) and sudden intrauterine unexpected death syndrome (SIUDS) are an unresolved teaser in the social-medical and health setting of modern medicine and are the result of multifactorial interactions. Recently, prenatal exposure to environmental contaminants has been associated with negative pregnancy outcomes, and verification of their presence in fetal and newborn tissues is of crucial importance. A gas chromatography-tandem mass spectrometry (MS/MS) method, using a triple quadrupole analyzer, is proposed to assess the presence of 20 organochlorine pesticides, two organophosphate pesticides, one carbamate (boscalid), and a phenol (bisphenol A) in human brain tissues. Samples were collected during autopsies of infants and fetuses that died suddenly without any evident cause. The method involves a liquid-solid extraction using n-hexane as the extraction solvent. The extracts were purified with Florisil cartridges prior to the final determination. Recovery experiments using lamb brain spiked at three different concentrations in the range of 1-50 ng g(-1) were performed, with recoveries ranging from 79 to 106%. Intraday and interday repeatability were evaluated, and relative standard deviations lower than 10% and 18%, respectively, were obtained. The selectivity and sensitivity achieved in multiple reaction monitoring mode allowed us to achieve quantification and confirmation in a real matrix at levels as low as 0.2-0.6 ng g(-1). Two MS/MS transitions were acquired for each analyte, using the Q/q ratio as the confirmatory parameter. This method was applied to the analysis of 14 cerebral cortex samples (ten SIUDS and four SIDS cases), and confirmed the presence of several selected compounds.

  7. Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope?

    PubMed Central

    Kiuchi, Márcio G.; Mion, Decio

    2015-01-01

    Several studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known. PMID:27069851

  8. The mystery of Gustave Flaubert's death: could sudden unexpected death in epilepsy be part of the context?

    PubMed

    Albuquerque, Marly de; Scorza, Carla A; Arida, Ricardo M; Cavalheiro, Esper A; Scorza, Fulvio A

    2009-06-01

    Epilepsy is the most common serious neurological condition and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Information concerning risk factors for SUDEP is conflicting, but high seizure frequency is a potential risk factor. Additionally, potential pathomechanisms for SUDEP are unknown, but it is very probable that cardiac arrhythmias during and between seizures or transmission of epileptic activity to the heart via the autonomic nervous system potentially play a role. More than two decades ago, temporal lobe epilepsy was suggested as having been the ''nervous disease'' of Gustave Flaubert, one of the most important French novelists. In these lines, as the circumstances of his death were the subject of fabulous and mysterious speculations, we postulated in this paper that Flaubert's death could be due SUDEP phenomenon.

  9. Unexpected and sudden death due to undiagnosed medulloblastoma in twin pregnancy: A case report.

    PubMed

    Ventura, Francesco; Barranco, Rosario; Gentile, Raffaella; Vergani, Patrizia

    2016-09-01

    The authors describe an unusual case of sudden and unexpected death caused by a medulloblastoma in a woman aged 28, native of South America, at the 33rd week of twin pregnancy, with neurological signs appeared a month before death. The initial symptoms were attributed to epiphenomena of pregnancy. Two weeks after hospitalization, the woman showed an acute frontal headache that prevented movement and caused a rapid lowering of arterial oxygen saturation. The patient died around 3h later, despite resuscitation. Immediately after, a caesarean section was performed but it was not enough to prevent the death of the two foetuses. The autopsy revealed the presence of a tumour between the left lobe of the cerebellum and the vermis. Histological examination enabled to identify a medulloblastoma. Death was attributed to acute cardio-respiratory insufficiency caused by compression of the brain stem. Foetuses showed no malformation and their death was due to an acute hypoxia resulting from the mother cardiovascular arrest.

  10. Weather and the risk of sudden infant death syndrome: the effect of wind

    PubMed Central

    Macey, P; Schluter, P; Ford, R

    2000-01-01

    STUDY OBJECTIVE—To examine and identify relations between sudden infant death syndrome (SIDS) and wind, particularly the föhn wind, in Christchurch, New Zealand.
DESIGN—A retrospective epidemiological study combining details of regional hourly meteorological variables and reported SIDS cases.
SETTING—Christchurch, New Zealand, between 1968 and 1997 inclusively.
PARTICIPANTS—All 646 infants reported as dying from SIDS within the greater Christchurch region.
MAIN RESULTS—Analysis of 1968-1989 data revealed nine wind variables significantly related to SIDS. When compared with corresponding variables calculated over the 1990-1997 period, only the northerly wind on the day of death and the southerly wind three days before a SIDS death had estimated associations with similar effect size and sign. However, both these variables had confidence intervals that included unity.
CONCLUSIONS—No evidence was found to suspect that föhn winds influenced SIDS occurrence. The relations identified between SIDS incidence and wind, after controlling for the effects of temperature and trend, were tenuous and relatively small. More data are necessary to substantiate whether northerly winds on the day of death or southerly winds occurring three days before a death are truly associated with SIDS. It seems that wind has little, if any effect on SIDS incidence in Christchurch.


Keywords: sudden infant death syndrome; weather; föhn wind PMID:10814652

  11. Forensic Pathological Study of 1656 Cases of Sudden Cardiac Death in Southern China

    PubMed Central

    Wu, Qiuping; Zhang, Liyong; Zheng, Jinxiang; Zhao, Qianhao; Wu, Yeda; Yin, Kun; Huang, Lei; Tang, Shuangbo; Cheng, Jianding

    2016-01-01

    Abstract Sudden cardiac death (SCD) is progressively threatening the lives of young people throughout the world. We conducted a retrospective study of SCD cases identified among sudden death cases based on comprehensive autopsies and pathological examinations in the Center for Medicolegal Expertise of Sun Yat-Sen University to investigate the exact etiological distribution and epidemiological features of SCD. One thousand six hundred fifty-six cases were identified, and SCD accounted for 43.0% of these sudden death cases. The mean age of the SCD cases—where the data of definite ages were accessible—was 38.2 years, and the highest incidence occurred among the 31- to 40-year-old cases (25.6%). The male-to-female ratio among SCD cases was 4.3:1, and this ratio peaked in the 41- to 50-year-old group (7.7:1). The places of death were confirmed in 1411 cases, and predominantly in hospitals (46.3%) and at home (33.8%). SCD occurred throughout the year with a marginally increase in April and May. The major causes of SCD were coronary atherosclerotic disease (CAD, 41.6%), unexplained sudden death (15.1%), and myocarditis (11.8%). Our data indicated that in the age group of younger affected persons (below 35 years old), sudden unexplained death and myocarditis were much more prevalent than CAD. According to anatomical examinations of the CAD-related SCD cases, the proportion of cases with coronary artery stenosis exceeding 75% (grade IV) was 67.2%. Moreover, the percentages of higher grades of coronary atherosclerosis increased with age. Among all branches of the coronary arteries, the left anterior descending branch was the most prone to atherosclerosis; atherosclerosis was present in this branch in 95.4% of the cases with atherosclerosis. Additionally, lesions of multiple branches of the coronary artery were associated with ageing. This is the first study to report the causes of death and basic epidemiological data related to SCD in Southern China. PMID:26844513

  12. Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death.

    PubMed

    Sabageh, Donatus; Odujoko, Oluwole Olaniyi; Komolafe, Akinwumi Oluwole

    2012-04-01

    Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.

  13. Correlations between CCN1 immunoexpression and myocardial histologic lesions in sudden cardiac death.

    PubMed

    Papetta, Angela; Gakiopoulou, Hariklia; Agapitos, Emmanouil; Patsouris, Efstratios S; Lazaris, Andreas C

    2013-06-01

    CCN1 (CYR61) is a member of the CCN family of secreted matricellular proteins; it can regulate the expression of genes involved in angiogenesis and matrix remodeling. The latter mechanisms seem to be of vital importance in the pathophysiology of sudden cardiac death. We performed an immunohistochemical analysis on 62 cardiac tissue specimens derived from individuals of young and middle age who had died of sudden cardiac death. CCN1 immunopositivity was detected in 80.6% of all specimens. Semiquantitative statistical analysis of the staining results revealed that CCN1 immunoreactivity was significantly associated with ischemic morphology and hypertrophy of myocardial fibers, interstitial edema, and atheromatosis of coronary arteries in more than 10% of the myocardial fibers. Taking the previously mentioned correlations into account, ischemia seems to induce myocardial expression of CCN1; therefore, CCN1 immunostaining could be evaluated as a complementary tool in the assessment of ischemic areas when no tissue evidence of necrosis is available.

  14. Sudden unexpected death in epilepsy: some approaches for its prevention and medico-legal consideration.

    PubMed

    Verma, Archana; Kumar, Alok

    2015-09-01

    Worldwide, mortality associated with epilepsy is a matter of grave concern. The mortality rate in epileptic population is two to three times more than that of the general population. Sudden unexplained death in epilepsy, better known as sudden unexpected death in epilepsy (SUDEP), is a mysterious and rare condition, in which typically young or middle-aged people with epilepsy die without a clearly defined cause. At times, this may raise a strong suspicion of foul play and raise several medico-legal issues. There may be several different underlying mechanisms but most research has focused on seizure-related cerebral and respiratory depression, cardiac arrhythmia and autonomic dysfunction. In recent years, some significant risk factors have been recognized and strategies have been suggested that could be useful in prevention of SUDEP. Present communication provides some of the updates on new advances in prevention of SUDEP as well as highlights related medico-legal issues.

  15. Predicting sudden cardiac death from T wave alternans of the surface electrocardiogram: promise and pitfalls

    NASA Technical Reports Server (NTRS)

    Rosenbaum, D. S.; Albrecht, P.; Cohen, R. J.

    1996-01-01

    Sudden cardiac death remains a preeminent public health problem. Despite advances in preventative treatment for patients known to be at risk, to date we have been able to identify, and thus treat, only a small minority of these patients. Therefore, there is a major need to develop noninvasive diagnostic technologies to identify patients at risk. Recent studies have demonstrated that measurement of microvolt-level T wave alternans is a promising technique for the accurate identification of patients at risk for ventricular arrhythmias and sudden cardiac death. In this article, we review the clinical data establishing the relationship between microvolt T wave alternans and susceptibility to ventricular arrhythmias. We also review the methods and technology that have been developed to measure microvolt levels of T wave alternans noninvasively in broad populations of ambulatory patients. In particular, we examine techniques that permit the accurate measurement of T wave alternans during exercise stress testing.

  16. Asbestos bodies in children's lungs. An association with sudden infant death syndrome and bronchopulmonary dysplasia

    SciTech Connect

    Haque, A.K.; Kanz, M.F.

    1988-05-01

    Lungs from 46 autopsied children (age range, 1 to 27 months) were examined for asbestos bodies using a bleach-digestion extraction technique. Ten (21.7%) of 46 children had asbestos bodies in their lungs. Of these ten children, seven were diagnosed with sudden infant death syndrome, and three were diagnosed with bronchopulmonary dysplasia. Thus, 46.6% of children with sudden infant death syndrome and 42.8% of children with bronchopulmonary dysplasia had asbestos bodies. Impaired lung-clearing mechanisms due to either abnormal lung physiology or reorganization of pulmonary architecture may be significant in the formation of asbestos bodies. Additionally, children with asbestos bodies may have been exposed to higher ambient levels of asbestos and other pollutants.

  17. Sudden death in an infant resulting from torsion of the uterine adnexa.

    PubMed

    Havlik, Dean M; Nolte, Kurt B

    2002-09-01

    A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.

  18. Substance P/Neurokinin 1 and Trigeminal System: A Possible Link to the Pathogenesis in Sudden Perinatal Deaths

    PubMed Central

    Mehboob, Riffat

    2017-01-01

    Sudden demise of a healthy fetus or a neonate is a very tragic episode in the life of parents. These deaths have been a mystery since ages but still remain unexplained. This review proposes the involvement of trigeminal nerve, neurotransmitter substance P (SP), and its receptor neurokinin 1 (NK-1R) in regulation of cardiorespiratory control in fetuses and newborns. Anomalies and immaturity of neuroregulatory systems such as trigeminal system in medulla oblongata of brainstem may provide a possible mechanism of sudden perinatal deaths. Vulnerable infants are born with respiratory center immaturity which in combination with any stressor such as cold, hypoxia, and smoking may lead to cessation of breathing and ventilatory response. SP/NK-1R may be involved in regulating the ventilatory control in neonates while it is decreased in fetal and adult life in humans, and any alterations from these may lead to irreversible sleep apnea and fatal breathing, ultimately sudden death. This review summarizes the studies performed to highlight the expression of SP or NK-1R in sudden perinatal deaths and proposes the involvement of trigeminal ganglion along with its nerve and SP/NK-1R expression alteration as one of the possible pathophysiological underlying mechanism. However, further studies are required to explore the role of SP, NK-1R, and trigeminal system in the pathogenesis of sudden infant deaths, sudden intrauterine deaths, stillbirths, and sudden deaths later in human life. PMID:28348544

  19. Does the lunar phase have an effect on sudden unexpected death in epilepsy?

    PubMed

    Terra-Bustamante, Vera C; Scorza, Carla A; de Albuquerque, Marly; Sakamoto, Américo C; Machado, Hélio R; Arida, Ricardo M; Cavalheiro, Esper A; Scorza, Fulvio A

    2009-02-01

    The incidence of sudden unexpected death in epilepsy (SUDEP) in our epilepsy unit over an 8-year period was analyzed to determine a possible association between phase of the moon and SUDEP. Analysis revealed that the number of SUDEPs was highest in full moon (70%), followed by waxing moon (20%) and new moon (10%). No SUDEPs occurred during the waning cycle. These preliminary findings suggest that the full moon appears to correlate with SUDEP.

  20. Abbreviated report of the NIH/NINDS workshop on sudden unexpected death in epilepsy

    PubMed Central

    Donner, E.J.; So, E.L.; Jacobs, M.; Nashef, L.; Noebels, J.L.; Buchhalter, J.R.

    2011-01-01

    Sudden unexpected death in epilepsy (SUDEP) is a devastating complication of epilepsy and is not rare. The NIH and National Institute of Neurological Disorders and Stroke sponsored a 3-day multidisciplinary workshop to advance research into SUDEP and its prevention. Parallel sessions were held: one with a focus on the science of SUDEP, and the other with a focus on issues related to the education of health care practitioners and people with epilepsy. This report summarizes the discussions and recommendations of the workshop, including lessons learned from investigations of sudden infant death syndrome (SIDS), sudden cardiac death, autonomic and respiratory physiology, medical devices, genetics, and animal models. Recommendations include educating all people with epilepsy about SUDEP as part of their general education on the potential harm of seizures, except in extenuating circumstances. Increasing awareness of SUDEP may facilitate improved seizure control, possibly decreasing SUDEP incidence. There have been significant advances in our understanding of the clinical and physiologic features of SIDS, sudden cardiac death, and SUDEP in both people and animals. Research should continue to focus on the cardiac, autonomic, respiratory, and genetic factors that likely contribute to the risk of SUDEP. Multicenter collaborative research should be encouraged, especially investigations with direct implications for the prevention of SUDEP. An ongoing SUDEP Coalition has been established to facilitate this effort. With the expansion of clinical, genetic, and basic science research, there is reasonable hope of advancing our understanding of SUDEP and ultimately our ability to prevent it. Neurology® 2011;76:1932–1938 PMID:21543734

  1. Posthumous reproduction and the presumption against consent in cases of death caused by sudden trauma.

    PubMed

    Collins, Rebecca

    2005-08-01

    The deceased's prior consent to posthumous reproduction is a common requirement in many common law jurisdictions. This paper critically evaluates four arguments advanced to justify the presumption against consent. It is argued that, in situations where death is caused by sudden trauma, not only is there inadequate justification for the presumption against consent, but there are good reasons to reverse the presumption. The article concludes that the precondition of prior consent may be inappropriate in these situations.

  2. Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum

    PubMed Central

    Mash, Deborah C.

    2016-01-01

    Over the past decade, the excited delirium syndrome (ExDS) has raised continued controversy regarding the cause and manner of death of some highly agitated persons held in police custody, restrained or incapacitated by electrical devices. At autopsy, medical examiners have difficulty in identifying an anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are most frequently associated with cocaine, methamphetamine, and designer cathinone abuse. Acute exhaustive mania and sudden death presents with behavioral symptoms that are identical to what is described for ExDS in psychostimulant abusers. Bell's mania or acute exhaustive mania was first described in the 1850's by American psychiatrist Luther Bell in institutionalized psychiatric patients. This rare disorder of violent mania, elevated body temperature and autonomic collapse continued to be described by others in the psychiatric literature, but with different names until the first cases of ExDS were seen at the beginning of the cocaine epidemic by medical examiners. The neurochemical pathology examination of brain tissues after death revealed a loss of dopamine transporter regulation together with increases in heat shock protein 70 (hsp70) expression as a biomarker of hyperthermia. The similarity in the behavioral symptoms between extremely agitated psychostimulant abusers and unmedicated psychiatric patients suggests that a genetic disorder that leads to dysregulated central dopamine transporter function could be a precipitating cause of the acute delirium and sudden death. While the precise cause and mechanism of lethality remains controversial, the likely whys and wherefores of sudden death of ExDS victims are seen to be

  3. A survey of the causes of sudden cardiac death in the under 35-year-age group.

    PubMed

    Quigley, F; Greene, M; O'Connor, D; Kelly, F

    2005-09-01

    CRY (Cardiac Risk in the Young) is a registered Irish charity established by parents who are bereaved as a result of sudden cardiac death. The aim of this study is to establish the incidence and causes of sudden cardiac death in Dublin city in the 10-year period from 1st January 1993 to 31st December 2002. All sudden cardiac deaths in the under 35-year age group which were reported to the city coroner in the study period were examined. Details regarding age, sex, previous symptoms, investigations, circumstances of death and main pathological finding were recorded in each case. A total of 72 cases of sudden cardiac death in the under-35 year age group were reported. 52 were men. The median age was 26.5 years (range 12-34 years). The cause of death in 20 cases was reported as atherosclerotic Coronary Artery Disease. The second commonest cause of death (24% cases) was Hypertrophic Cardiomyopathy. Hypertrophic Cardiomyopathy was the commonest cause of death under the age of 25 years. Overall atherosclerotic coronary artery disease was the commonest cause of death in this group. The importance of Hypertrophic Cardiomyopathy is highlighted by the fact it was the commonest cause of death in the under 25-year age group. Screening those at high risk of sudden cardiac death especially the relatives of those affected by Hypertrophic Cardiomyopathy need to be discussed and implemented.

  4. Modifiable Practices Associated with Sudden Death among Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study

    PubMed Central

    Thumma, Jyothi; Fuller, Douglas S.; Tentori, Francesca; Li, Yun; Morgenstern, Hal; Mendelssohn, David; Tomo, Tadashi; Ethier, Jean; Port, Friedrich; Robinson, Bruce M.

    2012-01-01

    Summary Background and objectives Sudden death is common in hemodialysis patients, but whether modifiable practices affect the risk of sudden death remains unclear. Design, setting, participants, & measurements This study analyzed 37,765 participants in 12 countries in the Dialysis Outcomes and Practice Patterns Study to explore the association of the following practices with sudden death (due to cardiac arrhythmia, cardiac arrest, and/or hyperkalemia): treatment time [TT] <210 minutes, Kt/V <1.2, ultrafiltration volume >5.7% of postdialysis weight, low dialysate potassium [KD <3]), and prescription of Q wave/T wave interval–prolonging drugs. Cox regression was used to estimate effects on mortality, adjusting for potential confounders. An instrumental variable approach was used to further control for unmeasured patient-level confounding. Results There were 9046 deaths, 26% of which were sudden (crude mortality rate, 15.3/100 patient-years; median follow-up, 1.59 years). Associations with sudden death included hazard ratios of 1.13 for short TT, 1.15 for large ultrafiltration volume, and 1.10 for low Kt/V. Compared with KD ≥3 mEq/L, the sudden death rate was higher for KD ≤1.5 and KD=2–2.5 mEq/L. The instrumental variable approach yielded generally consistent findings. The sudden death rate was elevated for patients taking amiodarone, but not other Q wave/T wave interval–prolonging drugs. Conclusions This study identified modifiable dialysis practices associated with higher risk of sudden death, including short TT, large ultrafiltration volume, and low KD. Because KD <3 mEq/L is common and easy to change, KD tailoring may prevent some sudden deaths. This hypothesis merits testing in clinical trials. PMID:22403271

  5. Electrophysiological predictors of sudden cardiac death on physical exercise test in young athletes

    NASA Astrophysics Data System (ADS)

    Balykova, L. A.; Kotlyarov, A. A.; Ivyanskiy, S. A.; Shirokova, A. A.; Miheeva, K. A.; Makarov, L. M.

    2017-01-01

    The problem of sudden death of young athletes continues to be actual. Among its reasons, primary electric myocardium diseases along with organic heart troubles (cardiomyopathies, cordites, anomalies of coronary arteries) take an important place. The most frequent variant of channelopathesis long QT syndrome (LQTS). Both inherited and acquired LQTS may be the reason of sudden cardiac death during physical activity and have to be revealed prior to sports admission. LQTS diagnostics in young athletes become problematic due to secondary exercise-related QT prolongation. Physical load test may reveal myocardium electric instability and enhance LQTS diagnostics accuracy without genetic testing. The aim was to study electrophysiological parameters of myocardium repolarization and reveal the signs of electrical instability as predictors of the life-threatening arrhythmias in young athletes during physical exercise test. In conclusion, electrophysiological myocardium parameters during physical exercise test noted to be markers of electrical myocardial instability and in combination with the other Schwartz criteria, was evidenced the inherited or acquired LQTS. QTc prolongation in athletes at the peak of exercise as well as in early recovery period were noted to be additional predictor life-threatening arrhythmias and sudden cardiac death in young athletes

  6. Sudden death in type 1 diabetes: the mystery of the 'dead in bed' syndrome.

    PubMed

    Tu, Emily; Twigg, Stephen M; Semsarian, Christopher

    2010-01-07

    Sudden cardiac death is an unpredictable and devastating event, particularly in the young. A significant proportion of sudden deaths in the young are unexplained-no cause is identified either during life or at post-mortem. This is seen in a subgroup of young patients with type 1 diabetes who have dead in bed syndrome, where these victims are in good health, retire to bed, only to be found dead the following morning in a bed which is undisturbed, suggesting no terminal struggle or seizure. The underlying cause of dead in bed syndrome remains unknown, but is likely to be due to a terminal malignant arrhythmia. A plausible hypothesis is that it may be secondary to QT interval prolongation (followed by a degenerate ventricular tachycardia), caused by a number of factors including acute hypoglycaemia, on a background of cardiac autonomic neuropathy, and possible genetic influences. It is envisaged that understanding the causes and triggers of dead in bed syndrome will allow appropriate therapeutic interventions to be initiated in high-risk patients with type 1 diabetes, with the ultimate goal to prevent sudden death.

  7. Magnetocardiography in the evaluation of fetuses at risk for sudden cardiac death before birth

    PubMed Central

    Cuneo, Bettina F.; Strasburger, Janette F.; Wakai, Ronald T.

    2012-01-01

    Background We hypothesized that fetuses at risk for sudden death may have abnormal conduction or depolarization, ischemia, or abnormal heart rate variability (HRV) detectable by magnetocardiography. Methods Using a 37-channel biomagnetometer, we evaluated 3 groups of fetuses at risk for sudden death: group 1, critical aortic stenosis (AS); group 2, arrhythmias; and group 3, heart failure and in utero demise. Five to 10 recordings of 10-minute duration were recorded, and signal was averaged to determine rhythm, conduction intervals, HRV, and T-wave morphology. Results In group 1, 2 of 3 had atrial and ventricular strain patterns. In (n = 53) group 2, 15% had prolonged QTc and 17% had T-wave alternans (TWA). Of 23 group 2 fetuses with atrioventricular block, 74% had ventricular ectopy, 21% had junctional ectopic tachycardia, and 29% had ventricular tachycardia. Group 3 (n = 2) had abnormal HRV and TWA. Conclusion Repolarization abnormalities, unexpected arrhythmias, and abnormal HRV suggest an arrhythmogenic mechanism for “sudden cardiac death before birth.” PMID:18328335

  8. Case-control study of sudden infant death syndrome in Scotland, 1992-5.

    PubMed Central

    Brooke, H.; Gibson, A.; Tappin, D.; Brown, H.

    1997-01-01

    OBJECTIVE: To investigate the relation between routine infant care practices and the sudden infant death syndrome in Scotland. METHODS: National study of 201 infants dying of the sudden infant death syndrome (cases) and 276 controls by means of home interviews comparing methods of infant care and socioeconomic factors. RESULTS: Sleeping prone (odds ratio 6.96 (95% confidence interval 1.51 to 31.97) and drug treatment in the previous week (odds ratio 2.33 (1.10 to 4.94)) were more common in the cases than controls on multivariate analysis. Smoking was confirmed as a significant risk factor (odds ratio for mother and father both smoking 5.19 (2.26 to 11.91)). The risk increased with the number of parents smoking (P < 0.0001), with the number of cigarettes smoked by mother or father (P = 0.0001), and with bed sharing (P < 0.005). A new finding was an increased risk of dying of the syndrome for infants who slept at night on a mattress previously used by another infant or adult (odds ratio 2.51 (1.39 to 4.52)). However, this increased risk was not established for mattresses totally covered by polyvinyl chloride. CONCLUSIONS: Sleeping prone and parental smoking are confirmed as modifiable risk factors for the sudden infant death syndrome. Sleeping on an old mattress may be important but needs confirmation before recommendations can be made. PMID:9169398

  9. [Relation of baseline examination results to death from ischemic heart disease, cerebro-vascular disease and sudden death].

    PubMed

    Matsumoto, K; Ohta, T; Iwatsuka, T; Hashimoto, S; Fukutomi, K

    1991-06-01

    The relation of variables obtained from a baseline examination to death from ischemic heart disease (IHD), cerebro-vascular disease (CVD) and sudden death (SUD) was analyzed in a case-control study. From questionnaire survey of approximately 180,000 subjects who underwent baseline health examinations in 1971-1986 at Aichi prefectural center of health care, 148 deaths were selected for this study. The number of cases on IHD, CVD and SUD was 36, 60, and 52, respectively. Mean age of cases was 54.8 years old and the mean follow up interval between baseline examination and death was 3.7 years. Four controls matched according to year of baseline examination, age and sex were chosen arbitrarily for each case, and odds ratios for the three diseases were estimated. In some of the matched sets, odds ratios at a follow up examination were compared with that at the first examination. The results were as follows: 1) Variables showing positive relationships to death from each of the three diseases were hypertension, high fasting blood sugar, abnormality of cardio-thoracic ratio, ST-T abnormality in ECG, left ventricular hypertrophy in ECG. The odds ratio for ST-T abnormality in ECG was significant for all three causes of death. 2) High total cholesterol showed a significant positive relation only to death from IHD. As to death from CVD and SUD, albuminuria and sclerotic changes in fundus oculi were positively and significantly related. Risk factors differed for deaths from the three diseases. 3) In death from IHD and CVD, odds ratio at the second examination was apt to be higher than that at baseline examination. In death from SUD, however, odds ratios at the first and the second examination showed no significant difference.

  10. Identifying sudden cardiac death risk and specifying its occurrence time by analyzing electrocardiograms in natural time

    NASA Astrophysics Data System (ADS)

    Varotsos, P. A.; Sarlis, N. V.; Skordas, E. S.; Lazaridou, M. S.

    2007-08-01

    Sudden cardiac death (SCD) is a frequent cause of death and may occur even if the electrocardiogram seems to be similar to that of a healthy individual. A method which not only identifies the risk but also provides an estimate of the time of an impending cardiac arrest is proposed. Analyzing 159 electrocardiograms in natural time, the authors find that the key quantity is the entropy change under time reversal. After it becomes maximum at the scale of 13 heartbeats, ventricular fibrillation starts within ˜3h in 16 out of 18 SCDs. The method also distinguishes congestive heart failure patients from SCD.

  11. [Genetic testing of patients with cardiomyopathies, the resuscitated and victims of sudden death--new international expert recommendations].

    PubMed

    Swan, Heikki

    2012-01-01

    Recent international expert group recommendations for gene tests of myocardial or conducting system diseases as well as those concerning molecular genetic investigations of persons resuscitated after cardiac arrest or victims of sudden death are summarized. Systematic examination of an index patient forms the basis for correct clinical diagnosis and is a prerequisite for successful genetic testing. The first-degree relatives of victims of unexplained sudden death should be referred to clinical assessment due to the possibility of an inherited heart disease. Genetic testing of sudden death victims should be performed more frequently than previously, but targeting of the tests must be done on the basis of clinical data.

  12. Investigation of sudden infant deaths in the State of Maryland (1990-2000).

    PubMed

    Li, Ling; Fowler, David; Liu, Liang; Ripple, Mary G; Lambros, Zoe; Smialek, John E

    2005-03-10

    The Office of the Chief Medical Examiner (OCME) has recorded a significant decline in the deaths of sudden infant death syndrome (SIDS) in the state of Maryland since 1994. However, infants who died of accidental or non-accidental injuries remained consistent during the same time period. This report focuses on the epidemiological characteristics and scene investigation findings of infant victims who died suddenly and unexpectedly in Maryland between 1990 and 2000. A retrospective study of OCME cases between 1990 and 2000 yielded a total of 1619 infant fatalities. 802 infant deaths were determined to be SIDS, which represented 50% of the total infant deaths in our study population. Five hundred and twenty-three (31.8%) deaths were due to natural diseases, 128 (7.9%) deaths were accidents, and 74 (4.6%) were homicides. The manner of death could not be determined after a thorough scene investigation, review of history and a complete postmortem examination in 92 (5.7%) infants. SIDS deaths most often involved infants who were male and black. The peak incidence of SIDS was between 2 and 4 months of age. The majority of SIDS infants (60%) were found unresponsive on their stomach. Among SIDS infants, 269 (33.4%) were found in bed with another person or persons (bed sharing). Of the bed-sharing SIDS cases, 182 (68%) were African-American. In the past 11 years, 52 infants died of asphyxia due to unsafe sleeping environment, such as defective cribs, ill-fitting mattresses, inappropriate bedding materials. Of the 74 homicide victims, 53 (70%) involved infants less than 6 months of age. Twenty (27%) exhibited the classical abuse syndrome characterized by repeated acts of trauma to the infants.

  13. Comprehensive review of sleep-related sudden unexpected infant deaths and their investigations: Florida 2008.

    PubMed

    Sauber-Schatz, Erin K; Sappenfield, William M; Shapiro-Mendoza, Carrie K

    2015-02-01

    To describe 2008 Florida sleep-related sudden unexpected infant deaths (SUIDs) by describing (a) percentage distribution of medical examiner (ME) cause-of-death determinations; (b) mortality rates by maternal and infant characteristics; (c) prevalence of selected suffocation or sudden infant death syndrome (SIDS) risk and protective factors; (d) frequency of selected scene investigation and autopsy components (including extent of missing data); and (e) percentage with public health program contact. In this population-based study, we identified sleep-related SUIDs occurring among Florida residents from the 2008-linked Florida infant death and birth certificates. Information about the circumstances of death was abstracted from ME, law enforcement, and hospital records. We used frequencies and percentages to describe characteristics of sleep-related SUID cases. Of 215 sleep-related SUID cases, MEs identified 47.9% as accidental suffocation and strangulation in bed, 35.4% as unknown or undetermined cause, and 16.7% as SIDS. Sleep-related SUID most frequently occurred in an adult bed (n = 108; 50.2%). At death, 82.4% of sleep-related SUIDs had ≥1 suffocation or SIDS risk factor with 54.4% infants sharing a sleep surface, 38.1% placed nonsupine, 24.2% placed on a pillow, and 10.2% having head covering. Missing data frequently resulted from incomplete scene investigation and autopsy components. SUID contributed to ≥1 in seven Florida infant deaths in 2008. Approximately 80% of sleep-related SUIDs were reported among infants placed in unsafe sleeping environments. Effective interventions are needed to promote safe sleep among caregivers of Florida infants. These interventions must reach infant caregivers at highest risk and change unsafe sleep practices. The substantial percentage of missing investigation data reinforces the need for standardized reporting.

  14. Depletion of medullary serotonergic neurons in patients with multiple system atrophy who succumbed to sudden death.

    PubMed

    Tada, Mari; Kakita, Akiyoshi; Toyoshima, Yasuko; Onodera, Osamu; Ozawa, Tetsutaro; Morita, Takashi; Nishizawa, Masatoyo; Takahashi, Hitoshi

    2009-07-01

    Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by prominent autonomic failure with ataxia and/or parkinsonism. The leading cause of death in MSA is sudden death. We have shown that the early development of autonomic failure is an independent risk factor for sudden death. The depletion of sympathetic preganglionic neurons in the spinal intermediolateral cell column (IML) and its afferent medullary catecholaminergic and serotonergic neurons has been proposed to be partly responsible for autonomic failure in MSA. In this study, we investigated whether the depletion of neurons in any of these autonomic neuron groups contributes to sudden death in MSA. Out of 52 autopsy-proven patients with MSA, we selected 12 individuals who had died within 3.5 years after disease onset to define the accurate levels of slices and identify early neuropathological changes of autonomic nuclei in MSA. Four patients succumbed to sudden death and eight patients died through established causes. Serial 10 mum sections were obtained from the 8th segment of the thoracic cord and the rostral medulla oblongata. Sections from the medulla oblongata were immunostained for thyrosine hydroxylase and tryptophan hydroxylase. The total cell number in the five sections was computed for comparison. Compared with the control, the MSA group showed a marked depletion of neurons in the IML (38.0 +/- 7.1 versus 75.2 +/- 7.6 cells, P < 0.001), thyrosine hydroxylase-immunoreactive neurons in the ventrolateral medulla (VLM) (17.4 +/- 5.1 versus 72.8 +/- 13.6 cells, P < 0.01) and tryptophan hydroxylase-immunoreactive neurons in the VLM (15.6 +/- 9.2 versus 60.8 +/- 17.0 cells, P < 0.01), nucleus raphe obscurus (19.3 +/- 4.4 versus 75.3 +/- 8.6 cells, P < 0.001), nucleus raphe pallidus (2.1 +/- 2.7 versus 9.0 +/- 3.4 cells, P < 0.03), and arcuate nucleus (0.4 +/- 0.8 versus 2.3 +/- 1.5 cells, P < 0.05). Moreover, in patients who succumbed to sudden death, when compared with patients who

  15. Cardiovascular evaluation of the athlete. Issues regarding performance, screening and sudden cardiac death.

    PubMed

    Franklin, B A; Fletcher, G F; Gordon, N F; Noakes, T D; Ades, P A; Balady, G J

    1997-08-01

    Recent studies have reported ECG anomalies and a high prevalence of exercise-related arrhythmias among well trained, apparently healthy endurance athletes with superior levels of cardiorespiratory fitness. The occurrence of sudden and premature cardiac deaths in amateur and professional athletes, who appear to embody all of the virtues of health and fitness, ahs raised our consciousness regarding the underlying atherosclerotic or nonatherosclerotic causes, and the need for, and extent of, preparticipation screening in competitive athletes. It appears that strenuous physical activity may trigger acute cardiovascular events in some athletes. Coronary artery disease is the most frequent autopsy finding in those over the age of 35 years who die suddenly. In contrast, structural cardiovascular abnormalities, including hypertrophic cardiomyopathy and malformations of the coronary arteries, are the major cause of sudden death in younger athletes. This article reviews these issues, with specific reference to the assessment of cardiorespiratory fitness, legal and prohibited performance-altering medications, the pathophysiological basis of exertion-related untoward events, the athlete at risk, limitations of conventional screening programmes and contemporary recommendations to identify latent cardiovascular disease in athletic populations.

  16. Vinculin variant M94I identified in sudden unexplained nocturnal death syndrome decreases cardiac sodium current

    PubMed Central

    Cheng, Jianding; Kyle, John W.; Wiedmeyer, Brandi; Lang, Di; Vaidyanathan, Ravi; Makielski, Jonathan C.

    2017-01-01

    Sudden unexplained nocturnal death syndrome (SUNDS) remains an autopsy negative disorder with unclear etiology. Vinculin (VCL) was linked to sudden arrhythmia death in VCL knockout mice prior to the appearance of cardiomyopathy. We hypothesized VCL mutations underlie risk for SUNDS. A rare heterozygous variant VCL-M94I was found in a SUNDS victim who suffered sudden nocturnal tachypnea and lacked pathogenic variants in known arrhythmia-causing genes. VCL was identified to interact with SCN5A in vitro/vivo. The VCL-M94I was co-expressed with the cardiac sodium channel in HEK293 cells and also overexpressed in induced pluripotent stem cells derived cardiomyocytes (iPSCs-CM). In HEK293 cells with pH 7.4, VCL-M94I caused ~30% decrease in peak sodium current (INa) amplitude compared to WT; under acidotic conditions (pH 7.0) typically found with hypoxia during sleep apnea, M94I resulted in 37% reduction in peak INa compared to WT and the combination of VCL-M94I and pH 7.0 decreased peak INa by ~56% compared to WT at pH 7.4. In iPSCs-CM, similar effects of M94I on reduction of peak INa were observed. This study initially shows both physical and functional interaction between VCL and cardiac sodium channel, and suggests an important role for respiratory acidosis in triggering the fatal arrhythmia underlying SUNDS. PMID:28218286

  17. The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole, Cape Town, South Africa(,)().

    PubMed

    Dempers, Johan J; Coldrey, Jean; Burger, Elsie H; Thompson, Vonita; Wadee, Shabbir A; Odendaal, Hein J; Sens, Mary Ann; Randall, Brad B; Folkerth, Rebecca D; Kinney, Hannah C

    2016-11-01

    The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.

  18. Month of birth as an independent variable in the sudden infant death syndrome.

    PubMed

    Douglas, A S; Gupta, R; Helms, P J; Jolliffe, I T

    1997-01-01

    Well-known epidemiological features of sudden infant death syndrome (SIDS) are age at death and the increased numbers in winter. There are more SIDS deaths in late autumn/early winter and there is a seasonal rhythm of births with a peak in late summer and early autumn. The data set was 14033 SIDS deaths from Scotland, England and Wales over the 11 years 1982-92. Using log-linear models, which accounted for age at death and month of death, birth month was found to be a statistically significant risk factor for SIDS independent of age at death and winter environment (P < 0.001). Although winter season had the largest effect (relative risk 2.7 in January compared with August), the independent effect of birth month was of clinical as well as statistical significance with a relative risk for August births of 1.37 compared with those born in April. The analysis of each birth month cohort revealed a change in age distribution with infants born in early winter (December) dying at a younger age (mean 108 days) than those born in midsummer (June) (mean 146 days). Although winter season and age are the most influential factors, the substantial effect of month of birth requires explanation and points to as yet unidentified environmental influences during pregnancy.

  19. [Analysis of the sudden heart death causes in selected sample of dead].

    PubMed

    Ondrusková, J; Sovová, E; Ivanová, K; Loyka, S; Táborský, M

    2011-07-01

    Sudden cardiac death (SCD) is death from cardiac causes within one hour of the onset of symptoms. In the Czech Republic, there is no SCD registry, analyses of SCD causes are rare and there is no functional connection between the results of an autopsy on a person with SCD and examination of relatives who are at risk of a similar disease. The authors reviewed available autopsy records of the Department of Forensic Medicine and Medical Law of the University Hospital Olomouc over a specified period of time to find persons with severe coronary artery disease, heart failure or deaths from unknown causes in a specific age range. Subsequently, the available information about the circumstances of SCD was analyzed.

  20. An autopsy case of sudden unexpected death due to a glial cyst of the pineal gland.

    PubMed

    Na, Joo-Young; Lee, Kyung-Hwa; Kim, Hyung-Seok; Park, Jong-Tae

    2014-09-01

    Pineal cysts are usually asymptomatic; however, they may rarely cause symptoms such as chronic headache, paroxysmal headache with gaze paresis, postural syncope, loss of consciousness, and sudden death. A 30-year-old woman with no specific medical history except chronic headache was found collapsed in a public toilet per se. Postmortem examination revealed no external injuries or internal diseases except a cystic lesion of the pineal gland. Histologic examination showed an internal cyst surrounded by glial tissues and pineal parenchyma that was diagnosed as a glial cyst of the pineal gland. Although the pineal cyst cannot be confirmed as the cause of death, it was considered, as no other cause was evident. Herein, we report a pineal cyst considered as an assumed cause of death.

  1. GENERAL: Sudden Death, Birth and Stable Entanglement in a Two-Qubit Heisenberg XY Spin Chain

    NASA Astrophysics Data System (ADS)

    Shan, Chuan-Jia; Cheng, Wei-Wen; Liu, Tang-Kun; Liu, Ji-Bing; Wei, Hua

    2008-09-01

    Taking the decoherence effect due to population relaxation into account, we investigate the entanglement properties for two qubits in the Heisenberg XY interaction and subject to an external magnetic Geld. It is found that the phenomenon of entanglement sudden death (ESD) as well as sudden birth (ESB) appear during the evolution process for particular initial states. The influence of the external magnetic Geld and the spin environment on ESD and ESB are addressed in detail. It is shown that the concurrence, a measure of entanglement, can be controlled by tuning the parameters of the spin chain, such as the anisotropic parameter, external magnetic Geld, and the coupling strength with their environment. In particular, we Gnd that a critical anisotropy constant exists, above which ESB vanishes while ESD appears. It is also notable that stable entanglement, which is independent of different initial states of the qubits, occurs even in the presence of decoherence.

  2. Sudden death in spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type.

    PubMed

    Dias, Cristina; Cairns, Robyn; Patel, Millan S

    2009-01-01

    The spondylo-meta-epiphyseal dysplasias are an expanding group of skeletal dysplasias with specific features differentiating each subtype. We review the precocious carpal mineralization, unique metacarpal shape, triangular distal phalanges and mushroom cloud-shaped proximal phalanges present at an early age in spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type (SMED SL-AC) and report two patients with clinical and radiographic features consistent with SMED SL-AC, who died suddenly because of spinal cord compression. The patients presented are female siblings, providing further evidence for autosomal recessive inheritance. Cervical cord compression is found in half of reported patients and is the major cause of mortality. SMED SL-AC should be added to the list of genetic causes of sudden death. Radiological features in the hand may be used in the first few years of life to support an early diagnosis and thus allow for prevention of premature demise.

  3. Evidence for Infection and Inflammation in Infant Deaths in a Country with Historically Low Incidences of Sudden Infant Death Syndrome

    PubMed Central

    Törő, Klára; Vörös, Krisztina; Mészner, Zsófia; Váradi-T, Aletta; Tóth, Adrienn; Kovács, Katalin

    2015-01-01

    Total infant mortality in Hungary has been higher than other European countries; however, the reported incidence of sudden infant death syndrome (SIDS) has been lower. The low incidence of SIDS in Hungary has been supported by evidence obtained from the high rate of scene of death investigation and medico-legal autopsy mandatory since the 1950s. In this study, we compared the incidence of explained and unexplained infant deaths in Hungary for three periods: 1979–1989 when the incidence of SIDS was high in western Europe; 1990–1999 when the incidence of infant deaths was falling following introduction of the public health campaigns to reduce the risk factors associated with SIDS; and 2000–2012 to determine if introduction of Haemophilus influenzae type b or pneumococcal vaccines or introduction of an earlier immunization schedule during this period had an effect on SIDS. Explained infant deaths fell consistently during this period; however, SIDS rose during the second period when the incidence of SIDS was falling in other European countries. Evidence for infection and/or inflammation was observed for the majority of SIDS during each period. The results are discussed in relation to campaigns to reduce infant mortality in Hungary and the introduction of new vaccines and an earlier immunization schedule in 2006. PMID:26379661

  4. The relationship between state abortion-restrictions and homicide deaths among children under 5 years of age: a longitudinal study.

    PubMed

    Sen, Bisakha; Wingate, Martha Slay; Kirby, Russell

    2012-07-01

    The purpose of this study is to explore whether, in the U.S., there are associations between state-level variations in mortality among young children and state abortion restriction policies - such as parental-consent requirements, parental-notification requirements, mandatory delay laws, and restrictions on Medicaid funding for abortion. To investigate this, we used NCHS Multiple Cause of Deaths public-use data files for the period 1983-2002, and compiled data on children ages 0-4 identified as having died as a result of assault/homicide in each state and year. Medicaid funding of abortion, mandatory delay laws, and parental involvement laws for minors seeking abortions were included as the main predictor variables of interest. Multivariate count data models using pooled state-year-age cohort data, with state and time fixed effects and other state-level controls, were estimated. Results indicated that, between 1983 and 2002, the average increase in the number of homicide deaths for children under 5 years of age was 5.70 per state among states that implemented stricter abortion policies over that time, and 2.00 per state for states that did not. In the count data models, parental-consent laws were associated with a 13 percent increase in child homicide deaths; parental-notification laws were associated with an 8 percent increase in child homicide deaths though the results were less robust to alternate model specifications; mandatory delay requirements were associated with a 13 percent increase in child homicide deaths. While these data do not allow us to discern precise pathways via which state abortion-restrictions can lead to more child homicide deaths, we speculate that state restrictions on abortion may result in a disproportionate increase in children born into relatively high-risk environments. Additional research is called for to explore the association of state abortion-restrictions with other measures of infant/child health and well-being.

  5. Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.

    PubMed

    Pun, Patrick H; Middleton, John P

    2012-01-01

    Sudden cardiac death is a major problem in hemodialysis patients, and our understanding of this disease is underdeveloped. The lack of a precise definition tailored for use in the hemodialysis population limits the reliability of epidemiologic reports. Efforts should be directed toward an accurate classification of all deaths that occur in this vulnerable population. The traditional paradigm of disease pathophysiology based on known cardiac risk factors appears to be inadequate to explain the magnitude of sudden cardiac death risk in chronic kidney disease, and numerous unique cofactors and exposures appear to determine risk in this population. Well-designed cohort studies will be needed for a basic understanding of disease pathophysiology and risk factors, and randomized intervention trials will be needed before best management practices can be implemented. This review examines available data to describe the characteristics of the high-risk patient and suggests a comprehensive common sense approach to prevention using existing cardiovascular medications and reducing and monitoring potential dialysis-related arrhythmic triggers. Other unproven cardiovascular therapies such as implantable cardioverter defibrillators should be used on a case-by-case basis, with recognition of the associated hazards that these devices carry among hemodialysis patients.

  6. The genetic message of a sudden, unexpected death due to thoracic aortic dissection.

    PubMed

    Ripperger, Tim; Tröger, Hans Dieter; Schmidtke, Jörg

    2009-05-30

    Thoracic aortic aneurysms are associated with sudden, unexpected death due to dissection and/or rupture. In such cases, the latent, preceding state of aortic dilatation has often gone undiagnosed. As a consequence of the sudden unresolved death, medico-legal autopsy requested by a public prosecutor will be the consequence to establish the cause and manner of death. Usually, autopsy records do not include relevant information for differential diagnosis of heritable syndromic and non-syndromic diseases associated with thoracic aortic aneurysms/dissections (TAAD), including e.g. Marfan syndrome, Loeys-Dietz syndrome, and isolated thoracic aortic aneurysms/dissection. However, for at-risk relatives of the deceased, it could be of great benefit to be alerted to the potential heritable aetiology, because early diagnosis of the latent stage of the disease would allow preventive management. Such attempts, including recommendations to seek genetic counselling, are nevertheless rarely made in the context of medico-legal autopsies, in which primarily the legal aspects are considered. We report here on three cases to underline the practical relevance of (i) documentation of relevant information for differential diagnosis of TAAD-associated disorders, (ii) storage of unfixed tissue samples for subsequent molecular genetic testing, and most importantly (iii) the information of relatives at risk. In view of the general ethical principal of nonmaleficience, direct or indirect contact with family members of victims of possible heritable forms of TAAD should be established as a standard of care, also in the medico-legal setting.

  7. Medullary serotonin defects and respiratory dysfunction in sudden infant death syndrome.

    PubMed

    Paterson, David S; Hilaire, Gerard; Weese-Mayer, Debra E

    2009-08-31

    Sudden infant death syndrome (SIDS) is defined as the sudden and unexpected death of an infant less than 12 months of age that occurs during sleep and remains unexplained after a complete autopsy, death scene investigation, and review of the clinical history. It is the leading cause of postneonatal mortality in the developed world. The cause of SIDS is unknown, but is postulated to involve impairment of brainstem-mediated homeostatic control. Extensive evidence from animal studies indicates that serotonin (5-HT) neurons in the medulla oblongata play a role in the regulation of multiple aspects of respiratory and autonomic function. A subset of SIDS infants have several abnormalities in medullary markers of 5-HT function and genetic polymorphisms impacting the 5-HT system, informing the hypothesis that SIDS results from a defect in 5-HT brainstem-mediated control of respiratory (and autonomic) regulation. Here we review the evidence from postmortem human studies and animal studies to support this hypothesis and discuss how the pathogenesis of SIDS is likely to originate in utero during fetal development.

  8. Weight charts of infants dying of sudden infant death in England.

    PubMed

    Scheimberg, Irene; Ashal, Husna; Kotiloglu-Karaa, Esin; French, Paul; Kay, Philippa; Cohen, Marta C

    2014-01-01

    The organ weights in cases of sudden infant death syndrome (SIDS) and undetermined deaths in previously healthy infants do not correspond to "the normal range" of organ weights in international standard charts for infants currently in use in some institutions. The aim of our study was to ascertain the organ weights of infants dying suddenly and unexpectedly in England and for whom a cause of death was not found, therefore falling under the category of SIDS or undetermined. We collated the organs weights from 2 institutions covering between them the South East and North of England including London, Yorkshire, and Derbyshire. The cases from The Royal London Hospital were autopsied between 1997 and 2013, and the cases from Sheffield Children's Hospital were autopsied between 2006 and 2013. There were 188 babies who had been born at term (62 female and 126 male) and 26 ex-premature babies (15 female and 11 male). Organs of male babies were slightly heavier than those of female babies but as there was no significant differences male and female babies were considered together. Comparison with standard charts (from 1932 and 1962) and with more recent charts confirmed the discrepancy between the older charts commonly in use with more recent measurements, including ours. The main reason for these differences is that babies in the recent charts were previously healthy babies with no long term disease and improved in the health of the population.

  9. Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

    PubMed Central

    Alexander, Janice

    2010-01-01

    Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks. PMID:20559634

  10. Prolonged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death?

    PubMed Central

    Bellavere, F; Ferri, M; Guarini, L; Bax, G; Piccoli, A; Cardone, C; Fedele, D

    1988-01-01

    Twenty four men with insulin dependent diabetes and different degrees of autonomic neuropathy were studied to establish the response of the QT interval to various heart rates. Nine men with autonomic neuropathy had a longer QT interval than 13 healthy individuals and 15 patients who had diabetes without, or with only mild, autonomic neuropathy. Those with autonomic neuropathy also had a proportionally greater lengthening of the QT interval for a given increase in RR interval. The results of this study suggest a basis for the finding that sudden death is more common in patients with diabetic autonomic neuropathy. PMID:3355728

  11. Congenital supravalvular aortic stenosis and sudden death associated with anesthesia: what's the mystery?

    PubMed

    Burch, Thomas M; McGowan, Francis X; Kussman, Barry D; Powell, Andrew J; DiNardo, James A

    2008-12-01

    Patients with congenital supravalvular aortic stenosis and associated peripheral pulmonary artery stenoses, the majority of whom have Williams-Beuren syndrome, are inherently at risk for development of myocardial ischemia. This is particularly true in the setting of procedural sedation and anesthesia. The biventricular hypertrophy that accompanies these lesions increases myocardial oxygen consumption and compromises oxygen delivery. In addition, these patients often have direct, multifactorial compromise of coronary blood flow. In this article, we review both the pathophysiology of congenital supravalvular aortic stenosis and the literature regarding sudden death in association with sedation and anesthesia. Recommendations as to preoperative assessment and management of these patients are made based on the best available evidence.

  12. GENERAL: Entanglement sudden death induced by the Dzialoshinskii-Moriya interaction

    NASA Astrophysics Data System (ADS)

    Zeng, Hong-Fang; Shao, Bin; Yang, Lin-Guang; Li, Jian; Zou, Jian

    2009-08-01

    In this paper, we study the entanglement dynamics of two-spin Heisenberg XYZ model with the Dzialoshinskii-Moriya (DM) interaction. The system is initially prepared in the Werner state. The effects of purity of the initial state and DM coupling parameter on the evolution of entanglement are investigated. The necessary and sufficient condition for the appearance of the entanglement sudden death (ESD) phenomenon has been deduced. The result shows that the ESD always occurs if the initial state is sufficiently impure for the given coupling parameter or the DM interaction is sufficiently strong for the given initial state. Moreover, the critical values of them are calculated.

  13. [Primary prevention of sudden cardiac death through a wearable cardioverter-defibrillator].

    PubMed

    Gabrielli, Domenico; Benvenuto, Manuela; Baroni, Matteo; Oliva, Fabrizio; Capucci, Alessandro

    2015-01-01

    Nowadays, the implantable cardioverter-defibrillator is the gold standard for the prevention of sudden cardiac death due to tachyarrhythmias. However, its use is not free from short and long-term risks. In the last years, the wearable cardioverter-defibrillator (WCD) has become a widespread option for patients who need a safe and reversible protection against ventricular tachyarrhythmias. Notwithstanding this, its everyday application is restricted by several limitations, including the risk of inappropriate shocks, the device size and the need for strict compliance of both patients and caregivers. In this review, we report the most relevant literature data on WCD usage along with the main fields of applications and future perspectives.

  14. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome.

    PubMed

    Bailey, Beth A; Sokol, Robert J

    2011-01-01

    In addition to fetal alcohol syndrome and fetal alcohol spectrum disorders, prenatal alcohol exposure is associated with many other adverse pregnancy and birth outcomes. Research suggests that alcohol use during pregnancy may increase the risk of miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. This research has some inherent difficulties, such as the collection of accurate information about alcohol consumption during pregnancy and controlling for comorbid exposures and conditions. Consequently, attributing poor birth outcomes to prenatal alcohol exposure is a complicated and ongoing task, requiring continued attention to validated methodology and to identifying specific biological mechanisms.

  15. Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

    NASA Astrophysics Data System (ADS)

    Alexander, Janice; Lee, Christopher A.

    2010-09-01

    Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks.

  16. Rupture of an ascending aortic aneurysm as a cause of sudden death

    PubMed Central

    de Freitas, Cristielle Peres; Petrini, Carla Andrade; Araújo, Ramon Souza Goes; Lima, Luiz Guilherme Cernaglia Aureliano; Picciarelli de Lima, Patrícia

    2016-01-01

    An 84-year-old female patient was brought to the emergency department in cardiac arrest. Cardiopulmonary resuscitation maneuvers were performed but were unsuccessful. The patient had a past medical history of systemic arterial hypertension with target-organ lesions, including stroke and myocardial infarction. The autopsy was carried out, and the most striking finding was cardiac tamponade due to the rupture of an ascending aortic aneurysm at the site of a complex atheromatous plaque. Rupture is the most serious complication of a thoracic aneurysm and must be considered in the differential diagnosis of sudden death. PMID:27818955

  17. Next generation sequencing for molecular confirmation of hereditary sudden cardiac death syndromes.

    PubMed

    Márquez, Manlio F; Cruz-Robles, David; Ines-Real, Selene; Vargas-Alarcón, Gilberto; Cárdenas, Manuel

    2015-01-01

    Hereditary sudden cardiac death syndromes comprise a wide range of diseases resulting from alteration in cardiac ion channels. Genes involved in these syndromes represent diverse mutations that cause the altered encoding of the diverse proteins constituting these channels, thus affecting directly the currents of the corresponding ions. In the present article we will briefly review how to arrive to a clinical diagnosis and we will present the results of molecular genetic studies made in Mexican subjects attending the SCD Syndromes Clinic of the National Institute of Cardiology of Mexico City.

  18. Bifid cardiac apex in a 25-year-old male with sudden cardiac death.

    PubMed

    Wu, Annie; Kay, Deborah; Fishbein, Michael C

    2014-01-01

    Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly.

  19. Value of the signal-averaged electrocardiogram as a predictor of sudden death in myocardial infarction and dilated cardiomyopathy.

    PubMed

    Ohnishi, Y; Inoue, T; Fukuzaki, H

    1990-02-01

    To clarify the prognostic significance of signal averaged electrocardiogram (SAE), 100 patients with old myocardial infarction (OMI) and 54 patients with dilated cardiomyopathy (DCM) were studied. Late potentials (LPs) were detected in 31 patients with OMI and in 21 patients with DCM. During a mean follow up of 18 months (3 to 60) in OMI and 28 months (3 to 71) in DCM, 29 patients died. Fifteen patients died suddenly (8 in OMI, 7 in DCM). In OMI, the sensitivity (Se), specificity (Sp), predictive accuracy (PA) of LPs for sudden death were 75%, 72%, and 73%, respectively. The presence of either LPs or prolonged filtered QRS (f-QRS) predicted sudden death with a high Se, and the presence of both LPs and prolonged f-QRS predicted with high Sp and PA. In DCM, Se, Sp, and PA of LPs were lower than those in OMI (Se; 71%, Sp; 66%, PA; 67%). A life table analysis showed that the probability of remaining free from sudden death was significantly lower in patients with LPs than those without them in OMI, but no significant difference was observed between those with and without LPs in DCM. Patients with either LPs or prolonged f-QRS, however, had a significantly higher probability of sudden death in both diseases and no patient with normal SAE died suddenly. SAE was also useful in separating high risk patients in either normal or low cardiac index group in both diseases. Ventricular tachycardia (VT) and % fractional shortening in OMI and only VT in DCM were also useful predictors among other parameters. In conclusion, SAE provides useful information in a noninvasive method to identify patients at risk of sudden death, and patients with normal SAE have a low risk of sudden death in OMI and DCM.

  20. Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach.

    PubMed

    Wilhelm, Matthias; Bolliger, Stephan A; Bartsch, Christine; Fokstuen, Siv; Gräni, Christoph; Martos, Viktor; Medeiros Domingo, Argelia; Osculati, Antonio; Rieubland, Claudine; Sabatasso, Sara; Saguner, Ardan M; Schyma, Christian; Tschui, Joelle; Wyler, Daniel; Bhuiyan, Zahurul A; Fellmann, Florence; Michaud, Katarzyna

    2015-01-01

    Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.

  1. Use of Cardiac Injury Markers in the Postmortem Diagnosis of Sudden Cardiac Death.

    PubMed

    Carvajal-Zarrabal, Octavio; Hayward-Jones, Patricia M; Nolasco-Hipolito, Cirilo; Barradas-Dermitz, Dulce Ma; Calderón-Garcidueñas, Ana Laura; López-Amador, Noé

    2017-01-23

    In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK-MB, myoglobin, troponins I and T (cTn-I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn-T and cTn-I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD.

  2. After sudden unexpected death in epilepsy: Lessons learned and the road forward.

    PubMed

    Donner, Elizabeth J; Waddell, Briony; Osland, Karen; Leach, John P; Duncan, Susan; Nashef, Lina; Picot, Marie Christine

    2016-01-01

    The devastating effects of sudden unexpected death in epilepsy (SUDEP) can be difficult to navigate, even for experienced clinicians. Mounting evidence supports full disclosure of the risks of epilepsy to those affected and their caregivers, and recommendations from regulatory and professional groups encourage the same. Following a death, families are faced with tragedy, guilt, and sometimes anger. Clinicians are often called upon to provide information and support. The development of a comprehensive approach to SUDEP education requires careful consideration of the people living with epilepsy, facts about SUDEP and known risk factors, as well as experiences of families and care providers. In this article, we share the experiences of those working in SUDEP education and epilepsy care, including the voluntary sector. We explore the experience of bereaved families and clinicians, derive lessons from published research, highlight areas where more research is needed, and report on preliminary data from a nationwide study from France.

  3. Left-Insular Damage, Autonomic Instability and Sudden Unexpected Death in Epilepsy

    PubMed Central

    Lacuey, Nuria; Zonjy, Bilal; Theerannaew, Wanchat; Loparo, Kenneth A.; Tatsuoka, Curtis; Sahadevan, Jayakumar; Lhatoo, Samden D.

    2015-01-01

    We analyzed the only two sudden unexpected death in epilepsy (SUDEP) cases from 320 prospectively recruited patients in the three-year Prevention and Risk Identification of SUDEP Mortality (PRISM) Project. Both patients had surgically refractory epilepsy, evidence of left insular damage following previous temporal/temporo-insular resections, and progressive changes in Heart Rate Variability (HRV) in monitored evaluations prior to death. Insular damage is known to cause autonomic dysfunction and increased mortality in acute stroke. This report suggests a possible role for the insula in the pathogenesis of SUDEP. The presence of intrinsic insular lesions or acquired insular damage in refractory epilepsy patients may be an additional risk factor for SUDEP. PMID:26797084

  4. Left-insular damage, autonomic instability, and sudden unexpected death in epilepsy.

    PubMed

    Lacuey, Nuria; Zonjy, Bilal; Theerannaew, Wanchat; Loparo, Kenneth A; Tatsuoka, Curtis; Sahadevan, Jayakumar; Lhatoo, Samden D

    2016-02-01

    We analyzed the only two sudden unexpected death in epilepsy (SUDEP) cases from 320 prospectively recruited patients in the three-year Prevention and Risk Identification of SUDEP Mortality (PRISM) project. Both patients had surgically refractory epilepsy, evidence of left insular damage following previous temporal/temporo-insular resections, and progressive changes in heart rate variability (HRV) in monitored evaluations prior to death. Insular damage is known to cause autonomic dysfunction and increased mortality in acute stroke. This report suggests a possible role for the insula in the pathogenesis of SUDEP. The presence of intrinsic insular lesions or acquired insular damage in patients with refractory epilepsy may be an additional risk factor for SUDEP.

  5. Sudden cardiac death while playing Australian Rules football: a retrospective 14 year review.

    PubMed

    Parsons, Sarah; Lynch, Matthew

    2016-06-01

    Australian Rules football is a sport which evolved from Gaelic football and which is played by a large number of predominantly male participants in a number of countries. The highest participation rates are in the southern states of Australia. A retrospective review over a period of 14 years identified 14 cases of sudden cardiac death that occurred in individuals while playing the sport. All were male and ranged in age from 13 to 36 years with a mean and median age of 23 years. A spectrum of cardiac causes was identified including coronary artery atherosclerosis, myocarditis, anomalous coronary artery anatomy, arrhythmogenic right ventricular cardiomyopathy, and healed Kawasaki disease. In 5 cases the heart was morphologically normal raising the possibility of a channelopathy. No traumatic deaths were identified. Some of the individuals had experienced symptoms prior to the fatal episode and the role of pre participation screening in reducing mortality is discussed.

  6. Evidence against barium in the mushroom Trogia venenata as a cause of sudden unexpected deaths in Yunnan, China.

    PubMed

    Zhang, Ying; Li, Yanchun; Wu, Gang; Feng, Bang; Yoell, Shanze; Yu, Zefen; Zhang, Keqin; Xu, Jianping

    2012-12-01

    This study examined barium concentrations in the mushroom Trogia venenata, the leading culprit for sudden unexpected deaths in Yunnan, southwest China. We found that barium concentrations in T. venenata from Yunnan were low and comparable to other foods, inconsistent with barium concentrations in this mushroom as a significant contributor to these deaths.

  7. [Diagnosis, sudden death risk stratification, and treatment of main long QT syndrome molecular-genetic variants].

    PubMed

    Shkol'nikova, M A; Kharlap, M S; Il'darova, R A; Bereznitskaia, V V; Kalinin, L A

    2011-01-01

    Inherited long QT syndrome (LQTS) refers to the primary electrical diseases of the heart. It is characterized by QT prolongation on resting ECG and syncope due to life-threatening ventricular arrhythmias. This review focuses on diagnosis, differential diagnosis, risk stratification of sudden cardiac death, and treatment strategy of patients with most prevalent genetic fOrms of LQTS - LQT1, LQT2 and LQT3, which accounted for about 90% of all genetically confirmed cases. Recent advances in understanding of relationship between clinical, electrocardiographic features (on ECG, body surface mapping, stress test) and genetic variants of LQT presented. Characteristics of syncopal events and ECG features of LQTl, LQT2 and LQT3 in the majority of cases are helpful to make an appropriate choice for therapy, even before positive result of molecular genetic testing. Management has focused on the use of beta blockers as first-line treatment and exclusion of triggers of life-threatening arrhythmia which are specific for each molecular-genetic variant. Implantation of cardioverter defibrillator for secondary prevention of sudden death in the high-risk patients or patients with insufficient effect of antiarrhythmic therapy is required.

  8. The physiological determinants of Sudden Infant Death Syndrome☆,☆☆

    PubMed Central

    Garcia, Alfredo J.; Koschnitzky, Jenna E.; Ramirez, Jan-Marino

    2013-01-01

    It is well-established that environmental and biological risk factors contribute to Sudden Infant Death Syndrome (SIDS). There is also growing consensus that SIDS requires the intersection of multiple risk factors that result in the failure of an infant to overcome cardio-respiratory challenges. Thus, the critical next steps in understanding SIDS are to unravel the physiological determinants that actually cause the sudden death, to synthesize how these determinants are affected by the known risk factors, and to develop novel ideas for SIDS prevention. In this review, we will examine current and emerging perspectives related to cardio-respiratory dysfunctions in SIDS. Specifically, we will review: (1) the role of the preBötzinger complex (preBötC) as a multi-functional network that is critically involved in the failure to adequately respond to hypoxic and hypercapnic challenges; (2) the potential involvement of the pre-BötC in the gender and age distributions that are characteristic for SIDS; (3) the link between SIDS and prematurity; and (4) the potential relationship between SIDS, auditory function, and central chemosensitivity. Each section underscores the importance of marrying the epidemiological and pathological data to experimental data in order to understand the physiological determinants of this syndrome. We hope that a better understanding will lead to novel ways to reduce the risk to succumb to SIDS. PMID:23735486

  9. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    PubMed

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  10. Identification and Genomic Characterization of a New Virus (Tymoviridae Family) Associated with Citrus Sudden Death Disease

    PubMed Central

    Maccheroni, Walter; Alegria, Marcos C.; Greggio, Christian C.; Piazza, João Paulo; Kamla, Rachel F.; Zacharias, Paula R. A.; Bar-Joseph, Moshe; Kitajima, Elliot W.; Assumpção, Laura C.; Camarotte, Giovana; Cardozo, Jussara; Casagrande, Elaine C.; Ferrari, Fernanda; Franco, Sulamita F.; Giachetto, Poliana F.; Girasol, Alessandra; Jordão, Hamilton; Silva, Vitor H. A.; Souza, Leonardo C. A.; Aguilar-Vildoso, Carlos I.; Zanca, Almir S.; Arruda, Paulo; Kitajima, João Paulo; Reinach, Fernando C.; Ferro, Jesus A.; da Silva, Ana C. R.

    2005-01-01

    Citrus sudden death (CSD) is a new disease that has killed approximately 1 million orange trees in Brazil. Here we report the identification of a new virus associated with the disease. RNAs isolated from CSD-affected and nonaffected trees were used to construct cDNA libraries. A set of viral sequences present exclusively in libraries of CSD-affected trees was used to obtain the complete genome sequence of the new virus. Phylogenetic analysis revealed that this virus is a new member of the genus Marafivirus. Antibodies raised against the putative viral coat proteins allowed detection of viral antigens of expected sizes in affected plants. Electron microscopy of purified virus confirmed the presence of typical isometric Marafivirus particles. The screening of 773 affected and nonaffected citrus trees for the presence of the virus showed a 99.7% correlation between disease symptoms and the presence of the virus. We also detected the virus in aphids feeding on affected trees. These results suggest that this virus is likely to be the causative agent of CSD. The virus was named Citrus sudden death-associated virus. PMID:15709023

  11. Neuroanatomical dysmorphology of the medial superior olivary nucleus in sudden fetal and infant death.

    PubMed

    Lavezzi, Anna M; Matturri, Luigi

    2012-01-01

    This study expands our understanding of the organization of the human caudal pons, providing a morphologic characterization of the medial superior olivary nucleus (MSO), component of the superior olivary complex (SOC) that plays an important role in the processing of acoustic information. We examined victims of sudden unexplained fetal and infant death and controls (n = 75), from 25 gestational weeks to 8 months of postnatal age, by complete autopsy and in-depth autonomic nervous system histological examination, particularly of the MSO nucleus, the focus of this study. Peculiar cytoarchitectural features of the MSO nucleus were found in sudden death cases, such as hypoplasia/agenesis and immature hypercellularity, frequently related to dysgenesis of contiguous structures involved in respiratory rhythm-generating circuit, in particular to hypoplasia of the retrotrapezoid and the facial nuclei. We propose the involvement of this nucleus in more important functions than those related to hearing, as breathing and, more extensively, all the vital activities. Besides, we highlight the fundamental role of the maternal smoking in pregnancy as etiological factor in the dysmorphic neuroanatomical development of the MSO nucleus.

  12. [The Wearable Cardioverter Defibrillator (WCD) for the prevention of sudden cardiac death -- a single center experience].

    PubMed

    Reek, S; Meltendorf, U; Geller, J C; Wollbrück, A; Grund, S; Klein, H U

    2002-12-01

    The Wearable Cardioverter Defibrillator (WCD) is an external defibrillator that automatically detects and treats ventricular tachyarrhythmias without the need for assistance from a bystander while at the same time allowing the patient to ambulate freely. The main components of the system are the defibrillator unit and a chest belt with electrodes for arrhythmia detection and therapy delivery. Between December 1998 and October 2001, 84 patients used the device at our institution. The majority of patients had a history of acute myocardial infarction or coronary artery bypass surgery with an increased risk for sudden cardiac death or were awaiting heart transplantation. During a mean follow-up of 116+/-90 days, 7 episodes of ventricular tachyarrhythmias were detected and terminated successfully by the WCD in 5 patients. In 9720 days, there was one inappropriate shock due to oversensing of electrical noise. Four patients died during follow-up; none of them had a cardiac arrest while wearing the device. Five patients were excluded because of irregularities in device use. An ICD was implanted in 24 patients at the end of the follow-up period. The WCD is effective in detecting and treating ventricular tachyarrhythmias in patients with an intermittently increased risk for sudden cardiac death. Further use of the system in larger patient populations is needed to confirm its safety and cost effectiveness.

  13. Sudden death as a late sequel of Kawasaki disease: postmortem CT demonstration of coronary artery aneurysm.

    PubMed

    Okura, Naoki; Okuda, Takahisa; Shiotani, Seiji; Kohno, Mototsugu; Hayakawa, Hideyuki; Suzuki, Atsuko; Kawasaki, Tomisaku

    2013-02-10

    Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents during childhood. The characteristic coronary arterial lesion of KD is an aneurysm. Ischemic heart disease derived from a CA aneurysm is experienced approximately two decades after the onset of acute KD. In recent years, the primary issue of concern has been asymptomatic adults with a CA aneurysm caused by undiagnosed KD. We present a case of sudden death as a late KD sequel in a young adult. A postmortem CT scan revealed a coarse calcification of a left anterior descending CA aneurysm, which was confirmed at the time of autopsy. A postmortem CT scan is useful in cases of sudden death where the detection of a calcified CA aneurysm would suggest to the forensic pathologist that the deceased suffered from a late sequel of KD. The use of screening postmortem CT scans for young people may detect cases of unsuspected CA aneurysms, raising the possibility of untreated KD.

  14. [Sleeping habits related to sudden infant death syndrome: a population-based study].

    PubMed

    Geib, Lorena Teresinha Consalter; Nunes, Magda Lahorgue

    2006-02-01

    This cross-sectional study on sleeping habits with potential risk for sudden infant death syndrome included all live births in Passo Fundo, Rio Grande do Sul, Brazil, in 2003 with data collection from Certificates of Live Birth and interviews, analyzed with descriptive statistics and the chi-squared test. From the 2,634 live births, 2,285 children were selected (86.75%), with 8.4% exclusion and 5.2% losses. Protective habits included 77% of infants with appropriate clothing, 90% loosely wrapped, 69% with thin blankets, 98% sleeping in the parents' bedroom, and 56% in the crib. Potentially risky habits included lateral decubitus (92%), use of a pillow (88%), and feet far from the lower edge of the crib (96%). Among low-income families, bed-sharing with other children was significant (p = 0.00). Thus, in a county with a low prevalence of sudden infant death syndrome, infants are exposed to both protective and risk factors, suggesting that in underprivileged populations in developing countries, other risk factors for this syndrome should be considered.

  15. Ion channel macromolecular complexes in cardiomyocytes: roles in sudden cardiac death.

    PubMed

    Abriel, Hugues; Rougier, Jean-Sébastien; Jalife, José

    2015-06-05

    The movement of ions across specific channels embedded on the membrane of individual cardiomyocytes is crucial for the generation and propagation of the cardiac electric impulse. Emerging evidence over the past 20 years strongly suggests that the normal electric function of the heart is the result of dynamic interactions of membrane ion channels working in an orchestrated fashion as part of complex molecular networks. Such networks work together with exquisite temporal precision to generate each action potential and contraction. Macromolecular complexes play crucial roles in transcription, translation, oligomerization, trafficking, membrane retention, glycosylation, post-translational modification, turnover, function, and degradation of all cardiac ion channels known to date. In addition, the accurate timing of each cardiac beat and contraction demands, a comparable precision on the assembly and organizations of sodium, calcium, and potassium channel complexes within specific subcellular microdomains, where physical proximity allows for prompt and efficient interaction. This review article, part of the Compendium on Sudden Cardiac Death, discusses the major issues related to the role of ion channel macromolecular assemblies in normal cardiac electric function and the mechanisms of arrhythmias leading to sudden cardiac death. It provides an idea of how these issues are being addressed in the laboratory and in the clinic, which important questions remain unanswered, and what future research will be needed to improve knowledge and advance therapy.

  16. Ion Channel Macromolecular Complexes in Cardiomyocytes: Roles in Sudden Cardiac Death

    PubMed Central

    Abriel, Hugues; Rougier, Jean-Sébastien; Jalife, José

    2015-01-01

    The movement of ions across specific channels embedded on the membrane of individual cardiomyocytes is crucial for the generation and propagation of the cardiac electrical impulse. Emerging evidence over the last 20 years strongly suggests that the normal electrical function of the heart is the result of dynamic interactions of membrane ion channels working in an orchestrated fashion as part of complex molecular networks. Such networks work together with exquisite temporal precision to generate each action potential and contraction. Macromolecular complexes play crucial roles in transcription, translation, oligomerization, trafficking, membrane retention, glycosylation, posttranslational modification, turnover, function and degradation of all cardiac ion channels known to date. In addition, the accurate timing of each cardiac beat and contraction demands, a comparable precision on the assembly and organizations of sodium, calcium and potassium channel complexes within specific subcellular microdomains, where physical proximity allows for prompt and efficient interaction. This review article, part of the Compendium on Sudden Cardiac Death, discusses the major issues related to the role of ion channel macromolecular assemblies in normal cardiac electrical function and the mechanisms of arrhythmias leading to sudden cardiac death. It provides an idea of how these issues are being addressed in the laboratory and in the clinic, which important questions remain unanswered, and what future research will be needed to improve knowledge and advance therapy. PMID:26044251

  17. Effects of acetyl-L-carnitine on cardiac dysautonomia in Rett syndrome: prevention of sudden death?

    PubMed

    Guideri, F; Acampa, M; Hayek, Y; Zappella, M

    2005-01-01

    There is a higher incidence of sudden death in patients with Rett syndrome than individuals in the general population. Previous studies have implicated cardiac dysautonomia and a long QT interval as causative factors. Because carnitine plays a critical role in cellular metabolism and may have beneficial effects on cardiac and nerve function, we investigated the effects of long-term treatment with acetyl-L-carnitine on heart rate variability and electrocardiographic abnormalities in 10 girls with Rett syndrome and compared the results with 12 control patients (girls with Rett syndrome who were not treated). The age range of the subjects was 2-21 years. The study design called for the evaluation of heart rate variability, corrected QT interval, and QTc dispersion. In the 10 Rett girls treated with acetyl-L-carnitine, a significant increase in heart rate variability was observed. To explain these results, we hypothesize that acetyl-L-carnitine has a neurotrophic action on the cardiac autonomic nervous system. This effect may reduce the risk of sudden death in patients with this syndrome.

  18. Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death.

    PubMed Central

    Gilbert, R; Rudd, P; Berry, P J; Fleming, P J; Hall, E; White, D G; Oreffo, V O; James, P; Evans, J A

    1992-01-01

    Three methods were used to investigate the role of infection in sudden unexpected infant death (SUD): (i) microbiological comparison of SUD victims and matched, live, community controls; (ii) postmortem classification of the contribution of infection to death; and (iii) case-control analysis of the relative risk associated with both infection and heavy wrapping. Limited sampling from the upper respiratory tract and gut in SUD victims and controls showed no significant excess of viral infection in the SUD victims (odds ratio = 1.98, 95% confidence interval (CI) 0.9 to 4.5). At postmortem examination, infection explained death in 3/95 babies and may have contributed to death in 37/95. Over 70 days of age, the combined presence of viral infection and wrapping in excess of 10 togs produced an odds ratio of SUD of 51.5 (95% CI 5.64 to 471.48) compared with wrapping of less than 6 togs. Viral infection was not a major risk factor as long as babies were lightly wrapped. In heavily wrapped babies the presence of a viral infection greatly increased the risk of SUD. PMID:1543374

  19. Sudden unexpected deaths in different age groups at Ramathibodi Hospital, Bangkok, Thailand: a retrospective autopsy study during 2003-2007.

    PubMed

    Udnoon, Jitta; Chirachariyavej, Thamrong; Peonim, Vichan

    2009-01-01

    A sudden unexpected death is considered one type of medico-legal death in Thailand. In some studies, it comprises up to 50-60% of all medico-legal deaths. In this retrospective study, data were collected from 1,460 cases of sudden unexpected deaths, 39.9% of all deaths in which a medico-legal autopsy had been carried out. The study was conducted over a 5-year period from January 2003 to December 2007. There were 1,009 males and 451 females (M:F ratio = 2.2:1). The mean age was 55.3+/-0.98 years. The peak age group was the 46-60 years accounting for 28.2% of cases. The most common cause of death in all age groups was coronary atherosclerosis. Understanding epidemiological autopsy data is vital for determining the characteristics of the population involved.

  20. Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death

    PubMed Central

    Turillazzi, Emanuela; Frati, Paola; Pascale, Natascha; Pomara, Cristoforo; Grilli, Giampaolo; Viola, Rocco Valerio; Fineschi, Vittorio

    2016-01-01

    Multi-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease. PMID:27928228

  1. Characteristics of Sudden Bath-Related Death Investigated by Medical Examiners in Tokyo, Japan

    PubMed Central

    Suzuki, Hideto; Hikiji, Wakako; Tanifuji, Takanobu; Abe, Nobuyuki; Fukunaga, Tatsushige

    2015-01-01

    Background Sudden bath-related deaths occur frequently in Japan, particularly among elderly people. However, the precise mechanism of bath-related death remains uncertain, and effective prevention strategies have not been established. Methods Cases of bath-related deaths (n = 3289) were selected from all cases handled by the Tokyo Medical Examiner’s Office from 2009 to 2011 (N = 41 336). The ages and occurrence dates were examined, and major autopsy findings, including toxicological analysis, were evaluated for the autopsied cases (n = 550). Results Most cases occurred in individuals older than 60 years of age during winter. Analysis of autopsy findings revealed water inhalation signs in many cases (n = 435, 79.1%). Circulatory system diseases constituted more than half of the pathological findings regarding factors that may have contributed significantly to death (n = 300, 54.5%), and cardiac lesions were the most common pathological finding (n = 250, 45.5%). However, approximately one-third of the cases exhibited no remarkable pathological findings (n = 198, 36.0%). A quarter of all cases involved blood ethanol levels that exceeded 0.5 mg/mL (n = 140). Conclusions The results suggested that drowning plays an important role in the final process of bath-related death. Circulatory system diseases may be the primary underlying pathology; however, there were variations in the medical histories and pathologies of cases of bath-related death. From a preventive perspective, family members should pay attention to elderly people with circulatory system diseases during bathing, particularly in winter. Additionally, the notion that ill or inebriated individuals should not take baths should be reinforced. PMID:25503827

  2. Sudden death and cervical spine: A new contribution to pathogenesis for sudden death in critical care unit from subarachnoid hemorrhage; first report – An experimental study

    PubMed Central

    Kazdal, Hizir; Kanat, Ayhan; Aydin, Mehmet Dumlu; Yazar, Ugur; Guvercin, Ali Riza; Calik, Muhammet; Gundogdu, Betul

    2017-01-01

    Context: Sudden death from subarachnoid hemorrhage (SAH) is not uncommon. Aims: The goal of this study is to elucidate the effect of the cervical spinal roots and the related dorsal root ganglions (DRGs) on cardiorespiratory arrest following SAH. Settings and Design: This was an experimental study conducted on rabbits. Materials and Methods: This study was conducted on 22 rabbits which were randomly divided into three groups: control (n = 5), physiologic serum saline (SS; n = 6), SAH groups (n = 11). Experimental SAH was performed. Seven of 11 rabbits with SAH died within the first 2 weeks. After 20 days, other animals were sacrificed. The anterior spinal arteries, arteriae nervorum of cervical nerve roots (C6–C8), DRGs, and lungs were histopathologically examined and estimated stereologically. Statistical Analysis Used: Statistical analysis was performed using the PASW Statistics 18.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Intergroup differences were assessed using a one-way ANOVA. The statistical significance was set at P < 0.05. Results: In the SAH group, histopathologically, severe anterior spinal artery (ASA) and arteriae nervorum vasospasm, axonal and neuronal degeneration, and neuronal apoptosis were observed. Vasospasm of ASA did not occur in the SS and control groups. There was a statistically significant increase in the degenerated neuron density in the SAH group as compared to the control and SS groups (P < 0.05). Cardiorespiratory disturbances, arrest, and lung edema more commonly developed in animals in the SAH group. Conclusion: We noticed interestingly that C6–C8 DRG degenerations were secondary to the vasospasm of ASA, following SAH. Cardiorespiratory disturbances or arrest can be explained with these mechanisms. PMID:28250634

  3. Induced abortion.

    PubMed

    2017-04-10

    Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.

  4. Sudden cardiac death in hemodialysis patients: an in-depth review.

    PubMed

    Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

    2011-06-01

    Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain.

  5. Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages.

    PubMed

    Horne, Rosemary S C; Hauck, Fern R; Moon, Rachel Y; L'hoir, Monique P; Blair, Peter S

    2014-03-01

    The large decline in deaths due to the sudden infant death syndrome (SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely uncontroversial and educators and researchers in this field are in agreement as to the specific recommendations that should be given to parents and health professionals. However, advice surrounding the apparent protective effect of dummies (also known as pacifiers) has been controversial. Several systematic reviews have demonstrated a strong association between the lack of a pacifier being used by the infant for the final sleep and SIDS, but it is not clear how pacifiers confer protection or if this is a marker for something as yet unmeasured. The Epidemiology and Physiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) are comprised of leading SIDS researchers with an objective to provide evidence-based position statements surrounding the factors associated with SIDS (http://www.ispid.org/) and risk-reduction strategies. The evidence, discussion and conclusions from these working groups regarding dummies (pacifiers) are described below to help inform this debate and describe the future evidence required so that we might find a common recommendation about dummies (pacifiers) and SIDS.

  6. Risk stratification for sudden cardiac death in North America - current perspectives.

    PubMed

    Buxton, Alfred E; Waks, Jonathan W; Shen, Changyu; Chen, Peng-Sheng

    Sudden cardiac death (SCD) accounts for approximately 360,000 deaths annually in the United States, and is the cause of half of all cardiovascular deaths. In patients with severely depressed left ventricular ejection fraction (LVEF), implantable cardioverter-defibrillators (ICDs) have been shown to significantly reduce total mortality, but many factors beyond LVEF influence the relative benefit afforded by ICD implantation. In fact, among patients with prior myocardial infarction, approximately half of all SCDs occur in patients without severe LV dysfunction, and in analyses of large ICD trials, certain patient subgroups derive no benefit to ICD implantation despite having low LVEF, often due to competing non-arrhythmic mortality. Improved risk stratification tools to help select patients who are likely to derive the most benefit from ICD implantation are therefore needed. This manuscript will review studies evaluating use of ICDs in patients with mild LV systolic dysfunction and LVEF >35%, currently available ICD risk stratification models, and the rationale for designing a cohort study to prospectively validate use of an ICD risk stratification score.

  7. Characteristics, circumstances and pathology of sudden or unnatural deaths of cases with evidence of pathological hoarding.

    PubMed

    Darke, Shane; Duflou, Johan

    2017-01-01

    The study aimed to determine the characteristics and circumstances of cases sudden or unnatural death (n = 61) with evidence of pathological hoarding, their major organ pathology and toxicology. The mean age was 65·8 yrs (a mean of 16.1 years of potential life lost), 62·3% were male, and 28·2% were obese. 95·1% lived alone, and 96·7% died in their residence, with no medical intervention. In all cases severe squalor and extensive hoarding were noted. The direct cause of death was attributed to disease in 75·4%, heart disease being a significant factor in 52·5%. Accidents causing death directly related to hoarding occurred in two cases. Autopsy revealed extensive pathology: severe coronary artery narrowing (42·4%), myocardial replacement fibrosis (44·1%), emphysema (39·0%), nephrosclerosis (46·6%). Signs of hypothermia were present in 14·8%, and diabetes was diagnosed in 21·3%. The most commonly detected substance was alcohol (32·1%). Medications for heart disease (5·4%) or diabetes (7·1%) were rare. The overall clinical picture was of an isolated group, with a heavy burden of physical disease and, in all probability, a high level of psychiatric disorders, who died alone in their homes.

  8. Polymorphisms in genes of respiratory control and sudden infant death syndrome.

    PubMed

    Läer, Katharina; Dörk, Thilo; Vennemann, Marielle; Rothämel, Thomas; Klintschar, Michael

    2015-09-01

    Sudden infant death syndrome (SIDS) is a multifactorial syndrome and assumingly, among other mechanisms, a deficit in respiratory control leads to a failure of arousal and autoresuscitation when the child is challenged by a stressful homeostatic event, e.g., hypoxia. We hypothesize that genetic polymorphisms involved in respiratory control mediated in the medulla oblongata contribute to SIDS. Therefore, a total of 366 SIDS cases and 421 controls were genotyped for 48 SNPs in 41 candidate genes. Genotyping was performed using Fluidigm nanofluidic technology. Results were obtained for 356 SIDS and 406 controls and 38 SNPs. After correction for multiple testing, one SNP retained a nominally significant association with seasonal SIDS: rs1801030 in the phenol sulfotransferase 1A1 gene (subgroup: death occurring during summer). A borderline association could be also observed for rs563649 in the opioid receptor μ1 gene in a recessive model (subgroup: death occurring during autumn). As a conclusion, although these data suggest two SNPs to be associated with different subgroups of SIDS cases, none of them can fully explain the SIDS condition, consistent with its multifactorial etiology. Given the great complexity of respiratory control and our initial findings reported here, we believe it is worthwhile to further investigate genes involved in the respiratory system.

  9. Strategies for the Prevention of Sudden Cardiac Death in Children and Adolescents.

    PubMed

    Berger, Stuart; Maccalli, Emanuele

    2015-12-01

    Sudden cardiac arrest (SCA) or sudden cardiac death (SCD) in children and adolescents is a devastating event. Although the true incidence is unclear, the etiologies are not. Strategies for prevention include both primary as well as secondary prevention strategies, and these strategies are not mutually exclusive. From a primary prevention standpoint, many of the episodes of SCA or SCD may occur without any antecedent warning signs and in the absence of an important family history. There are a subset of children and adolescents who may have antecedent warning signs and symptoms such as syncope with exercise, chest pain, and palpitations. This article addresses those symptoms specifically and in more detail to help guide the generalist with regard to a framework of risk stratification. The importance of secondary prevention is also discussed. It is critically important to promote and advocate for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) education for everyone, including all students prior to graduation from high school. CPR and AEDs save the lives of children, adolescents, and adults. A society that is able and willing to perform CPR will result in an increase in the incidence of lay-rescuer CPR and will undoubtedly save more lives.

  10. Sudden unexpected death related to enterovirus myocarditis: histopathology, immunohistochemistry and molecular pathology diagnosis at post-mortem

    PubMed Central

    2012-01-01

    Background Viral myocarditis is a major cause of sudden unexpected death in children and young adults. Until recently, coxsackievirus B3 (CVB3) has been the most commonly implicated virus in myocarditis. At present, no standard diagnosis is generally accepted due to the insensitivity of traditional diagnostic tests. This has prompted health professionals to seek new diagnostic approaches, which resulted in the emergence of new molecular pathological tests and a more detailed immunohistochemical and histopathological analysis. When supplemented with immunohistochemistry and molecular pathology, conventional histopathology may provide important clues regarding myocarditis underlying etiology. Methods This study is based on post-mortem samples from sudden unexpected death victims and controls who were investigated prospectively. Immunohistochemical investigations for the detection of the enteroviral capsid protein VP1 and the characterization and quantification of myocardial inflammatory reactions as well as molecular pathological methods for enteroviral genome detection were performed. Results Overall, 48 sudden unexpected death victims were enrolled. As for controls, 37 cases of unnatural traffic accident victims were studied. Enterovirus was detected in 6 sudden unexpected death cases (12.5 %). The control samples were completely enterovirus negative. Furthermore, the enteroviral capsid protein VP1 in the myocardium was detected in enterovirus-positive cases revealed by means of reverse transcriptase-polymerase chain reaction (RT-PCR). Unlike control samples, immunohistochemical investigations showed a significant presence of T and B lymphocytes in sudden unexpected death victims. Conclusions Our findings demonstrate clearly a higher prevalence of viral myocarditis in cases of sudden unexpected death compared to control subjects, suggesting that coxsackie B enterovirus may contribute to myocarditis pathogenesis significantly. PMID:22966951

  11. Paris Prospective Study III: a study of novel heart rate parameters, baroreflex sensitivity and risk of sudden death.

    PubMed

    Empana, Jean-Philippe; Bean, Kathy; Guibout, Catherine; Thomas, Frédérique; Bingham, Annie; Pannier, Bruno; Boutouyrie, Pierre; Jouven, Xavier

    2011-11-01

    Resting heart rate has been related to the risk of cardiovascular disease and sudden death in several large prospective studies. To investigate prospectively the association of novel heart rate parameters and of carotid artery stiffness with sudden death and other cardiovascular disease. The Paris Prospective Study III (PPS3) is a new, ongoing French prospective study. From June 2008 to December 2011, 10,000 men and women aged 50-75 years who will have a preventive medical check-up at the Centre d'Investigations Préventives et Cliniques in Paris (France), will be enrolled in the study, after signing an informed consent. In addition to the general health examination, each subject's heart rhythm will be recorded during the course of the health check-up (approximately 2(1/2) h) and an echo-tracking of the right carotid bulb will be performed by trained technicians. A bio bank and DNA bank will be established for further biomarker and genetic analyses. The occurrence of cardiovascular disease including acute coronary syndrome, stroke, peripheral artery disease and sudden death, and of mortality, of the participants will be followed up during 20 years. With an estimated mean annual rate of sudden death of 0.1% and its increasing incidence rate with age, between 250 and 300 sudden deaths are expected. This unique study should provide new insights into the regulation of heart rate and blood pressure and should enable to identify novel heart rate parameters that are associated with sudden death.

  12. [Sudden death of Alpine cattle in the canton Graubünden].

    PubMed

    Naegeli, H; Sahin, A; Braun, U; Hauser, B; Mez, K; Hanselmann, K; Preisig, H R; Bivetti, A; Eitel, J

    1997-01-01

    The aetiology of sudden deaths of cattle in the Kanton Graubünden has been elucidated by a multi-disciplinary approach. Certain small rivers and ponds located in the affected Alpine pastures in the areas of Misox, Rheinwald and Engadin provide favourable habitats for the growth of hepatotoxic cyanobacteria, particularly during long periods of hot and dry weather. As cattle frequently take up water from these sources, the toxins produced by cyanobacteria may lead to lethal poisonings that are typically associated with hemorrhagic liver necrosis. The latest reported case of cyanobacteria poisoning of Alpine cattle occurred during the summer of 1996. Further animal losses may be avoided by the implementation of appropriate pasture management schemes. To identify sites of potential hazards to human or animal health, we have developed a sensitive screening assay for the detection of cyanobacteria hepatotoxins in algae and water samples.

  13. Nurses' Knowledge and Adherence To Sudden Infant Death Syndrome Prevention Guidelines.

    PubMed

    Bartlow, Kendra L; Cartwright, Sara B; Shefferly, Erin K

    2016-01-01

    The American Academy of Pediatrics (AAP) defines standard guidelines for infant positioning and sleep environment to reduce the rate of sudden infant death syndrome (SIDS), but recent data on nurses' knowledge and adherence to these guidelines in hospital settings are limited. An observational, quantitative, and descriptive study was conducted on well-baby postpartum nurseries at two urban Washington, DC, hospitals. Sixty-six direct observations of infant position and crib environment were conducted, and a 17-question survey was administered to determine nurses' knowledge and practice regarding AAP SIDS prevention guidelines. Of observed sleeping conditions, 69.7% failed the guidelines for infant positioning, crib environment, or both, despite nurses' reporting knowledge of the AAP guidelines. Further research is needed to determine if the study's findings are consistent with hospitals elsewhere, and to better understand the disconnect between nurses' knowledge and behavior regarding SIDS prevention guidelines.

  14. Meaning-making in the aftermath of sudden infant death syndrome.

    PubMed

    Krueger, Guenther

    2006-09-01

    The reconstruction of meaning in the aftermath of sudden infant death syndrome (SIDS) is part of the grieving process but has to date been poorly understood. Earlier theorists including Freud, Bowlby and Kübler-Ross provided a foundation for what occurs during this time using stage theories. More recent researchers, often using qualitative techniques, have provided a more complex and expanded view that enhances our knowledge of meaning reconstruction following infant loss. This overview of representative contemporary authors compares and contrasts them with the longstanding models that are being supplanted within the emerging field of thanatology. Understanding parental reactions within this new framework can help healthcare professionals in dealing with those affected by SIDS and provide a more empathic and sensitive approach to individual differences. Parents' own accounts of their post-SIDS experience are consistent with these newer theories. Comprehending how parents cope and reconstruct their lives is an important element in providing appropriate psychological support services.

  15. Sudden Death Due to Unusual Complication of Takayasu Arteritis: An Autopsy Case.

    PubMed

    Jedidi, Maher; Chkirbene, Youssef; Abdessayed, Nihed; Masmoudi, Tasnim; Mahjoub, Mohamed; Mlayeh, Souheil; Dhiab, Mohamed Ben; Souguir, Mohamed Kamel; Yacoubi, Mohamed Taher

    2017-01-18

    Takayasu arteritis is an uncommon inflammatory disease with usually a good prognosis. However, sometimes, the evolution can be fatal essentially by a coronary arteries involvement. We present a case of a 19-year-old woman who died suddenly from cardiogenic shock complicating an unknown Takayasu arteritis.At the autopsy, the aorta showed a significant thickening of the wall. The coronary arteries were slightly thickened and did not show any occlusion. Microscopic examination of the aorta showed an abundant granulomatous and a lymphoplasmacytic infiltrate. Microscopic sections of other internal organs showed signs of cardiac hypertrophy and an extensive edema of the lung. Death was attributed to acute heart failure complicating a supravalvular aortic stenosis secondary to unknown Takayasu arteritis.Takayasu arteritis can be life-threatening by an occlusion of the ascending aorta and its major branches, without any coronary arteries involvement.

  16. [Sudden death caused by a less lethal weapon chest-wall injury (Commotio cordis)].

    PubMed

    Contargyris, C; Peytel, E

    2012-05-01

    Less lethal weapons, like Flashball, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.

  17. Sudden unexpected death in epilepsy following resective epilepsy surgery in two patients withdrawn from anticonvulsants.

    PubMed

    Mansouri, Alireza; Alhadid, Kenda; Valiante, Taufik A

    2015-09-01

    We report sudden unexpected death in epilepsy (SUDEP) following resective epilepsy surgery in two patients who had been documented as seizure free. One patient had been weaned off of anticonvulsants and was leading a normal life. The other patient had discontinued only one anticonvulsant but had recently started working night shifts. Following resective epilepsy surgery, one of the major objectives among patients, caregivers, and the healthcare team is to safely wean patients off anticonvulsant medications. The main concern regarding anticonvulsant withdrawal is seizure recurrence. While SUDEP following surgical resection has been reported, to our knowledge, there have been no confirmed cases in patients who have been seizure free. Considering the patients reported here, and given that there are no concrete guidelines for the safe withdrawal of anticonvulsants following epilepsy surgery, the discontinuation of anticonvulsants should be considered carefully and must be accompanied by close monitoring and counseling of patients regarding activities that lower seizure threshold, even after successful epilepsy surgery.

  18. Intra-beat Scaling Properties of Cardiac Arrhythmias and Sudden Cardiac Death

    NASA Astrophysics Data System (ADS)

    Rodríguez, Eduardo; Lerma, Claudia; Echeverría, Juan C.; Alvarez-Ramirez, Jose

    2008-02-01

    We applied detrended fluctuation analysis (DFA) to characterize the intra-beat scaling dynamics of electrocardiographic (ECG) recordings from the PhysioNet Sudden Cardiac Death Holter Database. The main finding of this contribution is that, in such recordings involving different types of arrhythmias; the ECG waveform, besides showing a less-random intra-beat dynamics, becomes more regular during bigeminy, ventricular tachycardia (VT) or even atrial fibrillation (AFIB) and ventricular fibrillation (VF) despite the appearance of erratic traces. Thus, notwithstanding that these cardiac rhythm abnormalities are generally considered as irregular and some of them generated by random impulses or wavefronts, the intra-beat scaling properties suggest that regularity dominates the underlying mechanisms of arrhythmias. Among other explanations, this may result from shorted or restricted -less complex- pathways of conduction of the electrical activity within the ventricles.

  19. Sudden Death After Endoscopic Retrograde Cholangiopancreatography (ERCP)—Case Report and Literature Review

    PubMed Central

    Hauser, Goran; Milosevic, Marko; Zelić, Marko; Stimac, Davor

    2014-01-01

    Abstract There are only a few cases found in literature regarding air embolism in endoscopic procedures, especially in connection to endoscopic retrograde cholangiopancreatography (ERCP). We are presenting a case of a 56-year-old female patient who suffered from non-Hodgkin lymphoma located in her right groin. She was also diagnosed with choledocholithiasis and underwent ERCP to remove the gallstones. Immediately after the procedure she went into sudden cardiac arrest and subsequently died, despite all of our efforts. We reviewed literature in order to identify possible causes of death because fatal outcome following an uneventful and successful procedure was not expected. It is important to bear in mind all possible complications of ERCP. Our focus during the literature search was on air embolism. PMID:25501087

  20. Relationship of substance P and gliosis in medulla oblongata in neonatal sudden infant death syndrome.

    PubMed

    Obonai, T; Takashima, S; Becker, L E; Asanuma, M; Mizuta, R; Horie, H; Tanaka, J

    1996-10-01

    Substance P and glial fibrillary acidic protein (GFAP) immunohistochemistry was applied to the medulla of neonatal infants who died of sudden infant death syndrome (SIDS). A quantitative analysis of cells demonstrating immunoreactivity to GFAP and substance P in 15 neonatal SIDS cases revealed increased GFAP immunoreactivity in the reticular formation, the dorsal vagal nucleus, and the solitary nucleus and an increase in substance P immunoreactivity in the spinal trigeminal nucleus and the solitary nucleus as compared with that in age-matched controls. GFAP immunopositivity suggests astrogliosis which implies a pathologic insult to neurons in the area of astrogliosis. The failure of neurons in these sites to show enhanced substance P immunopositivity may indirectly indicate altered neurons. Further study of prenatal events may be of importance in clarifying the pathogenesis of neonatal SIDS.

  1. Leptomeningeal neurons are a common finding in infants and are increased in sudden infant death syndrome.

    PubMed

    Rickert, Christian H; Gros, Oliver; Nolte, Kay W; Vennemann, Mechtild; Bajanowski, Thomas; Brinkmann, Bernd

    2009-03-01

    Developmental abnormalities of the brain, in particular, the brainstem potentially affecting centers for breathing, circulation and sleep regulation, are thought to be involved in the etiology of sudden infant death syndrome (SIDS). In order to investigate whether leptomeningeal neurons could serve as morphological indicators for a developmental failure or retardation in cerebral maturation, we evaluated the density of isolated leptomeningeal neurons (without associated glia) in 15 brain regions of 24 SIDS and 8 control cases, representing part of the German Study on sudden infant death. Leptomeningeal neurons were encountered in 79% of SIDS and 68% of control cases. More leptomeningeal neurons in SIDS versus control cases were found in lower pons (p = 0.002), upper pons (p = 0.016), cerebellar hemispheres (p = 0.012), lower medulla oblongata (p = 0.039), and temporal lobe (p = 0.041). Summarizing the data according to gross anatomical region of origin (i.e., brainstem, cerebellum or cerebrum), higher numbers of leptomeningeal neurons in SIDS cases were only found in the brainstem (p = 0.006 vs. 0.13 and 0.19, respectively). Our data show that single leptomeningeal neurons are present in most normal infantile brains. The age-dependent increase of leptomeningeal neurons among SIDS cases may either (a) represent a delayed maturation or retardation, i.e., a later or slower reduction of neurons or a delayed peak in occurrence (shift toward an older age), or (b) may be interpreted as a generally increased occurrence of leptomeningeal neurons among SIDS cases as a result of a diffuse developmental abnormality during central nervous system maturation.

  2. Sudden Death Following Selective Neuronal Lesions in the Rat Nucleus Tractus Solitarii

    PubMed Central

    Talman, William T.; Lin, Li-Hsien

    2013-01-01

    In efforts to assess baroreflex and cardiovascular responses in rats in which substance P (SP) or catecholamine transmission had been eliminated we studied animals after bilateral injections into the nucleus tractus solitarii (NTS) of SP or stabilized SP (SSP) conjugated to saporin (SP-SAP or SSP-SAP respectively) or SAP conjugated to an antibody to dopamine-β-hydroxylase (anti-DBH-SAP). We found that SP- and SSP-SAP eliminated NTS neurons that expressed the SP neurokinin-1 receptor (NK1R) while anti-DBH-SAP eliminated NTS neurons expressing tyrosine hydroxylase (TH) and DBH. The toxins were selective. Thus SP-or SSP-SAP did not eliminate TH/DBH neurons and anti-DBH-SAP did not eliminate NK1R neurons in the NTS. Each toxin, however, led to chronic lability of arterial blood pressure, diminished baroreflex function, cardiac ventricular irritability, coagulation necrosis of cardiac myocytes and, in some animals, sudden death associated with asystole. However, when TH/DBH neurons were targeted and eliminated by injection of 6-hydroxydopamine (6-OHDA), none of the cardiovascular or cardiac changes occurred. The studies reviewed here reveal that selective lesions of the NTS lead to altered baroreflex control and to cardiac changes that may lead to sudden death. Though the findings could support a role for SP or catecholamines in baroreflex transmission neither is proven in that NK1R colocalizes with glutamate receptors. Thus neurons with both are lost when treated with SP- or SSP-SAP. In addition, loss of catecholamine neurons after treatment with 6-OHDA does not affect cardiovascular control. Thus, the effect of the toxins may depend on an action of SAP independent of the effects of the SAP conjugates on targeted neuronal types. PMID:23245583

  3. Using a pacifier to decrease sudden infant death syndrome: an emergency department educational intervention

    PubMed Central

    Vieth, Teri; Rodriguez, Carolina; Lona, Nicole; Molina, Rogelio; Habebo, Emnet; Caldera, Enrique; Garcia, Cynthia; Veazey, Gregory

    2014-01-01

    Background. Pacifier use decreases the risk of sudden infant death syndrome (SIDS). An emergency department (ED) visit may provide an opportunistic ‘teachable moment’ for parents. Objectives. To test the hypotheses (1) that caregivers were less familiar with the role of pacifiers in sudden infant death (SIDS) prevention than other recommendations, and (2) that an ED educational intervention would increase pacifier use in infants younger than six months, and (3) that otitis media would not occur more frequently in pacifier users. Methods. We did an intervention-group-only longitudinal study in a county hospital ED. We measured pacifier use infants and baseline knowledge of SIDs prevention recommendations in caregivers. We followed up three months later to determine pacifier use, and 12 months later to determine episodes of otitis media. Results. We analyzed data for 780 infants. Parents knew of advice against co-sleeping in 469/780 (60%), smoking in 660/776 (85%), and prone sleeping in 613/780 (79%). Only 268/777 (35%) knew the recommendation to offer a pacifier at bedtime. At enrollment 449/780 (58%) did not use a pacifier. Of 210/338 infants aged less than 6 months followed up 41/112 (37%) non-users had started using a pacifier at bedtime (NNT 3). Over the same period, 37/98 (38%) users had discontinued their pacifier. Otitis media did not differ between users and non-users at 12 months. Conclusion. Caregiver knowledge of the role of pacifiers in SIDS prevention was less than for other recommendations. Our educational intervention appeared to increase pacifier use. Pacifier use was not associated with increased otitis media. PMID:24688883

  4. Anesthetic- and heat-induced sudden death in calsequestrin-1-knockout mice

    PubMed Central

    Dainese, Marco; Quarta, Marco; Lyfenko, Alla D.; Paolini, Cecilia; Canato, Marta; Reggiani, Carlo; Dirksen, Robert T.; Protasi, Feliciano

    2009-01-01

    Calsequestrin-1 (CASQ1) is a moderate-affinity, high-capacity Ca2+-binding protein in the sarcoplasmic reticulum (SR) terminal cisternae of skeletal muscle. CASQ1 functions as both a Ca2+-binding protein and a luminal regulator of ryanodine receptor (RYR1)-mediated Ca2+ release. Mice lacking skeletal CASQ1 are viable but exhibit reduced levels of releasable Ca2+ and altered contractile properties. Here we report that CASQ1-null mice exhibit increased spontaneous mortality and susceptibility to heat- and anesthetic-induced sudden death. Exposure of CASQ1-null mice to either 2% halothane or heat stress triggers lethal episodes characterized by whole-body contractures, elevated core temperature, and severe rhabdomyolysis, which are prevented by prior dantrolene administration. The characteristics of these events are remarkably similar to analogous episodes observed in humans with malignant hyperthermia (MH) and animal models of MH and environmental heat stroke (EHS). In vitro studies indicate that CASQ1-null muscle exhibits increased contractile sensitivity to temperature and caffeine, temperature-dependent increases in resting Ca2+, and an increase in the magnitude of depolarization-induced Ca2+ release. These results demonstrate that CASQ1 deficiency alters proper control of RYR1 function and suggest CASQ1 as a potential candidate gene for linkage analysis in families with MH/EHS where mutations in the RYR1 gene are excluded.—Dainese, M., Quarta, M., Lyfenko, A. D., Paolini, C., Canato, M., Reggiani, C., Dirksen, R. T., Protasi, F. Anesthetic- and heat-induced sudden death in calsequestrin-1-knockout mice. PMID:19237502

  5. The Effect of Increased Mineral Levels in the Feed on Leg Weakness and Sudden Death Syndrome in Broiler Chickens

    PubMed Central

    Julian, Richard J.

    1986-01-01

    In two experiments with 98,000 and 40,000 broilers on commercial broiler farms, half of each flock were fed starter, grower and finisher diets with 0.2% added calcium, 0.2% added phosphorus and 0.2% added magnesium. This ration had no significant effect on the incidence of sudden death syndrome but the incidence of leg weakness in broilers on the increased mineral ration was higher in both flocks. Approximately 28% of the mortality in both flocks was from sudden death syndrome, more than from any other condition. Approximately 20% of the mortality was associated with leg weakness. PMID:17422644

  6. A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

    PubMed Central

    Elhaik, Eran

    2016-01-01

    Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer

  7. Matters of life and death: social, political, and religious correlates of attitudes on abortion.

    PubMed

    Baker, Ross K; Epstein, Laurily K; Forth, Rodney D

    1981-01-01

    This article investigates the structure of attitudes toward abortion using several demographic, political, and religious variables. The analysis is based on a 1978 survey of New Jersey's voting age population. Responses to questions on 3 aspects of the abortion issue--a constitutional ban on abortion, abortion on demand, and government funding of abortions--are combined to form a scale of support and opposition to abortion. We find that support for abortion is related to youth, high socioeconomic status, a liberal ideology, opposition to right-to-die legislation, and support for the Equal Rights Amendment. Additionally, we find that approval for abortion is not a function of religious preference. Rather, attitudes on abortion are a function of intensity of religious adherence, regardless of specific religion.

  8. Sudden Infant Death Syndrome – Role of Trigeminocardiac Reflex: A Review

    PubMed Central

    Singh, Gyaninder Pal; Chowdhury, Tumul; Bindu, Barkha; Schaller, Bernhard

    2016-01-01

    Sudden infant death syndrome (SIDS) is an unexplained death in infants, which usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR), is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex that manifests as bradycardia, hypotension, apnea, and gastric hypermotility. The TCR shares many similarities with the DR, which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath holding (apnea), bradycardia, and vasoconstriction, leading to increase in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation, or decreased neuronal density of arcuate nucleus, hypoplasia, and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field. PMID:27994573

  9. The role of the autonomic nervous system in arrhythmias and sudden cardiac death.

    PubMed

    Franciosi, Sonia; Perry, Frances K G; Roston, Thomas M; Armstrong, Kathryn R; Claydon, Victoria E; Sanatani, Shubhayan

    2017-03-31

    The autonomic nervous system (ANS) is complex and plays an important role in cardiac arrhythmia pathogenesis. A deeper understanding of the anatomy and development of the ANS has shed light on its involvement in cardiac arrhythmias. Alterations in levels of Sema-3a and NGF, both growth factors involved in innervation patterning during development of the ANS, leads to cardiac arrhythmias. Dysregulation of the ANS, including polymorphisms in genes involved in ANS development, have been implicated in sudden infant death syndrome. Disruptions in the sympathetic and/or parasympathetic systems of the ANS can lead to cardiac arrhythmias and can vary depending on the type of arrhythmia. Simultaneous stimulation of both the sympathetic and parasympathetic systems is thought to lead to atrial fibrillation whereas increased sympathetic stimulation is thought to lead to ventricular fibrillation or ventricular tachycardia. In inherited arrhythmia syndromes, such as Long QT and Catecholaminergic Polymorphic Ventricular Tachycardia, sympathetic system stimulation is thought to lead to ventricular tachycardia, subsequent arrhythmias, and in severe cases, cardiac death. On the other hand, arrhythmic events in Brugada Syndrome have been associated with periods of high parasympathetic tone. Increasing evidence suggests that modulation of the ANS as a therapeutic strategy in the treatment of cardiac arrhythmias is safe and effective. Further studies investigating the involvement of the ANS in arrhythmia pathogenesis and its modulation for the treatment of cardiac arrhythmias is warranted.

  10. Sudden infant death syndrome in Canada: trends in rates and risk factors, 1985-1998.

    PubMed

    Rusen, I D; Liu, Shiliang; Sauve, Reg; Joseph, K S; Kramer, Michael S

    2004-01-01

    In Canada, sudden infant death syndrome (SIDS) remains the leading cause of postneonatal death. However, SIDS rates have been declining in many countries, including Canada. This decline has been largely attributed to recommendations to avoid placing infants to sleep in the prone position. We examined the postneonatal rate of mortality due to SIDS and to other causes in relation to the initial risk reduction campaign. The postneonatal mortality rate due to SIDS decreased from 0.97 to 0.54 per 1,000 neonatal survivors between 1985-1989 and 1994-1998 (relative risk [RR] = 0.56, 95% confidence interval [CI] 0.51-0.62). The rate of postneonatal mortality due to other causes also decreased during the same period, though to a smaller extent, from 1.19 to 0.86 (RR = 0.72, 95% CI 0.66-0.78). With the exception of seasonality, established risk factors for SIDS remained essentially unchanged between the two time periods. The observed reduction in postneonatal SIDS is consistent with a positive impact of the initial recommendations regarding risk reduction. However, the lack of reliable risk factor data limits the extent to which the decline can be attributed directly to the campaign.

  11. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death

    PubMed Central

    Günther, Michael; Quick, Silvio; Pfluecke, Christian; Rottstädt, Fabian; Szymkiewicz, Steven J.; Ringquist, Steven; Strasser, Ruth H.; Speiser, Uwe

    2016-01-01

    Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways. PMID:27458236

  12. Excessive sulfate and poor water quality as a cause of sudden deaths and an outbreak of diarrhea in horses

    PubMed Central

    Burgess, Brandy A.; Lohmann, Katharina L.; Blakley, Barry R.

    2010-01-01

    Sudden deaths and an outbreak of diarrhea in horses occurred in southern Saskatchewan in 2006. Five horses died while survivors presented with diarrhea and, in 1 case, acute neurologic signs attributed to hyponatremia. Diagnostic testing of affected horses and environmental testing suggested poor water quality, specifically high salinity and high sulfate concentration as the cause. PMID:20514251

  13. Epidemiology of abortion.

    PubMed

    Tyler C

    1976-06-01

    This brief summary presents information on the epidemiology of abortion requested by IPPF. In 1975, 8% of the world's population lived in areas where the law prohibits abortion completely, and 27% lived in areas where abortions are severely restricted. Over 2 years, 40,000 hospitalizations for abortion complications were reported in such countries, with 168 deaths. 21% of women hospitalized for a diagnosis related to abortion died. In Latin America, hospitalization and death because of illegal abortion led to epidemiological studies. In Chile, surveys indicate that 1/4 women has had an abortion. Colombia data state that 10 women die/week from abortion complications. Bangladesh identified 31 abortion deaths. When related to live births occurring in the area from which the deaths were reported, the abortion mortality ratio was 19/1000,000 live births. Data from Romania showed that before 1966, when abortion was legal, there were fewer than 100 reported deaths. After 1966, when abortion was restricted, crude birth rate increased from 15-40/1000 total population. During the following 4 years, the birth rate dropped until it was below 25, but concomitant deaths due to abortion increased. In 1965, 64 abortion-related deaths occurred, whereas by 1971, abortion-related deaths increased to 364. In North America abortion deaths and number of illegal abortions decreased dramatically after 1973, when abortion became legal in the U.S. In 1972, illegal abortions led to the deaths of 41 women, but in 1974 only 5 such deaths occurred. If women with unplanned or unwanted pregnancies all underwent abortion within the 1st 8 weeks of pregnancy, 90% of the deaths due to legal abortion could be prevented.

  14. Postmortem diagnosis of infectious heart diseases: A mystifying cause of Sudden Infant Death.

    PubMed

    Gaaloul, Imed; Riabi, Samira; Evans, Mark; Hunter, Timothy; Huber, Sally; Aouni, Mahjoub

    2016-05-01

    Sudden infant death (SID) is an unresolved problem of high relevance and previous studies have indicated a role of viral heart infections. The diagnosis remains difficult in clinical practice using routine diagnostic tests and must be substantially improved. A prospective study based on post-mortem samples from SID victims whose heart disease was not clinically recognized was conducted for 4 years in a Tunisian University Hospital. Pediatric cases of unnatural death served as controls. Both SID victims and controls were investigated for possible coxsackievirus-B (CV-B) infection in heart tissue. During the study period, 39 cases with a male predominance (77%) were reported. There was no positive family history of coronary artery disease among the victims. In 35 cases (90%), low birth weight and/or critical development period were reported. All SID victims had complained of mild fever and insomnia for a few days preceding death, which required infectious laboratory investigations marked with an elevated white blood cell count (WBC) and C-reactive protein (CRP). The cardiac biomarkers were also elevated. The histopathological investigations of the heart tissue samples revealed signs of myocardial and pericardial inflammation. Enterovirus was detected by immunohistochemistry (IHC) and PCR from myocardial samples from 6 cases (15.3%) having myocarditis and 3 cases (7.7%) having perimyocarditis. The current study is of great interest and is aimed at urging health professionals to adopt systematically long intensive heart care in infants with underlying vulnerability as well as new diagnostic approaches including histopathology complemented with IHC and molecular pathology.

  15. An association between sudden infant death syndrome (SIDS) and Helicobacter pylori infection

    PubMed Central

    Kerr, J; Al-Khattaf, A; Barson, A; Burnie, J

    2000-01-01

    BACKGROUND—Helicobacter pylori has recently been detected in the stomach and trachea of cases of sudden infant death syndrome (SIDS) and proposed as a cause of SIDS.
AIMS—To establish the incidence of H pylori in the stomach, trachea, and lung of cases of SIDS and controls.
METHODS—Stomach, trachea, and lung tissues from 32 cases of SIDS and eight control cases were examined retrospectively. Diagnosis of SIDS was based on established criteria. Controls were defined by death within 1 year of age and an identifiable cause of death. Tissues were examined histologically for the presence of bacteria. Extracted DNA from these tissues was tested for H pylori ureC and cagA sequences by nested polymerase chain reaction and amplicons detected by enzyme linked immunosorbent assay (ELISA). The cut off for each ELISA for each of the tissue types was taken as the mean optical density plus two times the standard deviation of a range of negative controls.
RESULTS—Ages of SIDS cases ranged from 2 to 28 weeks. Ages of controls ranged from 3 to 44 weeks. For the ureC gene, 25 SIDS cases were positive in one or more tissues compared with one of the controls. For the cagA gene, 25 SIDS cases were positive in one or more tissues compared with one of the controls.
CONCLUSIONS—There is a highly significant association between H pylori ureC and cagA genes in the stomach, trachea, and lung of cases of SIDS when compared with controls.

 PMID:11040154

  16. Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients

    PubMed Central

    Barberato, Silvio Henrique; Bucharles, Sérgio Gardano Elias; Barberato, Marcia Ferreira Alves; Pecoits-Filho, Roberto

    2016-01-01

    Background: Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. Objectives: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. Methods: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. Results: We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. Conclusions: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients. PMID:27411094

  17. [Sudden infant death and sickle cell anemia in the Sahel region of Africa].

    PubMed

    Vix, J; Buguet, A; Straboni, S; Beidari, H

    1987-01-01

    The authors investigated the incidence of sudden infant death syndrome (S.I.D.S.) in families of government employees who benefited of free health care. Out of approximately 400 families with around 2000 children, 29 reported at least one infant death meeting the chosen criteria for S.I.D.S. A total of 41 children, mostly males, died between 1 day and 30 months of age, amongst the 149 children born in these families; most of them died during the first 3 months of life. The mothers were generally house wives, aged 26.2 +/- 1.0 years. Sickle cell trait was found in at least one parent of 21 families. In the other 8 families, 11 out of 38 children died, giving a prevalence rate of 6.9/1000 live births for S.I.D.S. in the healthy population. In the sickle cell trait population, the prevalence rate for S.I.D.S. reached 75.0/1000 live births, the prevalence of sickle cell anemia being about 20% in Niger. When very strict criteria were used for diagnosing S.I.D.S., the prevalence rate was 2.5/1000 and 40/1000 live births in the healthy and the sickle trait populations respectively. This study is the first attempt to determine the place of S.I.D.S. in the infant mortality rate in Sahelian Africa. In families with sickle cell disease, the risk of S.I.D.S. was 11.5 times greater than in healthy families. The role of sleep apnea as a cause of S.I.D.S. is discussed. It may represent a common cause of death in both healthy families at risk and sickle cell trait families.

  18. Common mitochondrial DNA deletion associated with sudden natural death in adults.

    PubMed

    Polisecki, Eliana Y; Schreier, Laura E; Ravioli, Julio; Corach, Daniel

    2004-11-01

    One of the most frequent causes of death in developed countries is sudden natural death (SND), which is the most common indication for medico-legal autopsies. Cardiac diseases are frequently detected among SND. Mitochondrial DNA (mtDNA) is easily damaged by reactive oxygen species, and it may cause dysfunction in tissues, leading to early events in cardiovascular disease. A specific mtDNA deletion of 4977 bp is associated to aging, myocardial dysfunction, and bioenergetic deficit. The potential link between mtDNA damage and SND has not been investigated before. Our aim was to evaluate the accumulation of the common mtDNA4977-deletion in cardiac muscle samples from autopsies of SND in adults (n = 14) in comparison to control samples from unnatural deaths (n = 12). Serial dilution-polymerase chain reaction method was performed to estimate the proportion of the total mtDNA harboring the mtDNA4977-deletion. Coefficient variation intra-assay was 8%, and inter-assay was 12%. MtDNA4977-deletion percentage was higher in samples obtained from victims of SND than in those from subjects who died of unnatural causes (p < 0.05). No differences in mtDNA4977-deletion were found between SND victims 39-51 years old, and no correlation was found between these samples and age, r = 0.30, p = 0.29 while it was significant among control samples, r = 0.68, p < 0.05. The association between mtDNA4977 deletion with SND victims might offer a tool to provide additional information to clarify complex SND investigations.

  19. Gas dispersal potential of bedding as a cause for sudden infant death.

    PubMed

    Sakai, Jun; Kanetake, Jun; Takahashi, Shirushi; Kanawaku, Yoshimasa; Funayama, Masato

    2008-09-18

    We assessed the gas dispersal potential of bedding articles used by 14 infants diagnosed with sudden unexpected infant death at autopsy. Of these cases, eight exhibited FiCO(2) values greater than 10% within 2.5 min, six of which were found prone and two supine. The results demonstrated that these eight beddings had a high rebreathing potential if they covered the babies' faces. We did not, however, take into account in our model the large tissue stores of CO(2). As some bicarbonate pools will delay or suppress the increase of FiCO(2), the time-FiCO(2) graphs of this study are not true for living infants. This model, however, demonstrated the potential gas dispersal ability of bedding. The higher the FiCO(2) values, the more dangerous the situation for rebreathing infants. In addition, FiO(2) in the potential space around the model's face can be estimated mathematically using FiCO(2) values. The FiO(2) graph pattern for each bedding item corresponded roughly to the inverse of the FiCO(2) time course. The FiO(2) of the above eight cases decreased by 8.5% within 2.5 min. Recent studies using living infants placed prone to sleep reported that some babies exhibited larger decreases in FiO(2) than increases observed in FiCO(2). While the decrease of FiO(2) in our model is still theoretical, CO(2) accumulation and O(2) deprivation are closely related. If a striking O(2) deficiency occurs in a short period, babies can lose consciousness before an arousal response is evoked and all infants could be influenced by the poor gas dispersal of bedding; the main cause of sudden death in infancy would thus be asphyxia. When the bedding is soft, the potential for trapping CO(2) seems to be high; however, it is impossible to assess it by appearance alone. We sought to provide some objective indices for the assessment of respiratory compromise in relation to bedding using our model. When a baby is found unresponsive with his/her face covered with poor gas dispersal bedding, we should

  20. Unsafe abortion in Kenya.

    PubMed

    Biddlecom, Ann

    2008-11-01

    Though pregnancy termination is highly restricted in Kenya, induced abortion remains common. Illegal abortion is often unsafe, putting women at risk of death or severe complications. In eastern Africa as a whole, an estimated 14% of all pregnancies end in abortion, and nearly one in five maternal deaths are due to unsafe abortion.

  1. Anatomopathological changes of the cardiac conduction system in sudden cardiac death, particularly in infants: advances over the last 25 years.

    PubMed

    Ottaviani, Giulia; Buja, L Maximilian

    Sudden cardiac death (SCD) is defined as the unexpected death without an obvious noncardiac cause that occurs within 1 h of witnessed symptom onset (established SCD) or within 24 h of unwitnessed symptom onset (probable SCD). In the United States, its incidence is 69/100,000 per year. Dysfunctions of the cardiac conduction and autonomic nervous systems are known to contribute to SCD pathogenesis, even if most clinicians and cardiovascular pathologists lack experience with detailed examination of the cardiac conduction system and fail to recognize lesions that are crucial to explain the SCD itself. In this review, we sought to describe the advances over the last 25 years in the study of the anatomopathological changes of the conducting tissue, in SCD, in mature hearts and particularly in sudden infant death syndrome (SIDS) and sudden intrauterine unexpected death syndrome (SIUDS), through the articles published in our journal Cardiovascular Pathology (CVP). We carried out an extensive Medline search to retrieve and review all articles published in CVP in which the sudden unexpected death of one or more subjects believed healthy was reported, especially if associated with lesions of the conducting tissue in settings that revealed no other explained causes of death, particularly in infants and fetuses. The cardiac conduction findings of resorptive degeneration, His bundle dispersion, Mahaim fibers, cartilaginous meta-hyperplasia, persistent fetal dispersion, left-sided His bundle, septation of the bifurcation, atrioventricular node dispersion, sinus node hypoplasia, Zahn node, His bundle hypoplasia, atrioventricular node, and His bundle dualism were similarly detected in SIDS and SIUDS victims.

  2. Experiences, considerations and emotions relating to cardiogenetic evaluation in relatives of young sudden cardiac death victims.

    PubMed

    van der Werf, Christian; Onderwater, Astrid T; van Langen, Irene M; Smets, Ellen M A

    2014-02-01

    Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at risk and allow preventive measures to be taken. However, at present, the number of families attending a cardiogenetics clinic after the SCD of a young relative is low in the Netherlands. We performed a qualitative study and report on the experiences and attitudes of first-degree relatives who attended a cardiogenetics clinic for evaluation. In total, we interviewed nine first-degree relatives and one spouse of seven SCD victims about their experiences, considerations and emotions before attendance and at the first stage of the cardiogenetic evaluation before DNA results were available. Interviews were transcribed verbatim and analysed. Medical professionals did not have an important role in informing or referring relatives to a cardiogenetics clinic. Importantly, all participants indicated that they would have appreciated a more directive approach from medical professionals, because their mourning process hampered their own search for information and decision-making. A need to understand the cause of death and wanting to prevent another SCD event occurring in the family were the most important reasons for attending a clinic. There are possibilities to improve the information process and better support their decision-making. The multidisciplinary cardiogenetic evaluation was appreciated, but could be improved by minor changes in the way it is implemented.

  3. Incidence of sudden cardiac death in athletes: a state-of-the-art review.

    PubMed

    Harmon, Kimberly G; Drezner, Jonathan A; Wilson, Mathew G; Sharma, Sanjay

    2014-08-01

    Sudden cardiac death (SCD) is the leading medical cause of death in athletes; however, the precise incidence is unknown. The objectives of this review were to examine studies on the rate of SCD in athletes, assess the methodological strengths and weaknesses used to arrive at estimates, compare studies in athletes with estimates in similar populations and arrive at an approximation of the incidence of SCD based on the best available evidence. A comprehensive literature search was performed in PubMed using key terms related to SCD in athletes. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 40. The reference list from each manuscript was reviewed for additional relevant articles. The methods for case identification were examined, as well as the inclusion and exclusion criteria and the precision of the population denominator studied. Thirteen studies were found investigating the rate of SCD in athletes who ranged in age from 9 to 40. An additional 15 incidence studies were located examining the rate of SCD in other populations under the age of 40. Rates of SCD varied from 1:917,000 to 1:3000. Studies with higher methodological quality consistently yielded incidence rates in the range of 1:40,000 to 1:80,000. Some athlete subgroups, specifically men, African-American/black athletes and basketball players, appear to be at higher risk. The incidence of SCD in athletes is likely higher than traditional estimates which may impact the development of more effective prevention strategies.

  4. Sports-related sudden cardiac deaths in the young population of Switzerland

    PubMed Central

    Vital, Cristina; Kellerhals, Christoph; Medeiros-Domingo, Argelia; Gräni, Christoph; Trachsel, Lukas D.; Schmied, Christian M.; Saguner, Ardan M.; Eser, Prisca; Herzig, David; Bolliger, Stephan; Michaud, Katarzyna; Wilhelm, Matthias

    2017-01-01

    Background In Switzerland, ECG screening was first recommended for national squad athletes in 1998. Since 2001 it has become mandatory in selected high-risk professional sports. Its impact on the rates of sports-related sudden cardiac death (SCD) is unknown. Objective We aimed to study the incidence, causes and time trends of sports-related SCD in comparison to SCD unrelated to exercise in Switzerland. Methods We reviewed all forensic reports of SCDs of the German-speaking region of Switzerland in the age group of 10 to 39 years, occurring between 1999 and 2010. Cases were classified into three categories based on whether or not deaths were associated with sports: no sports (NONE), recreational sports (REC), and competitive sports (COMP). Results Over the 12-year study period, 349 SCD cases were recorded (mean age 30±7 years, 76.5% male); 297 cases were categorized as NONE, 31 as REC, and 21 as COMP. Incidences of SCD per 100,000 person-years [mean (95% CI)] were the lowest in REC [0.43 (0.35–0.56)], followed by COMP [1.19 (0.89–1.60)] and NONE [2.46 (2.27–2.66)]. In all three categories, coronary artery disease (CAD) with or without acute myocardial infarction (MI) was the most common cause of SCD. Three professional athletes were identified in COMP category which all had SCD due to acute MI. There were no time trends, neither in overall, nor in cause-specific incidences of SCD. Conclusions The incidence of SCD in young individuals in Switzerland is low, both related and unrelated to sports. In regions, like Switzerland, where CAD is the leading cause of SCD associated with competitions, screening for cardiovascular risk factors in addition to the current PPS recommendations might be indicated to improve detection of silent CAD and further decrease the incidence of SCD. PMID:28350812

  5. Chronic intermittent mental stress promotes atherosclerotic plaque vulnerability, myocardial infarction and sudden death in mice.

    PubMed

    Roth, Lynn; Rombouts, Miche; Schrijvers, Dorien M; Lemmens, Katrien; De Keulenaer, Gilles W; Martinet, Wim; De Meyer, Guido R Y

    2015-09-01

    Vulnerable atherosclerotic plaques are prone to plaque rupture leading to acute cardiovascular syndromes and death. Elucidating the risk of plaque rupture is important to define better therapeutic or preventive strategies. In the present study, we investigated the effect of chronic intermittent mental stress on atherosclerotic plaque stability and cardiovascular mortality in apolipoprotein E-deficient (ApoE(-/-)) mice with a heterozygous mutation in the fibrillin-1 gene (Fbn1(C1039G+/)(-)). This mouse model displays exacerbated atherosclerosis with spontaneous plaque ruptures, myocardial infarction and sudden death, when fed a Western-type diet (WD). Female ApoE(-/-)Fbn1(C1039G+/-) mice were fed a WD for up to 25 weeks. After 10 weeks WD, mice were divided in a control (n = 27) and mental stress (n = 29) group. The chronic intermittent mental stress protocol consisted of 3 triggers: water avoidance, damp bedding and restraint stress, in a randomly assigned order lasting 6 h every weekday for 15 weeks. Chronic intermittent mental stress resulted in a significant increase in the amount of macrophages in atherosclerotic plaques of the proximal ascending aorta, whereas type I collagen and fibrous cap thickness were decreased. The coronary arteries of mental stress-treated mice showed larger plaques, more stenosis, and an increased degree of perivascular fibrosis. Moreover, myocardial infarctions occurred more frequently in the mental stress group. As compared to the control group, the survival of stressed ApoE(-/-)Fbn1(C1039G+/-) mice decreased from 67% to 52% at 25 weeks WD, presumably due to myocardial infarctions. In conclusion, chronic intermittent mental stress promotes plaque instability, myocardial infarctions, and mortality of ApoE(-/-)Fbn1(C1039G+/-) mice.

  6. [Prevention of sudden infant death by monitoring: effects on psychological stress of involved parents].

    PubMed

    Lohaus, A; Ossenbrügger, J; Kämmer, P

    1996-08-01

    Effects on the emotional distress of addicted parents. The present paper focuses on the emotional distress that parents may experience during their use of a monitor to prevent the Sudden Infant Death Syndrome (SIDS). Since the parents are confronted with the risk of a life threatening event, it is important to know more about influential and relief factors to be able to contribute to the emotional support of parents. 229 parents of children whose siblings died of SIDS of children with an otherwise increased risk participated at the present questionnaire study. The results showed a lower emotional distress for parents with a previous SIDS experience than for parents confronted with an increased risk for other reasons. In general, the emotional distress was higher for mothers than for fathers. During the monitoring interval there are only small changes of the emotional distress experienced by the parents. The rate of false alarms leads to the highest impact on the emotional condition, while the highest relief results from a good quality of the monitoring instructions and from the knowledge thereby acquired by the parents. The significance of the results for the support of parents is evaluated and discussed.

  7. Plasma Fatty Acid Binding Protein 4 and Risk of Sudden Cardiac Death in Older Adults

    PubMed Central

    Djoussé, Luc; Maziarz, Marlena; Biggs, Mary L.; Ix, Joachim H.; Zieman, Susan J.; Kizer, Jorge R.; Lemaitre, Rozenn N.; Mozaffarian, Dariush; Tracy, Russell P.; Mukamal, Kenneth J.; Siscovick, David S.; Sotoodehnia, Nona

    2013-01-01

    Although fatty acid binding protein 4 (FABP4) may increase risk of diabetes and exert negative cardiac inotropy, it is unknown whether plasma concentrations of FABP4 are associated with incidence of sudden cardiac death (SCD). We prospectively analyzed data on 4,560 participants of the Cardiovascular Health Study. FABP4 was measured at baseline using ELISA, and SCD events were adjudicated through review of medical records. We used Cox proportional hazards to estimate effect measures. During a median followup of 11.8 years, 146 SCD cases occurred. In a multivariable model adjusting for demographic, lifestyle, and metabolic factors, relative risk of SCD associated with each higher standard deviation (SD) of plasma FABP4 was 1.15 (95% CI: 0.95–1.38), P = 0.15. In a secondary analysis stratified by prevalent diabetes status, FABP4 was associated with higher risk of SCD in nondiabetic participants, (RR per SD higher FABP4: 1.33 (95% CI: 1.07–1.65), P = 0.009) but not in diabetic participants (RR per SD higher FABP4: 0.88 (95% CI: 0.62–1.27), P = 0.50), P for diabetes-FABP4 interaction 0.049. In summary, a single measure of plasma FABP4 obtained later in life was not associated with the risk of SCD in older adults overall. Confirmation of our post-hoc results in nondiabetic people in other studies is warranted. PMID:24455402

  8. Decreased GABAA receptor binding in the medullary serotonergic system in the sudden infant death syndrome.

    PubMed

    Broadbelt, Kevin G; Paterson, David S; Belliveau, Richard A; Trachtenberg, Felicia L; Haas, Elisabeth A; Stanley, Christina; Krous, Henry F; Kinney, Hannah C

    2011-09-01

    γ-Aminobutyric acid (GABA) neurons in the medulla oblongata help regulate homeostasis, in part through interactions with the medullary serotonergic (5-HT) system. Previously, we reported abnormalities in multiple 5-HT markers in the medullary 5-HT system of infants dying from sudden infant death syndrome (SIDS), suggesting that 5-HT dysfunction is involved in its pathogenesis. Here, we tested the hypothesis that markers of GABAA receptors are decreased in the medullary 5-HT system in SIDS cases compared with controls. Using tissue receptor autoradiography with the radioligand H-GABA, we found 25% to 52% reductions in GABAA receptor binding density in 7 of 10 key nuclei sampled of the medullary 5-HT system in the SIDS cases (postconceptional age [PCA] = 51.7 ± 8.3, n = 28) versus age-adjusted controls (PCA = 55.3 ± 13.5, n = 8) (p ≤ 0.04). By Western blotting, there was 46.2% reduction in GABAAα3 subunit levels in the gigantocellularis (component of the medullary 5-HT system) of SIDS cases (PCA = 53.9 ± 8.4, n = 24) versus controls (PCA = 55.3 ± 8.3, n = 8) (56.8% standard in SIDS cases vs 99.35% in controls; p = 0.026). These data suggest that medullary GABAA receptors are abnormal in SIDS infants and that SIDS is a complex disorder of a homeostatic network in the medulla that involves deficits of the GABAergic and 5-HT systems.

  9. A New Theory to Explain the Underlying Pathogenetic Mechanism of Sudden Infant Death Syndrome

    PubMed Central

    Lavezzi, Anna Maria

    2015-01-01

    The author, on the basis of numerous studies on the neuropathology of SIDS, performed on a very wide set of cases, first highlights the neuronal centers of the human brainstem involved in breathing control in perinatal life, with the pontine Kölliker–Fuse nucleus (KFN) as main coordinator. What emerges from this analysis is that the prenatal respiratory movements differ from those post-natally in two respects: (1) they are episodic, only aimed at the lung development and (2) they are abolished by hypoxia, not being of vital importance in utero, mainly to limit the consumption of oxygen. Then, as this fetal inhibitory reflex represents an important defense expedient, the author proposes a new original interpretation of the pathogenetic mechanism leading to SIDS. Infants, in a critical moment of the autonomic control development, in hypoxic conditions could awaken the reflex left over from fetal life and arrest breathing, as he did in similar situations in prenatal life, rather than promote the hyperventilation usually occurring to restore the normal concentration of oxygen. This behaviour obviously leads to a fatal outcome. This hypothesis is supported by immunohistochemical results showing in high percentage of SIDS victims, and not in age-matched infant controls, neurochemical alterations of the Kölliker–Fuse neurons, potentially indicative of their inactivation. The new explanation of SIDS blames a sort of auto-inhibition of the KFN functionality, wrongly arisen with the same protective purpose to preserve the life in utero, as trigger of the sudden infant death. PMID:26539157

  10. Heritability of sudden death syndrome and its associated correlations to ascites and body weight in broilers.

    PubMed

    Moghadam, H K; McMillan, I; Chambers, J R; Julian, R J; Tranchant, C C

    2005-02-01

    (1) Genetic parameters for the sudden death syndrome (SDS) were estimated in meat-type chickens. Data were collected over 11 generations of selection for body weight within two distinct breeds (Cornish and White Rock). (2) The animal model was used exclusively with linear methods (LM) to estimate genetic parameters. Heritability (h2) of SDS on the liability scale was 0.30 +/- 0.002 and 0.25 +/- 0.002 in the Cornish and White Rock breeds, respectively. (3) A positive genetic correlation (r(g)) with ascites (AS) was determined (approximately 0.3 +/- 0.006). However, it was not possible to estimate the rg of SDS with body weight because of the low prevalence of the defect trait studied (1.8% in the Cornish and 1-5% in the White Rock). (4) Heritability of SDS calculated using male records only was 0.45 +/- 0.009 and 0.35 +/- 0.009, and r(g) with body weight was 0.30 +/- 0.010 and 0.27 +/- 0.009, in the Cornish and White Rock breeds, respectively. (5) In conclusion, the heart defect investigated was heritable with a positive genetic correlation with AS and body weight.

  11. The 12-lead electrocardiogram and risk of sudden death: current utility and future prospects.

    PubMed

    Narayanan, Kumar; Chugh, Sumeet S

    2015-10-01

    More than 100 years after it was first invented, the 12-lead electrocardiogram (ECG) continues to occupy an important place in the diagnostic armamentarium of the practicing clinician. With the recognition of relatively rare but important clinical entities such as Wolff-Parkinson-White and the long QT syndrome, this clinical tool was firmly established as a test for assessing risk of sudden cardiac death (SCD). However, over the past two decades the role of the ECG in risk prediction for common forms of SCD, for example in patients with coronary artery disease, has been the focus of considerable investigation. Especially in light of the limitations of current risk stratification approaches, there is a renewed focus on this broadly available and relatively inexpensive test. Various abnormalities of depolarization and repolarization on the ECG have been linked to SCD risk; however, more focused work is needed before they can be deployed in the clinical arena. The present review summarizes the current knowledge on various ECG risk markers for prediction of SCD and discusses some future directions in this field.

  12. Potential Effects of Heliogeophysical Activity on the Dynamics of Sudden Cardiac Death at Earth Middle Latitudes

    NASA Astrophysics Data System (ADS)

    Dimitrova, S.; Babayev, E.; Mustafa, F.

    2017-01-01

    Limited studies exist on comparing the possible effects of heliogeophysical activity (solar and geomagnetic) on the dynamics of sudden cardiac death (SCD) as a function of latitude on Earth. In this work we continue our earlier studies concerning the changing space environment and SCD dynamics at middle latitudes. The study covered 25 to 80-year old males and females, and used medical data provided by all emergency and first medical aid stations in the Grand Baku Area, Azerbaijan. Data coverage includedthe second peak of Solar Cycle 23 and its descending activity years followed by its long-lasting minimum. Gradation of geomagnetic activity into six levels was introduced to study the effect of space weather on SCD. The ANalysis Of VAriance (ANOVA) test was applied to study the significance of the geomagnetic activity effect, estimated by different geomagnetic indices, on SCD dynamics. Variations inthe number of SCDs occurring on days preceding and following the development of geomagnetic storms were also studied. Results revealed that the SCD number was largest on days of very low geomagnetic activity and on days proceeding and following geomagnetic storms with different intensities. Vulnerability for males was found to be higher around days of major and severe geomagnetic storms. Females, on the other hand, were more threatened around days of lower intensity storms. It is concluded that heliogeophysical activity could be considered as one of the regulating external/environmental factors in human homeostasis.

  13. Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing.

    PubMed

    Burtscher, M; Pachinger, O; Mittleman, M A; Ulmer, H

    2000-11-01

    More than 90% of all sudden cardiac deaths (SCDs) during downhill skiing, the most popular winter sport world-wide, are attributed to men over the age of 34. However, no data exist on additional risk factors and triggers for SCD related to downhill skiing. Therefore risk factor profiles of 68 males who died from SCD during downhill skiing were compared to those of 204 matched controls. Skiers who suffered SCD had much more frequently prior myocardial infarction (MI) (41% vs. 1.5%; p<0.001), hypertension (50% vs. 17%; p<0.001), known coronary heart disease (CHD) without prior MI (9% vs. 3%; p=0.05) and were less engaged in strenuous exercise (4% vs. 15%; p<0.05) when compared to controls. Multivariate analyses even enhanced the importance of these risk factors. Downhill skiing is considered to be a serious trigger for SCD especially in skiers with prior MI but also for those with hypertension, known CHD without prior MI, or insufficient adaptation to strenuous exercise. Skiing-related increased sympathetic activity might well disturb the autonomic balance with subsequent arrhythmias and/or may increase cardiac work and platelet aggregability with possible plaque rupture and coronary thrombosis. Therefore adaptation to high intensity exercise and therapeutic interventions or abstinence from skiing in certain cases should be considered for downhill skiers at high risk.

  14. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians.

    PubMed

    Chatard, J-C; Mujika, I; Goiriena, J J; Carré, F

    2016-04-01

    Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.

  15. Medico-legal perspectives on sudden cardiac death in young athletes.

    PubMed

    Oliva, Antonio; Grassi, Vincenzo M; Campuzano, Oscar; Brion, Maria; Arena, Vincenzo; Partemi, Sara; Coll, Monica; Pascali, Vincenzo L; Brugada, Josep; Carracedo, Angel; Brugada, Ramon

    2017-03-01

    Sudden cardiac death (SCD) in a young athlete represents a dramatic event, and an increasing number of medico-legal cases have addressed this topic. In addition to representing an ethical and medico-legal responsibility, prevention of SCD is directly correlated with accurate eligibility/disqualification decisions, with an inappropriate pronouncement in either direction potentially leading to legal controversy. This review summarizes the common causes of SCD in young athletes, divided into structural (hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, congenital coronary artery anomalies, etc.), electrical (Brugada, congenital LQT, Wolf-Parkinson-White syndrome, etc.), and acquired cardiac abnormalities (myocarditis, etc.). In addition, the roles of hereditary cardiac anomalies in SCD in athletes and the effects of a positive result on them and their families are discussed. The medico-legal relevance of pre-participation screening is analyzed, and recommendations from the American Heart Association and European Society of Cardiology are compared. Finally, the main issues concerning the differentiation between physiologic cardiac adaptation in athletes and pathologic findings and, thereby, definition of the so-called gray zone, which is based on exact knowledge of the mechanism of cardiac remodeling including structural or functional adaptions, will be addressed.

  16. Power blackouts, sudden death, and flash crashes: The physics of interdependent networks

    NASA Astrophysics Data System (ADS)

    Stanley, H. Eugene

    2014-03-01

    Recent disasters ranging from abrupt financial ``flash crashes'' and large-scale power outages to sudden death among the elderly dramatically exemplify the fact that the most dangerous vulnerability is hiding in the many interdependencies among different networks. This talk reports recent work quantifying failure mechanisms in interconnected networks, and demonstrates the need to consider mutually dependent network properties in designing resilient systems. Specifically, we have uncovered new laws governing the nature of switching phenomena in coupled networks, and found that phenomena that are continuous ``second order'' phase transitions in isolated networks become discontinuous abrupt ``first order'' transitions in interdependent networks [J. Gao, S. V. Buldyrev, H. E. Stanley, and S. Havlin, ``Novel Behavior of Networks Formed from Interdependent Networks,'' Nature Physics 8, 40 (2012)]. We also report parallel efforts to understand the phenomenon of spontaneous recovery in dynamical networks as occurs, e.g., immediately after a flash crash [A. Majdandzic, B. Podobnik, S. V. Buldyrev, D. Y. Kenett, S. Havlin, and H. E. Stanley, ``Spontaneous Recovery in Dynamic Networks,'' Nature Physics 9, No. 1 (2014)].

  17. Gut Microbiota and Immunity: Possible Role in Sudden Infant Death Syndrome

    PubMed Central

    Goldwater, Paul N.

    2015-01-01

    The gut microbiome influences the development of the immune system of young mammals; the establishment of a normal gut microbiome is thought to be important for the health of the infant during its early development. As the role of bacteria in the causation of sudden infant death syndrome (SIDS) is backed by strong evidence, the balance between host immunity and potential bacterial pathogens is likely to be pivotal. Bacterial colonization of the infant colon is influenced by age, mode of delivery, diet, environment, and antibiotic exposure. The gut microbiome influences several systems including gut integrity and development of the immune system; therefore, gut microflora could be important in protection against bacteria and/or their toxins identified in SIDS infants. The aims of the review are to explore (1) the role of the gut microbiome in relation to the developmentally critical period in which most SIDS cases occur; (2) the mechanisms by which the gut microbiome might induce inflammation resulting in transit of bacteria from the lumen into the bloodstream; and (3) assessment of the clinical, physiological, pathological, and microbiological evidence for bacteremia leading to the final events in SIDS pathogenesis. PMID:26089821

  18. Peripheral chemoreceptors: postnatal development and cytochemical findings in Sudden Infant Death Syndrome.

    PubMed

    Porzionato, Andrea; Macchi, Veronica; Parenti, Anna; Matturri, Luigi; De Caro, Raffaele

    2008-03-01

    The aim of the present study is to give a review of the postnatal development of peripheral chemoreceptors - carotid body, paraganglia, and pulmonary neuroendocrine cells (PNEC) - with implications in Sudden Infant Death Syndrome (SIDS). In the postnatal period, the hypoxic chemosensitivity of the carotid body gradually develops. Changes include proliferation of type I and II cells, increased numbers of dense core vesicles and K+ channels, and modifications of neurotransmitter/neuromodulator and receptor expression. Chromaffin paraganglia show increased expression of nitric oxide synthase and neuropeptides, and increased innervation. Innervation of PNEC develops fully only in the first postnatal period, after which their density falls. The neuropeptides produced by PNEC also changes, with increased expression of calcitonin gene-related peptide and neuropeptide YY and reduced expression of calcitonin and gastrin-releasing peptide. Most of the findings in the carotid body of SIDS victims, i.e., decrease in type I cells and dense cytoplasmic granules, and increase in progenitor cells, indicates immaturity of the carotid body, which may play a role in SIDS in the form of underlying biologic vulnerability. Aorticopulmonary paraganglia hyperplasia and increase of PNEC are also found in SIDS, and may be epiphenomena of alterations of the respiratory function with a pathogenetical role in SIDS. A comprehensive view of the pathogenesis of SIDS should also arise from the integration of peripheral chemoreceptors findings with neuro- and cardiopathologic ones.

  19. Maternal smoking and increased risk of sudden infant death syndrome: a meta-analysis.

    PubMed

    Zhang, Kui; Wang, Xianmin

    2013-05-01

    Maternal smoking is detrimental to the development of fetuses and neonates. This meta-analysis was performed to measure the accumulated association of sudden infant death syndrome (SIDS) risk with both prenatal and postnatal maternal smoking. The odds ratio (OR) corresponding to the 95% confidence interval (CI) was used to assess the associations between maternal smoking and SIDS risk. The statistical heterogeneity among studies was assessed with the Q-test and I(2) statistics. The data for this meta-analysis were available from 35 case-control studies. The prenatal and postnatal maternal smoking was associated with a significantly increased risk of SIDS (OR=2.25, 95% CI=2.03-2.50 for prenatal maternal smoking analysis, and OR=1.97, 95% CI=1.77-2.19 for postnatal maternal smoking analysis, respectively) by random effects model. After stratified analyses, regardless of prenatal or postnatal smoking, heavy cigarette consumption increased the risk of SIDS and significantly elevated SIDS risk was found to be associated with co-sleeping with postnatal smoking mothers. Our results suggested that maternal smoking were associated with elevated SIDS risk, the effects were dose-dependent. In addition, SIDS risk was significantly increased in infants co-sleeping with postnatal smoking mothers.

  20. Assessing Field-Specific Risk of Soybean Sudden Death Syndrome Using Satellite Imagery in Iowa.

    PubMed

    Yang, S; Li, X; Chen, C; Kyveryga, P; Yang, X B

    2016-08-01

    Moderate resolution imaging spectroradiometer (MODIS) satellite imagery from 2004 to 2013 were used to assess the field-specific risks of soybean sudden death syndrome (SDS) caused by Fusarium virguliforme in Iowa. Fields with a high frequency of significant decrease (>10%) of the normalized difference vegetation index (NDVI) observed in late July to middle August on historical imagery were hypothetically considered as high SDS risk. These high-risk fields had higher slopes and shorter distances to flowlines, e.g., creeks and drainages, particularly in the Des Moines lobe. Field data in 2014 showed a significantly higher SDS level in the high-risk fields than fields selected without considering NDVI information. On average, low-risk fields had 10 times lower F. virguliforme soil density, determined by quantitative polymerase chain reaction, compared with other surveyed fields. Ordinal logistic regression identified positive correlations between SDS and slope, June NDVI, and May maximum temperature, but high June maximum temperature hindered SDS. A modeled SDS risk map showed a clear trend of potential disease occurrences across Iowa. Landsat imagery was analyzed similarly, to discuss the ability to utilize higher spatial resolution data. The results demonstrated the great potential of both MODIS and Landsat imagery for SDS field-specific risk assessment.

  1. Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence

    PubMed Central

    Bergman, Nils J

    2016-01-01

    AIM To identify a hypothesis on: Supine sleep, sudden infant death syndrome (SIDS) reduction and association with increasing autism incidence. METHODS Literature was searched for autism spectrum disorder incidence time trends, with correlation of change-points matching supine sleep campaigns. A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism. RESULTS In five countries (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, change-points coinciding with supine sleep campaigns were identified. The model proposes that supine sleep does not directly cause autism, but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility, thereby specifically increasing the incidence of autism without intellectual disability. CONCLUSION Supine sleep is likely a physiological stressor, that does reduce SIDS, but at the cost of impact on emotional and social development in the population, a portion of which will be susceptible to, and consequently express autism. A re-evaluation of all benefits and harms of supine sleep is warranted. If the SIDS mechanism proposed and autism model presented can be verified, the research agenda may be better directed, in order to further decrease SIDS, and reduce autism incidence. PMID:27610351

  2. Mortality and community changes drive sudden oak death impacts on litterfall and soil nitrogen cycling.

    PubMed

    Cobb, Richard C; Eviner, Valerie T; Rizzo, David M

    2013-10-01

    Few studies have quantified pathogen impacts to ecosystem processes, despite the fact that pathogens cause or contribute to regional-scale tree mortality. We measured litterfall mass, litterfall chemistry, and soil nitrogen (N) cycling associated with multiple hosts along a gradient of mortality caused by Phytophthora ramorum, the cause of sudden oak death. In redwood forests, the epidemiological and ecological characteristics of the major overstory species determine disease patterns and the magnitude and nature of ecosystem change. Bay laurel (Umbellularia californica) has high litterfall N (0.992%), greater soil extractable NO3 -N, and transmits infection without suffering mortality. Tanoak (Notholithocarpus densiflorus) has moderate litterfall N (0.723%) and transmits infection while suffering extensive mortality that leads to higher extractable soil NO3 -N. Redwood (Sequoia sempervirens) has relatively low litterfall N (0.519%), does not suffer mortality or transmit the pathogen, but dominates forest biomass. The strongest impact of pathogen-caused mortality was the potential shift in species composition, which will alter litterfall chemistry, patterns and dynamics of litterfall mass, and increase soil NO3 -N availability. Patterns of P. ramorum spread and consequent mortality are closely associated with bay laurel abundances, suggesting this species will drive both disease emergence and subsequent ecosystem function.

  3. Manipulation of entanglement sudden death in an all-optical setup

    NASA Astrophysics Data System (ADS)

    Singh, Ashutosh; Pradyumna, Siva; Rau, A. R. P.; Sinha, Urbasi

    2017-03-01

    The unavoidable and irreversible interaction between an entangled quantum system and its environment causes decoherence of the individual qubits as well as degradation of the entanglement between them. Entanglement sudden death (ESD) is the phenomenon wherein disentanglement happens in finite time even when individual qubits decohere only asymptotically in time due to noise. Prolonging the entanglement is essential for the practical realization of entanglement-based quantum information and computation protocols. For this purpose, the local NOT operation in the computational basis on one or both qubits has been proposed. Here, we formulate an all-optical experimental set-up involving such NOT operations that can hasten, delay, or completely avert ESD, all depending on when it is applied during the process of decoherence. Analytical expressions for these are derived in terms of parameters of the initial state's density matrix, whether for pure or mixed entangled states. After a discussion of the schematics of the experiment, the problem is theoretically analyzed, and simulation results of such manipulations of ESD are presented.

  4. Discussing sudden unexpected death in epilepsy: Are we empowering our patients? A questionnaire survey

    PubMed Central

    Keddie, S; Angus-Leppan, H; Parker, T; Toescu, S; Nash, A; Adewunmi, O

    2016-01-01

    Objective To examine patient knowledge about sudden unexpected death in epilepsy (SUDEP) compared to other risks in epilepsy. To explore patients’ experiences surrounding SUDEP disclosure and opinions on how information should be delivered. Design A cross-sectional questionnaire. Setting Royal Free Hospital, London outpatient epilepsy clinics. Participants New and follow-up patients attending epilepsy clinics at a London teaching hospital over six months. Patients identified as being at risk of suffering negative emotional or psychological consequences of SUDEP discussions were excluded. Main outcome measures Patient knowledge about epilepsy risks; patient opinion regarding source, timing and delivery of SUDEP information; impact on health seeking behaviour. Results Ninety-eight per cent of patients were aware of medication adherence, 84% of factors influencing seizure frequency, 78% of driving regulations, 50% of SUDEP and 38% of status epilepticus; 72% of patients felt that SUDEP information should be given to all patients. Preferences for timing of SUDEP discussions varied between those wanting information at diagnosis (40%) and those preferring to receive it after three clinic appointments (18%) to avoid information overload at the first consultation. Emotional responses (48% positive, 38% negative) predominated over measurable behavioural change following SUDEP discussions. Conclusions Less than half the patients knew about SUDEP and status epilepticus. Although the majority of patients with epilepsy wish to be informed about SUDEP early on in their diagnosis, information must be delivered in a way that promotes patient knowledge and empowerment. PMID:27688898

  5. [The automatic implantable cardioverter-defibrillator for prevention of sudden heart death in children and adolescents].

    PubMed

    Paul, T; Luhmer, I; Trappe, H J; Klein, H; Fieguth, H G; Brauer, C; Scharpwinkel, U; Kallfelz, H C

    1993-08-01

    Little experience exists with the automatic implantable cardioverter-defibrillator in the pediatric population. Since 1990, an automatic implantable cardioverter defibrillator was implanted in four young patients (mean age 15.8 years, mean body weight 53.3 kg) with life-threatening ventricular tachyarrhythmias at our institution. In three patients, a cardiac anomaly was evident (dilated cardiomyopathy, status post Rastelli operation for complex transposition of the great arteries, status post atrial switch for transposition of the great arteries), the last patient had a normal cardiac anatomy. Indications for implantation were resuscitation from documented hypotensive ventricular tachycardia in one patient and recurrent syncope of suspected cardiac origin in the remaining three patients. At preimplantation electrophysiological study, all four patients had inducible ventricular tachycardia and/or ventricular fibrillation. At implantation of the cardioverter defibrillator in the operating theatre, the ventricular tachyarrhythmias were again induced and terminated reliably by the device. After a mean follow-up of 13 months, three of the four patients had appropriate discharges without syncope or resuscitation. The automatic implantable cardioverter-defibrillator appears to be a feasible and effective therapy also in pediatric patients for prevention of sudden cardiac death due to ventricular tachyarrhythmias.

  6. Anesthetic- and heat-induced sudden death in calsequestrin-1-knockout mice.

    PubMed

    Dainese, Marco; Quarta, Marco; Lyfenko, Alla D; Paolini, Cecilia; Canato, Marta; Reggiani, Carlo; Dirksen, Robert T; Protasi, Feliciano

    2009-06-01

    Calsequestrin-1 (CASQ1) is a moderate-affinity, high-capacity Ca(2+)-binding protein in the sarcoplasmic reticulum (SR) terminal cisternae of skeletal muscle. CASQ1 functions as both a Ca(2+)-binding protein and a luminal regulator of ryanodine receptor (RYR1)-mediated Ca(2+) release. Mice lacking skeletal CASQ1 are viable but exhibit reduced levels of releasable Ca(2+) and altered contractile properties. Here we report that CASQ1-null mice exhibit increased spontaneous mortality and susceptibility to heat- and anesthetic-induced sudden death. Exposure of CASQ1-null mice to either 2% halothane or heat stress triggers lethal episodes characterized by whole-body contractures, elevated core temperature, and severe rhabdomyolysis, which are prevented by prior dantrolene administration. The characteristics of these events are remarkably similar to analogous episodes observed in humans with malignant hyperthermia (MH) and animal models of MH and environmental heat stroke (EHS). In vitro studies indicate that CASQ1-null muscle exhibits increased contractile sensitivity to temperature and caffeine, temperature-dependent increases in resting Ca(2+), and an increase in the magnitude of depolarization-induced Ca(2+) release. These results demonstrate that CASQ1 deficiency alters proper control of RYR1 function and suggest CASQ1 as a potential candidate gene for linkage analysis in families with MH/EHS where mutations in the RYR1 gene are excluded.

  7. Spatial and Temporal Analysis of Populations of the Sudden Oak Death Pathogen in Oregon Forests.

    PubMed

    Kamvar, Z N; Larsen, M M; Kanaskie, A M; Hansen, E M; Grünwald, N J

    2015-07-01

    Sudden oak death caused by the oomycete Phytophthora ramorum was first discovered in California toward the end of the 20th century and subsequently emerged on tanoak forests in Oregon before its first detection in 2001 by aerial surveys. The Oregon Department of Forestry has since monitored the epidemic and sampled symptomatic tanoak trees from 2001 to the present. Populations sampled over this period were genotyped using microsatellites and studied to infer the population genetic history. To date, only the NA1 clonal lineage is established in this region, although three lineages exist on the North American west coast. The original introduction into the Joe Hall area eventually spread to several regions: mostly north but also east and southwest. A new introduction into Hunter Creek appears to correspond to a second introduction not clustering with the early introduction. Our data are best explained by both introductions originating from nursery populations in California or Oregon and resulting from two distinct introduction events. Continued vigilance and eradication of nursery populations of P. ramorum are important to avoid further emergence and potential introduction of other clonal lineages.

  8. Sudden death caused by unsuspected pulmonary arterial hypertension, 10 years after surgery for extrahepatic biliary atresia.

    PubMed

    Moscoso, G; Mieli-Vergani, G; Mowat, A P; Portmann, B

    1991-04-01

    A case of extrahepatic biliary atresia presenting with an acute respiratory episode and rapid deterioration, 10 years after a successful portoenterostomy and a very active life, was the setting of unsuspected severe pulmonary arterial hypertension leading to sudden death. The pulmonary arteries showed widespread plexiform lesions, thickening of the muscular media, and subendothelial proliferation. Occasionally, eccentric arterial obstructive lesions and fibrinous thrombi were observed. There was marked reduction of preacinar arterioles with a consequent increase in the alveolar/arterial ratio. The pulmonary veins showed arterialization of their walls. There was marked hypertrophy of myocardial fibres in the right ventricle together with foci of myocardial degeneration and fibrosis. Areas of endocardial thickening were observed in both ventricles. The absence of clinical indicators of pulmonary arterial hypertension at any but the terminal stages of the disease precluded any form of conservative management. Lung-heart and presumably liver transplantation might have been the only option. Prospective assessment of pulmonary function and haemodynamic studies should be considered in cirrhotic patients with portal hypertension.

  9. Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes.

    PubMed

    Kataoka, Masaaki; Ito, Chikako; Sasaki, Hideo; Yamane, Kiminori; Kohno, Nobuoki

    2004-04-01

    The purpose of this study is to examine the association between sudden cardiac death (SCD) and heart rate variability (HRV) in subjects with and without type 2 diabetes and to determine whether low HRV can predict SCD in type 2 diabetes. Subjects were 8917 consecutively examined persons (3089 diabetic, and 5828 nondiabetic subjects) aged 35-69 years who underwent a 75 g oral glucose tolerance test (OGTT) together with electrocardiography (ECG). HRV was calculated from the 12-lead ECG as the coefficient of variance for 100 R-R intervals (CV(R-R)). During a median observation period of 5.2 years, SCD occurred in 56 subjects (33 diabetic, and 23 nondiabetic). Among diabetic subjects, mortality from SCD tended to be higher in subjects with a low CV(R-R) (P=0.004). After adjustment for age, gender, systolic blood pressure, total cholesterol (TC), triglycerides (TG), BMI, ischemic ECG change, and smoking history, relative risk (RR) of SCD was 2.07 (95% CI 1.02-4.17) in diabetic subjects with a CV(R-R) <2.2% compared with those with a CV(R-R) > or =2.2%. Diabetic subjects with a CV(R-R) <2.2% had significantly higher cumulative mortality from SCD than those with a CV(R-R) > or =2.2% (P=0.007). In type 2 diabetes, a low CV(R-R) carried an increased risk of SCD.

  10. Sleeping position and sudden infant death syndrome in Norway 1967-91.

    PubMed Central

    Irgens, L M; Markestad, T; Baste, V; Schreuder, P; Skjaerven, R; Oyen, N

    1995-01-01

    OBJECTIVE--To investigate, in a population based national study, the association between sleeping position of infants and the occurrence of sudden infant death syndrome (SIDS). DESIGN--A retrospective survey and registry based ecological study. A questionnaire based surveillance of sleeping position was obtained in a random sample (n = 34,799) and surveillance of SIDS was based on all infants born in Norway 1967-91, surviving the perinatal period. Variables studied from the questionnaire were usual sleeping position (placed), breast feeding at 3 months, and maternal smoking in pregnancy, and from the Medical Birth Registry maternal age, birth order, and birth weight. RESULTS--Proportion of infants sleeping prone increased from 1970 (7.4%) to 1989 (49.1%) and dropped in 1990 (26.8%) and 1991 (28.3%). Occurrence of SIDS increased from 1970 (1.1/1000) to 1989 (2.0) before dropping in 1990 and 1991 (1.1). IMPLICATION AND RELEVANCE OF RESULTS--A cause effect relationship between prone sleeping and SIDS as suggested in previous studies is supported by the present; and so far only, national study of infants' sleeping position. PMID:7618929

  11. The Role of Spatial Dispersion of Repolarization in Inherited and Acquired Sudden Cardiac Death Syndromes

    PubMed Central

    Antzelevitch, Charles

    2007-01-01

    This review examines the role of spatial electrical heterogeneity within ventricular myocardium on the function of the heart in health and disease. The cellular basis for transmural dispersion of repolarization (TDR) is reviewed and the hypothesis that amplification of spatial dispersion of repolarization underlies the development of life-threatening ventricular arrhythmias associated with inherited ion channelopathies is evaluated. The role of TDR in the long QT, short QT and Brugada syndromes as well as catecholaminergic polymorphic ventricular tachycardia (CPVT) are critically examined. In the long QT Syndrome, amplification of TDR is often secondary to preferential prolongation of the action potential duration (APD) of M cells, whereas in the Brugada Syndrome, it is thought to be due to selective abbreviation of the APD of right ventricular (RV) epicardium. Preferential abbreviation of APD of either endocardium or epicardium appears to be responsible for amplification of TDR in the short QT syndrome. In catecholaminergic polymorphic VT, reversal of the direction of activation of the ventricular wall is responsible for the increase in TDR. In conclusion, the long QT, short QT, Brugada and catecholaminergic polymorphic VT syndromes are pathologies with very different phenotypes and etiologies, but which share a common final pathway in causing sudden cardiac death. PMID:17586620

  12. Alpha2 receptor binding in the medulla oblongata in the sudden infant death syndrome.

    PubMed

    Mansouri, J; Panigrahy, A; Filiano, J J; Sleeper, L A; St John, W M; Kinney, H C

    2001-02-01

    The sudden infant death syndrome (SIDS) is the leading cause of postnatal infant mortality in the United States. Its etiology remains unknown. We propose that SIDS, or a subset of SIDS, is due to a failure of autoresuscitation, a protective brainstem response to asphyxia or hypoxia, in a vulnerable infant during a critical developmental period. Gasping is an important component of autoresuscitation that is thought to be mediated by the "gasping center" in the lateral tegmentum of the medulla, a region homologous in its cytoarchitecture and chemical anatomy to the intermediate reticular zone (IRZ) in the human. Since we found that [3H]para-aminoclonidine ([3H]PAC) binding to alpha2-adrenergic receptors localizes to this region in human infants and, thereby provides a neurochemical marker for it, we tested the hypothesis that [3H]PAC binding to alpha2-adrenergic receptors is decreased in the IRZ in SIDS victims. Using quantitative tissue autoradiography with [3H]PAC as the radioligand and phentolamine as the displacer, we analyzed alpha2-receptor binding density in the IRZ, as well as in 7 additional sites for comparison, in 10 SIDS and 10 control medullae. There were no significant differences in alpha2 receptor binding in the IRZ, vagal nuclei, or other medullary sites examined between SIDS and control cases. These results suggest that the putative gasping defect in the IRZ in SIDS victims is not related to [3H]PAC binding to alpha2-adrenergic receptors.

  13. Outbreak of Sudden Cardiac Deaths in a Tire Manufacturing Facility: Can It Be Caused by Nanoparticles?

    PubMed Central

    Kim, Eun-A; Kim, Kun-Hyung; Lee, Naroo; Kim, Dae-Seong; Kang, Seong-Kyu

    2012-01-01

    Objectives The purpose of this study was to review clinical characteristics and working environments of sudden cardiac death (SCD) cases associated with a tire manufacturer in Korea, and review possible occupational risk factors for cardiovascular disease including nanoparticles (ultrafine particles, UFPs). Methods We reviewed (i) the clinical course of SCD cases and (ii) occupational and non-occupational risk factors including chemicals, the physical work environment, and job characteristics. Results Possible occupational factors were chemicals, UFPs of rubber fume, a hot environment, shift work, overworking, and noise exposure. The mean diameter of rubber fume (63-73 nm) was (larger than diesel exhaust [12 nm] and outdoor dust [50 nm]). The concentration of carbon disulfide, carbon monoxide and styrene were lower than the limit of detection. Five SCD cases were exposed to shift work and overworking. Most of the cases had several non-occupational factors such as hypertension, overweight and smoking. Conclusion The diameter of rubber fume was larger than outdoor and the diesel exhaust, the most well known particulate having a causal relationship with cardiovascular disease. The possibility of a causal relation between UFPs of rubber fume and SCD was not supported in this study. However, it is necessary to continue studying the relationship between large sized UFPs and SCD. PMID:22953232

  14. Avoiding sports-related sudden cardiac death in children with congenital channelopathy : Recommendations for sports activities.

    PubMed

    Lang, C N; Steinfurt, J; Odening, K E

    2017-04-01

    For the past few years, children affected by an inherited channelopathy have been counseled to avoid (recreational) sports activities and all competitive sports so as to prevent exercise-induced arrhythmia and sudden cardiac death. An increased understanding of the pathophysiological mechanisms, better anti-arrhythmic strategies, and, in particular, more epidemiological data on exercise-induced arrhythmia in active athletes with channelopathies have changed the universal recommendation of "no sports," leading to revised, less strict, and more differentiated guidelines (published by the American Heart Association/American College of Cardiology in 2015). In this review, we outline the disease- and genotype-specific mechanisms of exercise-induced arrhythmia; give an overview of trigger-, symptom-, and genotype-dependent guidance in sports activities for children with long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), or short QT syndrome (SQTS); and highlight the novelties in the current guidelines compared with previous versions. While it is still recommended for patients with LQT1 and CPVT (even when asymptomatic) and all symptomatic LQTS patients (independent of genotype) to avoid any competitive and high-intensity sports, other LQTS patients successfully treated with anti-arrhythmic therapies and phenotype-negative genotype-positive patients may be allowed to perform sports at different activity levels - provided they undergo regular, sophisticated evaluations to detect any changes in arrhythmogenic risk.

  15. Degree Of Diminution In Vagal-Cardiac Activity Predicts Sudden Death In Familial Dysautonomia When Resting Tachycardia Is Absent

    NASA Technical Reports Server (NTRS)

    Schlegel, T. T.; Marthol, H.; Bucchner, S.; Tutaj, M.; Berlin, D.; Axelrod, F. B.; Hilz, M. J.

    2004-01-01

    Patients with familial dysautonomia (FD) have an increased risk of sudden death, but sensitive and specific predictors of sudden death in FD are lacking. Methods. We recorded 10-min resting high-fidelity 12-lead ECGs in 14 FD patients and in 14 age/gender-matched healthy subjects and studied 25+ different heart rate variability (HRV) indices for their ability to predict sudden death in the FD patients. Indices studied included those from 4 "nonlinear" HRV techniques (detrended fluctuation analysis, approximate entropy, correlation dimension, and PoincarC analyses). The predictive value of PR, QRS, QTc and JTc intervals, QT dispersion (QTd), beat-to-beat QT and PR interval variability indices (QTVI and PRVI) and 12- lead high frequency QRS ECG (150-250 Hz) were also studied. FD patients and controls (C) differed (Pless than 0.0l) with respect to 20+ of the HRV indices (FD less than C) and with respect to QTVI and PRVI (FDBC) and HF QRS- related root mean squared voltages (FDBC) and reduced amplitude zone counts (FD less than C). They differed less with respect to PR intervals (FD less than C) and JTc intervals (FD greater than C) (P less than 0.05 for both) and did not differ at all with respect to QRS and QTc intervals and to QTd. Within 12 months after study, 2 of the 14 patients succumbed to sudden cardiac arrest. The best predictor of sudden death was the degree of diminution in HRV vagal-cardiac (parasympathetic) parameters such as RMSSD, the SDl of Poincare plots, and HF spectral power. Excluding the two FD patients who had resting tachycardia (HR greater than 100, which confounds traditional HRV analyses), the following criteria were independently 100% sensitive and 100% specific for predicting sudden death in the remaining 12 FD patients during spontaneous breathing: RMSSD less than 13 ms and/or PoincarC SD1 less than 9 ms. In FD patients without supine tachycardia, the degree of diminution in parasympathetic HRV parameters (by high-fidelity ECG) predicts

  16. Circadian variation of the QT interval in patients with sudden cardiac death after myocardial infarction.

    PubMed

    Yi, G; Guo, X H; Reardon, M; Gallagher, M M; Hnatkova, K; Camm, A J; Malik, M

    1998-04-15

    To evaluate the potential prognostic value of the circadian variation of QT intervals in predicting sudden cardiac death (SCD) in patients after myocardial infarction (MI), 15 pairs of post-MI patients (15 died suddenly within 1 year after MI [SCD victims] and 15 remained event-free [MI survivors]) were studied (mean age 60 +/- 8 years; 24 men and 6 women). The pairs were matched for age, gender, infarct site, presence of Q wave, left ventricular ejection fraction, thrombolytic and beta-blocker therapy. Fourteen normal subjects served as controls (mean age 55 +/- 9 years; 12 men). A 24-hour Holter electrocardiographic (ECG) recording was obtained from each subject. All recordings were analyzed using a Holter ECG analyser. QT, RR, and heart rate-corrected QT intervals (QTc) were automatically calculated by the analyzer, and hourly and 24-hour mean values of each measurement were derived from each recording. There was a pronounced circadian variation in the QT interval in parallel with the trend in the RR interval in normal subjects and in MI survivors. Circadian variation in both indexes was blunted in SCD victims. The QT interval was significantly longer at night than during the day in normal subjects (388 +/- 28 vs 355 +/- 21 ms, p = 0.001) and in MI survivors (358 +/- 25 vs 346 +/- 15 ms, p = 0.008), but not in SCD victims (357 +/- 32 vs 350 +/- 31 ms, p = 0.6). The 24-hour mean value of the QT interval in SCD victims did not differ significantly from that in normal subjects or MI survivors. The QT interval at night was significantly shorter in SCD victims than in normal subjects (357 +/- 32 vs 388 +/- 28 ms, p = 0.02), but daytime values were similar. The QT interval in SCD victims did not differ significantly from that of MI survivors at any time. The QTc interval exhibited a small circadian variation in normal subjects. This variation was abolished in SCD victims and MI survivors. The 24-hour mean value of QTc was significantly longer in SCD victims than in

  17. Usefulness of combined history, physical examination, electrocardiogram, and limited echocardiogram in screening adolescent athletes for risk for sudden cardiac death.

    PubMed

    Anderson, Jeffrey B; Grenier, Michelle; Edwards, Nicholas M; Madsen, Nicolas L; Czosek, Richard J; Spar, David S; Barnes, Allison; Pratt, Jesse; King, Eileen; Knilans, Timothy K

    2014-12-01

    Sudden cardiac death in the young (SCDY) is the leading cause of death in young athletes during sport. Screening young athletes for high-risk cardiac defects is controversial. The purpose of this study was to assess the utility and feasibility of a comprehensive cardiac screening protocol in an adolescent population. Adolescent athletes were recruited from local schools and/or sports teams. Each subject underwent a history and/or physical examination, an electrocardiography (ECG), and a limited echocardiography (ECHO). The primary outcome measure was identification of cardiac abnormalities associated with an elevated risk for sudden death. We secondarily identified cardiac abnormalities not typically associated with a short-term risk of sudden death. A total of 659 adolescent athletes were evaluated; 64% men. Five subjects had cardiac findings associated with an elevated risk for sudden death: prolonged QTc >500 ms (n = 2) and type I Brugada pattern (n = 1), identified with ECG; dilated cardiomyopathy (n = 1) and significant aortic root dilation; and z-score = +5.5 (n = 1). History and physical examination alone identified 76 (11.5%) subjects with any cardiac findings. ECG identified 76 (11.5%) subjects in which a follow-up ECHO or cardiology visit was recommended. Left ventricular mass was normal by ECHO in all but 1 patient with LVH on ECG. ECHO identified 34 (5.1%) subjects in whom a follow-up ECHO or cardiology visit was recommended. In conclusion, physical examination alone was ineffective in identification of subjects at elevated risk for SCDY. Screening ECHO identified patients with underlying cardiac disease not associated with immediate risk for SCDY. Cost of comprehensive cardiac screening is high.

  18. Nonzero-temperature entanglement negativity of quantum spin models: Area law, linked cluster expansions, and sudden death.

    PubMed

    Sherman, Nicholas E; Devakul, Trithep; Hastings, Matthew B; Singh, Rajiv R P

    2016-02-01

    We show that the bipartite logarithmic entanglement negativity (EN) of quantum spin models obeys an area law at all nonzero temperatures. We develop numerical linked cluster (NLC) expansions for the "area-law" logarithmic entanglement negativity as a function of temperature and other parameters. For one-dimensional models the results of NLC are compared with exact diagonalization on finite systems and are found to agree very well. The NLC results are also obtained for two dimensional XXZ and transverse field Ising models. In all cases, we find a sudden onset (or sudden death) of negativity at a finite temperature above which the negativity is zero. We use perturbation theory to develop a physical picture for this sudden onset (or sudden death). The onset of EN or its magnitude are insensitive to classical finite-temperature phase transitions, supporting the argument for absence of any role of quantum mechanics at such transitions. On approach to a quantum critical point at T=0, negativity shows critical scaling in size and temperature.

  19. Nonzero-temperature entanglement negativity of quantum spin models: Area law, linked cluster expansions, and sudden death

    NASA Astrophysics Data System (ADS)

    Sherman, Nicholas E.; Devakul, Trithep; Hastings, Matthew B.; Singh, Rajiv R. P.

    2016-02-01

    We show that the bipartite logarithmic entanglement negativity (EN) of quantum spin models obeys an area law at all nonzero temperatures. We develop numerical linked cluster (NLC) expansions for the "area-law" logarithmic entanglement negativity as a function of temperature and other parameters. For one-dimensional models the results of NLC are compared with exact diagonalization on finite systems and are found to agree very well. The NLC results are also obtained for two dimensional X X Z and transverse field Ising models. In all cases, we find a sudden onset (or sudden death) of negativity at a finite temperature above which the negativity is zero. We use perturbation theory to develop a physical picture for this sudden onset (or sudden death). The onset of EN or its magnitude are insensitive to classical finite-temperature phase transitions, supporting the argument for absence of any role of quantum mechanics at such transitions. On approach to a quantum critical point at T =0 , negativity shows critical scaling in size and temperature.

  20. Genome-wide Polygenic Burden of Rare Deleterious Variants in Sudden Unexpected Death in Epilepsy

    PubMed Central

    Leu, Costin; Balestrini, Simona; Maher, Bridget; Hernández-Hernández, Laura; Gormley, Padhraig; Hämäläinen, Eija; Heggeli, Kristin; Schoeler, Natasha; Novy, Jan; Willis, Joseph; Plagnol, Vincent; Ellis, Rachael; Reavey, Eleanor; O'Regan, Mary; Pickrell, William O.; Thomas, Rhys H.; Chung, Seo-Kyung; Delanty, Norman; McMahon, Jacinta M.; Malone, Stephen; Sadleir, Lynette G.; Berkovic, Samuel F.; Nashef, Lina; Zuberi, Sameer M.; Rees, Mark I.; Cavalleri, Gianpiero L.; Sander, Josemir W.; Hughes, Elaine; Helen Cross, J.; Scheffer, Ingrid E.; Palotie, Aarno; Sisodiya, Sanjay M.

    2015-01-01

    Sudden unexpected death in epilepsy (SUDEP) represents the most severe degree of the spectrum of epilepsy severity and is the commonest cause of epilepsy-related premature mortality. The precise pathophysiology and the genetic architecture of SUDEP remain elusive. Aiming to elucidate the genetic basis of SUDEP, we analysed rare, protein-changing variants from whole-exome sequences of 18 people who died of SUDEP, 87 living people with epilepsy and 1479 non-epilepsy disease controls. Association analysis revealed a significantly increased genome-wide polygenic burden per individual in the SUDEP cohort when compared to epilepsy (P = 5.7 × 10− 3) and non-epilepsy disease controls (P = 1.2 × 10− 3). The polygenic burden was driven both by the number of variants per individual, and over-representation of variants likely to be deleterious in the SUDEP cohort. As determined by this study, more than a thousand genes contribute to the observed polygenic burden within the framework of this study. Subsequent gene-based association analysis revealed five possible candidate genes significantly associated with SUDEP or epilepsy, but no one single gene emerges as common to the SUDEP cases. Our findings provide further evidence for a genetic susceptibility to SUDEP, and suggest an extensive polygenic contribution to SUDEP causation. Thus, an overall increased burden of deleterious variants in a highly polygenic background might be important in rendering a given individual more susceptible to SUDEP. Our findings suggest that exome sequencing in people with epilepsy might eventually contribute to generating SUDEP risk estimates, promoting stratified medicine in epilepsy, with the eventual aim of reducing an individual patient's risk of SUDEP. PMID:26501104

  1. Examining the strength and possible causes of the relationship between fire history and Sudden Oak Death.

    PubMed

    Moritz, Max A; Odion, Dennis C

    2005-06-01

    Fire can be a dominant process in the ecology of forest vegetation and can also affect forest disease dynamics. Little is known about the relationship between fire and an emerging disease epidemic called Sudden Oak Death, which is caused by a new pathogen, Phytophthora ramorum. This disease has spread across a large, fire-prone portion of California, killing great numbers of oaks and tanoaks and infecting most associated woody plants. Suitable hosts cover a much broader geographic range, raising concern over where the disease may spread. To understand the strength and potential sensitivities of a fire-disease relationship, we examined geographic patterns of confirmed P. ramorum infections in relation to past fire history. We found these infections to be extremely rare within the perimeter of any area burned since 1950. This finding is not caused by spatial bias in sampling for the disease, and is robust to variation in host abundance scenarios and to aggregation of closely spaced sampling locations. We therefore investigated known fire-related factors that could result in significantly lower incidence of the disease in relatively recently burned landscapes. Chemical trends in post-fire environments can influence the success of pathogens like P. ramorum, either by increasing plant nutrient stress or by reducing the occurrence of chemicals antagonistic to Phytophthoras. Succession in the absence of fire leads to greater abundance of host species, which will provide increased habitat for P. ramorum; this will also increase intraspecific competition where these trees are abundant, and other density-dependent effects (e.g. shading) can reduce resource allocation to defenses. Despite these findings about a fire-disease relationship, a much deeper understanding is necessary before fire can be actively used as a tool in slowing the epidemic.

  2. Sudden deaths and colony population decline in Greek honey bee colonies.

    PubMed

    Bacandritsos, N; Granato, A; Budge, G; Papanastasiou, I; Roinioti, E; Caldon, M; Falcaro, C; Gallina, A; Mutinelli, F

    2010-11-01

    During June and July of 2009, sudden deaths, tremulous movements and population declines of adult honey bees were reported by the beekeepers in the region of Peloponnesus (Mt. Mainalo), Greece. A preliminary study was carried out to investigate these unexplained phenomena in this region. In total, 37 bee samples, two brood frames containing honey bee brood of various ages, eight sugar samples and four sugar patties were collected from the affected colonies. The samples were tested for a range of pests, pathogens and pesticides. Symptomatic adult honey bees tested positive for Varroa destructor, Nosema ceranae, Chronic bee paralysis virus (CBPV), Acute paralysis virus (ABPV), Deformed wing virus (DWV), Sacbrood virus (SBV) and Black queen cell virus (BQCV), but negative for Acarapis woodi. American Foulbrood was absent from the brood samples. Chemical analysis revealed that amitraz, thiametoxan, clothianidin and acetamiprid were all absent from symptomatic adult bees, sugar and sugar patty samples. However, some bee samples, were contaminated with imidacloprid in concentrations between 14 ng/g and 39 ng/g tissue. We present: the infection of Greek honey bees by multiple viruses; the presence of N. ceranae in Greek honey bees and the first record of imidacloprid (neonicotonoid) residues in Greek honey bee tissues. The presence of multiple pathogens and pesticides made it difficult to associate a single specific cause to the depopulation phenomena observed in Greece, although we believe that viruses and N. ceranae synergistically played the most important role. A follow-up in-depth survey across all Greek regions is required to provide context to these preliminary findings.

  3. The Genome Sequence of the Fungal Pathogen Fusarium virguliforme That Causes Sudden Death Syndrome in Soybean

    PubMed Central

    Srivastava, Subodh K.; Huang, Xiaoqiu; Brar, Hargeet K.; Fakhoury, Ahmad M.; Bluhm, Burton H.; Bhattacharyya, Madan K.

    2014-01-01

    Fusarium virguliforme causes sudden death syndrome (SDS) of soybean, a disease of serious concern throughout most of the soybean producing regions of the world. Despite the global importance, little is known about the pathogenesis mechanisms of F. virguliforme. Thus, we applied Next-Generation DNA Sequencing to reveal the draft F. virguliforme genome sequence and identified putative pathogenicity genes to facilitate discovering the mechanisms used by the pathogen to cause this disease. Methodology/Principal Findings We have generated the draft genome sequence of F. virguliforme by conducting whole-genome shotgun sequencing on a 454 GS-FLX Titanium sequencer. Initially, single-end reads of a 400-bp shotgun library were assembled using the PCAP program. Paired end sequences from 3 and 20 Kb DNA fragments and approximately 100 Kb inserts of 1,400 BAC clones were used to generate the assembled genome. The assembled genome sequence was 51 Mb. The N50 scaffold number was 11 with an N50 Scaffold length of 1,263 Kb. The AUGUSTUS gene prediction program predicted 14,845 putative genes, which were annotated with Pfam and GO databases. Gene distributions were uniform in all but one of the major scaffolds. Phylogenic analyses revealed that F. virguliforme was closely related to the pea pathogen, Nectria haematococca. Of the 14,845 F. virguliforme genes, 11,043 were conserved among five Fusarium species: F. virguliforme, F. graminearum, F. verticillioides, F. oxysporum and N. haematococca; and 1,332 F. virguliforme-specific genes, which may include pathogenicity genes. Additionally, searches for candidate F. virguliforme pathogenicity genes using gene sequences of the pathogen-host interaction database identified 358 genes. Conclusions The F. virguliforme genome sequence and putative pathogenicity genes presented here will facilitate identification of pathogenicity mechanisms involved in SDS development. Together, these resources will expedite our efforts towards discovering

  4. [Sleeping position to prevent sudden infant death syndrome in Latin-american and Caribbean hospitals].

    PubMed

    Cafferata Mf, M feminine L; Althabe, F; Belizán, J M; Cowan, S; Nelson, E A S

    2002-12-01

    Background The prone sleeping position for sleeping has been identified as the principal risk factor for sudden infant death syndrome (SIDS).ObjectiveThe aim of this study was to determine the prevalence of different sleeping positions and other risk factors for SIDS and to identify the advice given to parents in several maternity units in Latin America and the Caribbean through a specially-designed questionnaire.MethodsDescriptive cross-sectional study based in hospitals. All the countries in Latin America and the Caribbean were contacted through the Pan American Health Organization and responses were obtained from 16 countries.ResultsTwo hundred thirteen hospitals answered the survey. The preferred sleeping position for healthy infants was prone in 8.5 % of the hospitals, side in 48.8 %, and supine in 25.2 %. In 17.5 % of the hospitals no position was preferred or the answers were inconsistent.Concerning the recommendations given to parents on the best position for their infants at home, 25.7 % recommended the supine position, 7.6 % the prone position, 59.0 % the side position while 7.6 % made no recommendations.ConclusionsThe results of this study show that in the hospitals surveyed there is a policy of not placing healthy neonates in the prone position. However, the most frequent position was the side, which is not advisable as it increases the risk of SIDS. To reduce in the incidence of SIDS, campaigns to increase the use of the supine position should be carried out in hospitals and among the general public.

  5. Possibility of separating toxins from bacteria associated with sudden infant death syndrome using anion exchange chromatography.

    PubMed Central

    Drucker, D B; Aluyi, H A; Morris, J A; Telford, D R; Oppenheim, B A; Crawley, B A

    1992-01-01

    AIMS: To develop techniques for the characterisation of toxins elaborated by a strain of Escherichia coli associated with sudden infant death syndrome (SIDS). METHODS: E coli SIDS 04, isolated from the nasopharynx of a case of SIDS, was studied. Cell-free toxin preparations were standardised, their protein measured, and analytical separation of proteins achieved using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Acetone precipitation of proteins was required prior to Coomassie blue staining of bands. Preparative separation was achieved on an anion exchange column using a programmed concentration gradient of NaCl in TRIS buffer. Fractions were tested individually or pooled for presence of lethal toxin including endotoxin. Lethal toxin was detected with the chick embryo test system. Endotoxin was measured using a chromogenic modification of the Limulus amoebocyte assay. RESULTS: Twenty one peaks were detected by chromatography. Ten individual, or pooled, fractions were assayed for endotoxin which ranged from 27-33 pg/ml. Much greater variation was found when the same fractions were assayed in chick embryos. E coli fractions varied considerably in lethal toxicity, from 0/10 to 10/10 chick embryos killed/tested. Certain E coli fractions tested individually (lethality four out of 10 to eight out of 10) proved more lethal (10 out of 10) if pooled prior to testing. CONCLUSIONS: In E coli infection associated with SIDS relatively low concentrations of extracellular protein are lethally toxigenic for the chick embryo model of SIDS. These proteins can be separated analytically by SDS-PAGE and preparatively by anion exchange chromatography. Toxicity of individual fractions is not correlated with endotoxin concentrations in samples tested. PMID:1401212

  6. Balancing detection and eradication for control of epidemics: sudden oak death in mixed-species stands.

    PubMed

    Ndeffo Mbah, Martial L; Gilligan, Christopher A

    2010-09-14

    Culling of infected individuals is a widely used measure for the control of several plant and animal pathogens but culling first requires detection of often cryptically-infected hosts. In this paper, we address the problem of how to allocate resources between detection and culling when the budget for disease management is limited. The results are generic but we motivate the problem for the control of a botanical epidemic in a natural ecosystem: sudden oak death in mixed evergreen forests in coastal California, in which species composition is generally dominated by a spreader species (bay laurel) and a second host species (coast live oak) that is an epidemiological dead-end in that it does not transmit infection but which is frequently a target for preservation. Using a combination of an epidemiological model for two host species with a common pathogen together with optimal control theory we address the problem of how to balance the allocation of resources for detection and epidemic control in order to preserve both host species in the ecosystem. Contrary to simple expectations our results show that an intermediate level of detection is optimal. Low levels of detection, characteristic of low effort expended on searching and detection of diseased trees, and high detection levels, exemplified by the deployment of large amounts of resources to identify diseased trees, fail to bring the epidemic under control. Importantly, we show that a slight change in the balance between the resources allocated to detection and those allocated to control may lead to drastic inefficiencies in control strategies. The results hold when quarantine is introduced to reduce the ingress of infected material into the region of interest.

  7. Balancing Detection and Eradication for Control of Epidemics: Sudden Oak Death in Mixed-Species Stands

    PubMed Central

    Ndeffo Mbah, Martial L.; Gilligan, Christopher A.

    2010-01-01

    Culling of infected individuals is a widely used measure for the control of several plant and animal pathogens but culling first requires detection of often cryptically-infected hosts. In this paper, we address the problem of how to allocate resources between detection and culling when the budget for disease management is limited. The results are generic but we motivate the problem for the control of a botanical epidemic in a natural ecosystem: sudden oak death in mixed evergreen forests in coastal California, in which species composition is generally dominated by a spreader species (bay laurel) and a second host species (coast live oak) that is an epidemiological dead-end in that it does not transmit infection but which is frequently a target for preservation. Using a combination of an epidemiological model for two host species with a common pathogen together with optimal control theory we address the problem of how to balance the allocation of resources for detection and epidemic control in order to preserve both host species in the ecosystem. Contrary to simple expectations our results show that an intermediate level of detection is optimal. Low levels of detection, characteristic of low effort expended on searching and detection of diseased trees, and high detection levels, exemplified by the deployment of large amounts of resources to identify diseased trees, fail to bring the epidemic under control. Importantly, we show that a slight change in the balance between the resources allocated to detection and those allocated to control may lead to drastic inefficiencies in control strategies. The results hold when quarantine is introduced to reduce the ingress of infected material into the region of interest. PMID:20856850

  8. The clinical challenge of preventing sudden cardiac death immediately after acute ST-elevation myocardial infarction.

    PubMed

    Manolis, Antonis S

    2014-12-01

    Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI. In-hospital SCD due to ventricular tachyarrhythmias is manageable, with either preventive measures or drugs or electrical cardioversion. There is general agreement for secondary prevention of SCD post-MI with implantation of a cardioverter defibrillator (ICD) when malignant ventricular arrhythmias occur late (>48 h) after an MI, and are not due to reversible or correctable causes. The major challenge remains that of primary prevention, that is, how to prevent SCD during the first 1-3 months after ST-elevation MI for patients who have low left ventricular ejection fraction and are not candidates for an ICD according to current guidelines, due to the results of two studies, which did not show any benefits of early (<40 days after an MI) ICD implantation. Two recent documents may provide direction as to how to bridge the gap for this early post-MI period. Both recommend an electrophysiology study to guide implantation of an ICD, at least for those developing syncope or non-sustained ventricular tachycardia, who have an inducible sustained ventricular tachycardia at the electrophysiology study. An ICD is also recommended for patients with indication for a permanent pacemaker due to bradyarrhythmias, who also meet primary prevention criteria for SCD.

  9. Decreased GABAA Receptor Binding in the Medullary Serotonergic System In the Sudden Infant Death Syndrome

    PubMed Central

    Broadbelt, Kevin G.; Paterson, David S.; Belliveau, Richard A.; Trachtenberg, Felicia L.; Haas, Elisabeth A.; Stanley, Christina; Krous, Henry F.; Kinney, Hannah C.

    2011-01-01

    γ-Aminobutyric acid (GABA) neurons in the medulla oblongata help regulate homeostasis, in part through interactions with the medullary serotonergic (5-HT) system. Previously, we reported abnormalities in multiple 5-HT markers in the medullary 5-HT system of infants dying from sudden infant death syndrome (SIDS), suggesting that 5-HT dysfunction is involved in its pathogenesis. Here, we tested the hypothesis that markers of GABAA receptors are decreased in the medullary 5-HT system in SIDS cases compared to controls. Using tissue receptor autoradiography with the radioligand 3H-GABA, we found 25–52% reductions in GABAA receptor binding density in 7 of 10 key nuclei sampled of the medullary 5-HT system in the SIDS cases (postconceptional age [PCA] = 51.7 ± 8.3, n = 28) vs. age-adjusted controls (PCA = 55.3 ± 13.5, n = 8) (p ≤ 0.04). By Western blotting there was 46.2% reduction in GABAAα3 subunit levels in the gigantocellularis (component of the medullary 5-HT system) of SIDS cases (PCA = 53.9 ± 8.4, n = 24) vs. controls (PCA = 55.3 ± 8.3, n = 8) (56.8% standard in SIDS cases vs. 99.35% in controls; p = 0.026). These data suggest that medullary GABAA receptors are abnormal in SIDS infants and that SIDS is a complex disorder of a homeostatic network in the medulla that involves deficits of the GABAergic and 5-HT systems. PMID:21865888

  10. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death.

    PubMed

    Tse, Gary; Yan, Bryan P

    2016-10-04

    Sudden cardiac death, frequently due to ventricular arrhythmias, is a significant problem globally. Most affected individuals do not arrive at hospital in time for medical treatment. Therefore, there is an urgent need to identify the most-at-risk patients for insertion of prophylactic implantable cardioverter defibrillators. Clinical risk markers derived from electrocardiography are important for this purpose. They can be based on repolarization, including corrected QT (QTc) interval, QT dispersion (QTD), interval from the peak to the end of the T-wave (Tpeak - Tend), (Tpeak - Tend)/QT, T-wave alternans (TWA), and microvolt TWA. Abnormal repolarization properties can increase the risk of triggered activity and re-entrant arrhythmias. Other risk markers are based solely on conduction, such as QRS duration (QRSd), which is a surrogate marker of conduction velocity (CV) and QRS dispersion (QRSD) reflecting CV dispersion. Conduction abnormalities in the form of reduced CV, unidirectional block, together with a functional or a structural obstacle, are conditions required for circus-type or spiral wave re-entry. Conduction and repolarization can be represented by a single parameter, excitation wavelength (λ = CV × effective refractory period). λ is an important determinant of arrhythmogenesis in different settings. Novel conduction-repolarization markers incorporating λ include Lu et al.' index of cardiac electrophysiological balance (iCEB: QT/QRSd), [QRSD× (Tpeak - Tend)/QRSd] and [QRSD × (Tpeak - Tend)/(QRSd × QT)] recently proposed by Tse and Yan. The aim of this review is to provide up to date information on traditional and novel markers and discuss their utility and downfalls for risk stratification.

  11. Outcomes After Implantable Cardioverter-Defibrillator Generator Replacement for Primary Prevention of Sudden Cardiac Death

    PubMed Central

    Madhavan, Malini; Waks, Jonathan W.; Friedman, Paul A.; Kramer, Daniel B.; Buxton, Alfred E.; Noseworthy, Peter A.; Mehta, Ramila A.; Hodge, David O.; Higgins, Angela Y.; Webster, Tracy L.; Witt, Chance M.; Cha, Yong-Mei; Gersh, Bernard J.

    2016-01-01

    Background The effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with an ejection fraction (EF) ≤35% and clinical heart failure is well established. However, outcomes after replacement of the ICD generator in patients with recovery of EF to >35% and no previous therapies are not well characterized. Methods and Results Between 2001 and 2011, generator replacement was performed at 2 tertiary medical centers in 253 patients (mean age, 68.3±12.7 years; 82% men) who had previously undergone ICD placement for primary prevention but subsequently never received appropriate ICD therapy. EF had recovered to >35% in 72 of 253 (28%) patients at generator replacement. During median (quartiles) follow-up of 3.3 (1.8–5.3) years after generator replacement, 68 of 253 (27%) experienced appropriate ICD therapy. Patients with EF ≤35% were more likely to experience ICD therapy compared with those with EF >35% (12% versus 5% per year; hazard ratio, 3.57; P=0.001). On multivariable analysis, low EF predicted appropriate ICD therapy after generator replacement (hazard ratio, 1.96 [1.35–2.87] per 10% decrement; P=0.001). Death occurred in 25% of patients 5 years after generator replacement. Mortality was similar in patients with EF ≤35% and >35% (7% versus 5% per year; hazard ratio, 1.10; P=0.68). Atrial fibrillation (3.24 [1.63–6.43]; P<0.001) and higher blood urea nitrogen (1.28 [1.14–1.45] per increase of 10 mg/dL; P<0.001) were associated with mortality. Conclusions Although approximately one fourth of patients with a primary prevention ICD and no previous therapy have EF >35% at the time of generator replacement, these patients continue to be at significant risk for appropriate ICD therapy (5% per year). These data may inform decisions on ICD replacement. PMID:26921377

  12. Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

    PubMed Central

    Erskine, Kathleen E.; Hidayatallah, Nadia Z.; Walsh, Christine A.; McDonald, Thomas V.; Cohen, Lilian; Marion, Robert W.; Dolan, Siobhan M.

    2014-01-01

    Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing. PMID:24664857

  13. The unexpected finding of a benign mature teratoma in a forensic pathology autopsy: a rare cause for sudden, unexpected death.

    PubMed

    Høyer, Christian Bjerre; Ulhøi, Benedicte Parm; Charles, Annie Vesterby

    2013-12-01

    Intracranial teratomas are rare tumors that are usually discovered in infancy due to progressive symptoms. We describe a case of a 38-year-old man who was found dead 9 hours after the last sign of life. The deceased's medical history could not explain the sudden, unexpected death. A forensic autopsy revealed an asymptomatic, mature teratoma in the left frontal and temporal lobes. We concluded that the cause of death must have been a generalized epileptiform seizure originating in the tumor site(s) leading to aspiration of the stomach contents and unfavorable positioning, resulting in asphyxia.

  14. Rationale and design of the Pan-African Sudden Cardiac Death survey: the Pan-African SCD study

    PubMed Central

    Bonny, Aimé; Bonny, Aimé; Ngantcha, Marcus; Ndongo Amougou, Sylvie; Kane, Adama; Marrakchi, Sonia; Okello, Emmy; Taty, Georges; Gehani, Abdulrrazzak; Diakite, Mamadou; Talle, Mohammed A; Lambiase, Pier D; Houenassi, Martin; Chin, Ashley; Otieno, Harun; Temu, Gloria; Koffi Owusu, Isaac; Karaye, Kamilu M; Awad, Abdalla AM; Gregers Winkel, Bo; Priori, Silvia G; Priori, Silvia G

    2014-01-01

    Summary Background The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as ‘witnessed natural death occurring within one hour of the onset of symptoms’ or ‘unwitnessed natural death within 24 hours of the onset of symptoms’. After appro val from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world. PMID:25192301

  15. Vulnerability of fourth ventricle choroid plexus in sudden unexplained fetal and infant death syndromes related to smoking mothers.

    PubMed

    Lavezzi, Anna M; Matturri, Luigi; Del Corno, Giuseppe; Johanson, Conrad E

    2013-08-01

    The human choroid plexuses in the ventricular system represent the main source of cerebrospinal fluid secretion and constitute a major barrier interface that controls the brain's environment. The present study focused on the choroid plexus of the fourth ventricle, the main cavity of the brainstem containing important nuclei and/or structures mediating autonomic vital functions. In serial sections of 84 brainstems of subjects aged from 17 gestational weeks to 8 postnatal months of life, the deaths due to both known and unknown causes, we examined the cytoarchitecture and the developmental steps of the fourth ventricle choroid plexus to determine whether this structure shows morphological and/or functional alterations in unexplained perinatal deaths (Sudden Infant Death Syndrome and Sudden Intrauterine Unexplained Death Syndrome). High incidence of histological and immunohistochemical alterations (prevalence of epithelial dark cells, the presence of cystic cells in the stroma, decreased number of blood capillaries, hyperexpression of Substance P and apoptosis) were prevalently observed in unexplained death victims (p<0.05 vs. controls). A significant correlation was found between maternal smoking in pregnancy and choroidal neuropathological parameters (p<0.01). This work underscores the negative effects of prenatal exposure to nicotine on the development of the autonomic nervous system, and in particular of the fourth ventricle choroid plexus that is a very vulnerable structure in the developing CSF-brain system.

  16. Septic abortion.

    PubMed

    Stubblefield, P G; Grimes, D A

    1994-08-04

    Abortion-related deaths, which account for 47% of total maternal mortality in the world, result primarily from sepsis and are widespread in developing countries where abortion is illegal or inaccessible. Septic abortion offers opportunities for prevention on the primary, secondary, and tertiary level of medial care. Primary prevention of septic abortion encompasses the provision of effective contraception, provision of safe and legal abortion in cases of contraceptive failure, and appropriate medical management of abortion. Secondary prevention involves the prompt diagnosis of endometriosis and effective treatment to avert more serious infection. The diagnosis of septic abortion should be considered when women of reproductive age present to health facilities with vaginal bleeding, lower abdominal pain, and fever. Tertiary prevention is aimed at avoiding the serious complications of postabortal infection, including hysterectomy and death. Women with high fever, pelvic peritonitis, and tachycardia should undergo uterine evacuation and parental antibiotic therapy. Supportive care for cardiovascular system and other organs may be essential. The medical technology needed to avert serious complications and deaths from septic abortion is available. Lacking is a political commitment on the part of many governments and health care agencies to address this avoidable contributor to maternal morbidity and mortality.

  17. Sudden Cardiac Arrest

    MedlinePlus

    ... from American Heart Association Aneurysms and Dissections Angina Arrhythmia Bundle Branch Block Cardiomyopathy Carotid Artery Disease Chronic ... terms: SCA, sudden cardiac death (SCD), sudden death, arrhythmias, ... ventricular fibrillation, defibrillator, automatic cardiac defibrillator ( ...

  18. Incidence of sudden cardiac death, myocardial infarction and far- and near-transyears.

    PubMed

    Halberg, F; Cornélissen, G; Otsuka, K; Fiser, B; Mitsutake, G; Wendt, H W; Johnson, P; Gigolashvili, M; Breus, T; Sonkowsky, R; Chibisov, S M; Katinas, G; Siegelova, J; Dusek, J; Singh, R B; Berri, B L; Schwartzkopff, O

    2005-10-01

    We analyzed cycles with periods, tau, in the range of 0.8-2.0 years, characterizing, mostly during 1999-2003, the incidence of sudden cardiac death (SCD), according to the International Classification of Diseases, 10th revision (ICD10), code I46.1. In the tau range examined, only yearly components could be documented in time series from North Carolina, USA; Tbilisi, Georgia; and Hong Kong, in the latter two locations based on relatively short time series. By contrast, in Minnesota, USA, we found only a component with a longer than (= trans) yearly (transyearly) tau of 1.39 years; the 95% confidence interval (CI) of the tau extended from 1.17 to 1.61 years, falling into the category of transyears (defined as a tau and a 95% CI between 1.0 and 2.0 years, with the limits of the 95% CI of the spectral component's tau overlapping neither of these lengths). During the same span from 1999 to 2003 in Arkansas, USA, a component of about 1-year in length was present, and in addition, one with a tau of 1.69 year with a CI extending from 1.29 to 2.07 years, a far-transyear candidate, far-transyears being defined as having a tau with a CI between 1.20 and 2.0 year, with the CI overlapping neither of these lengths. In the Czech Republic, there was also a calendar-yearly tau and one of 1.76 years. In the latter two geographic/geomagnetic areas, the about-yearly and the longer cycles' amplitudes were of similar prominence. The taus are only candidate transyears; the 95% CIs of their taus overlap the 2-year length. When a series on SCD from 1994 to 2003 from the Czech Republic was analyzed, the 95% CI of the transyear's tau no longer overlapped the 2-year length. Transyears were also found in the Czech Republic for myocardial infarctions (MI), meeting the original transyear definition in both a shorter and a longer series. Moreover, in the 1994-2003 series on MI from the Czech Republic, a near-transyear was also found, meeting the definition of a period with a 95% CI overlapping

  19. Animal Models for Assessment of Infection and Inflammation: Contributions to Elucidating the Pathophysiology of Sudden Infant Death Syndrome

    PubMed Central

    Blood-Siegfried, Jane

    2015-01-01

    Sudden infant death syndrome (SIDS) is still not well understood. It is defined as the sudden and unexpected death of an infant without a definitive cause. There are numerous hypotheses about the etiology of SIDS but the exact cause or causes have never been pinpointed. Examination of theoretical pathologies might only be possible in animal models. Development of these models requires consideration of the environmental and/or developmental risk factors often associated with SIDS, as they need to explain how the risk factors could contribute to the cause of death. These models were initially developed in common laboratory animals to test various hypotheses to explain these infant deaths – guinea pig, piglet, mouse, neonatal rabbit, and neonatal rat. Currently, there are growing numbers of researchers using genetically altered animals to examine specific areas of interest. This review describes the different systems and models developed to examine the diverse hypotheses for the cause of SIDS and their potential for defining a causal mechanism or mechanisms. PMID:25870597

  20. AICAR prevents heat-induced sudden death in RyR1 mutant mice independent of AMPK activation.

    PubMed

    Lanner, Johanna T; Georgiou, Dimitra K; Dagnino-Acosta, Adan; Ainbinder, Alina; Cheng, Qing; Joshi, Aditya D; Chen, Zanwen; Yarotskyy, Viktor; Oakes, Joshua M; Lee, Chang Seok; Monroe, Tanner O; Santillan, Arturo; Dong, Keke; Goodyear, Laurie; Ismailov, Iskander I; Rodney, George G; Dirksen, Robert T; Hamilton, Susan L

    2012-01-08

    Mice with a knock-in mutation (Y524S) in the type I ryanodine receptor (Ryr1), a mutation analogous to the Y522S mutation that is associated with malignant hyperthermia in humans, die when exposed to short periods of temperature elevation (≥37 °C). We show here that treatment with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR) prevents this heat-induced sudden death in this mouse model. The protection by AICAR is independent of AMP-activated protein kinase (AMPK) activation and results from a newly identified action of the compound on mutant Ryr1 to reduce Ca(2+) leak from the sarcoplasmic reticulum to the sarcoplasm. AICAR thus prevents Ca(2+)-dependent increases in the amount of both reactive oxygen species (ROS) and reactive nitrogen species (RNS) that act to further increase resting Ca(2+) concentrations. If unchecked, the temperature-driven increases in resting Ca(2+) concentrations and the amounts of ROS and RNS create an amplifying cycle that ultimately triggers sustained muscle contractions, rhabdomyolysis and death. Although antioxidants are effective in reducing this cycle in vitro, only AICAR prevents heat-induced death in vivo. Our findings suggest that AICAR is probably effective in prophylactic treatment of humans with enhanced susceptibility to exercise- and/or heat-induced sudden death associated with RYR1 mutations.

  1. Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young.

    PubMed

    Methner, D Nicole R; Scherer, Steven E; Welch, Katherine; Walkiewicz, Magdalena; Eng, Christine M; Belmont, John W; Powell, Mark C; Korchina, Viktoriya; Doddapaneni, Harsha Vardhan; Muzny, Donna M; Gibbs, Richard A; Wolf, Dwayne A; Sanchez, Luis A; Kahn, Roger

    2016-09-01

    Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners' and coroners' offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents.

  2. Neuropathology of the Guillain-Mollaret Triangle (Dentato-Rubro-Olivary Network) in Sudden Unexplained Perinatal Death and SIDS

    PubMed Central

    Lavezzi, Anna Maria; Corna, Melissa; Matturri, Luigi; Santoro, Franco

    2009-01-01

    The present study was undertaken to evaluate the possible alterations of the triangle of Guillain and Mollaret (G-Mt), a neuronal brainstem/cerebellum network (from the dentate nucleus to red nucleus and inferior olivary nucleus) already known for its involvement in the pathogenesis of the palatal myoclonus, in sudden unexplained perinatal and infant death. In 44 cases of perinatal and infant death victims, aged from 26 gestational weeks to 10 months of life, we investigated, besides the histological morphology of the three nuclei, the c-fos and apoptotic expression, as well as the possible effects elicited by maternal cigarette smoking. A significant increase of lesions (hypoplasia and/or increased c-fos and apoptotic neuronal immunopositivity) of the three nuclei was found in unexplained death victims, compared with age-matched controls. These alterations were related to maternal cigarette smoking habit. We postulated that the G-Mt is an important network involved in the pathogenesis of a wide spectrum of pathological manifestations and that maternal smoking during pregnancy can exert an adverse influence on this complex, even leading to sudden death in vulnerable periods of perinatal or infant development. PMID:19597559

  3. The conduction system in sudden death in Alaskan sled dogs during the Iditarod race and/or during training.

    PubMed

    Bharati, S; Cantor, G H; Leach, J B; Schmidt, K E; Blake, J

    1997-03-01

    Using serial section examination, we studied the conduction system in five Alaskan sled dogs that died suddenly; four during the Iditarod race and one during training. We compared our findings with the conduction system of three sled dogs of similar age that died of natural causes unrelated to the cardiovascular system. The conduction system of sudden death dogs revealed marked fibrosis of the sinoatrial (SA) node and/or its approaches and narrowing of the SA nodal artery in 3 dogs, fibrosis and marked fatty infiltration in and around the AV node in all 5, total isolation and/or tenuous connection of the AV node with its approaches in 4, fat and fibrosis in the AV bundle and bundle branches to a varying degree in all, and focal fibrotic scars in the left ventricle with fat and/or some disarray in 3. The control group revealed mild fibro-fatty changes in the conduction system without fibrotic scar areas in the heart. These findings are similar to the pathological findings in and around the conduction system in cases of sudden death in humans, especially trained athletes. These changes may form an anatomical substrate for an arrhythmic event in susceptible dogs during an altered physiological state.

  4. The dorsal motor nucleus of the vagus (DMNV) in sudden infant death syndrome (SIDS): pathways leading to apoptosis.

    PubMed

    Bejjani, Charbel; Machaalani, Rita; Waters, Karen A

    2013-01-15

    Sudden infant death syndrome (SIDS) remains the commonest cause of death in the post-neonatal period in the developed world. A leading hypothesis is that an abnormality in the brainstem of infants who succumb to SIDS, either causes or predisposes to failure to respond appropriately to an exogenous stressor. Neuronal apoptosis can lead to loss of cardiorespiratory reflexes, compromise of the infant's ability to respond to stressors such as hypoxia, and ultimately a sleep-related death. The dorsal motor nucleus of the vagus (DMNV) is a medullary autonomic nucleus where abnormalities have regularly been identified in SIDS research. This review collates neurochemical findings documented over the last 30 years, including data from our laboratory focusing on neuronal apoptosis and the DMNV, and provides potential therapeutic interventions targeting neurotransmitters, growth factors and/or genes.

  5. Sudden death involving inhalation of 1,1-difluoroethane (HFC-152a) with spray cleaner: three case reports.

    PubMed

    Sakai, Kentaro; Maruyama-Maebashi, Kyoko; Takatsu, Akihiro; Fukui, Kenji; Nagai, Tomonori; Aoyagi, Miwako; Ochiai, Eriko; Iwadate, Kimiharu

    2011-03-20

    Spray cleaner is a cleaning product containing compressed 1,1-difluoroethane (HFC-152a) to blow dust off electric devices and other sensitive equipment; however, it is also inhaled to induce euphoria. This report describes three cases of death involving HFC-152a inhalation with spray cleaner under different circumstances. In case 1, death was during inhalation for euphoria with which led to having frostbite. In case 2, death may have been associated with suicidal intention. Case 3 was also considered an accidental autoerotic death. In all three cases, HFC-152a was detected at 99.2-136.2mg/l in blood samples, 94.5-191.9 mg/l in urine samples and 3.6-18.4 mg in the gastric contents according to gas chromatography with flame ionization detection. To prevent death associated with HFC-152a inhalation from spray cleaner, the danger of the sudden death should be announced to people, given the ready availability of commercial products containing HFC-152a.

  6. Forensic pathological evaluation of postmortem pulmonary CT high-density areas in serial autopsy cases of sudden cardiac death.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Oritani, Shigeki; Kamikodai, Yasunobu; Tsuda, Kohei; Okazaki, Shuji; Maeda, Hitoshi

    2013-10-10

    Previous studies suggested substantial postmortem interference with pulmonary CT findings. The present study evaluated postmortem CT (PM-CT) morphology of the lung, compared with histology, in autopsy cases of sudden cardiac death without recovery from cardiac arrest (SCD, n=22) with regard to the posture at the time of death and postmortem interference from a forensic pathological viewpoint. In witnessed cases (n=5), a case of SCD in a prone position had anterior consolidation with weak hypostatic opacification in the posterior about 18 h later. Among unwitnessed deaths (n=17), 8 cases of death lying prone, sitting facedown and lying laterally had possible gravity-dependent opacity about 15-38 h postmortem. Hypostatic opacification with 'niveau' formation was not evident in more than half of the cases (n=15). Histological findings for ground glass opacification and consolidation on PM-CT varied by case, involving intraalveolar edema and hemorrhages, accompanied by marked congestion; however, possible postmortem hypostatic opacification mostly represented intraalveolar edema. CT morphology of acute pulmonary congestion in SCD may often remain without serious postmortem interference in cases without clinical intervention involving massive fluid infusion, suggesting plain PM-CT findings of the lung to be useful for investigating the death process when combined with histology; however, the possible influence of the hydration status of the lungs at the time of death should be assessed by evaluation of CT and autopsy findings.

  7. Identifying potential functional impact of mutations and polymorphisms: linking heart failure, increased risk of arrhythmias and sudden cardiac death

    PubMed Central

    Jagu, Benoît; Charpentier, Flavien; Toumaniantz, Gilles

    2013-01-01

    Researchers and clinicians have discovered several important concepts regarding the mechanisms responsible for increased risk of arrhythmias, heart failure, and sudden cardiac death. One major step in defining the molecular basis of normal and abnormal cardiac electrical behavior has been the identification of single mutations that greatly increase the risk for arrhythmias and sudden cardiac death by changing channel-gating characteristics. Indeed, mutations in several genes encoding ion channels, such as SCN5A, which encodes the major cardiac Na+ channel, have emerged as the basis for a variety of inherited cardiac arrhythmias such as long QT syndrome, Brugada syndrome, progressive cardiac conduction disorder, sinus node dysfunction, or sudden infant death syndrome. In addition, genes encoding ion channel accessory proteins, like anchoring or chaperone proteins, which modify the expression, the regulation of endocytosis, and the degradation of ion channel a-subunits have also been reported as susceptibility genes for arrhythmic syndromes. The regulation of ion channel protein expression also depends on a fine-tuned balance among different other mechanisms, such as gene transcription, RNA processing, post-transcriptional control of gene expression by miRNA, protein synthesis, assembly and post-translational modification and trafficking. The aim of this review is to inventory, through the description of few representative examples, the role of these different biogenic mechanisms in arrhythmogenesis, HF and SCD in order to help the researcher to identify all the processes that could lead to arrhythmias. Identification of novel targets for drug intervention should result from further understanding of these fundamental mechanisms. PMID:24065925

  8. [Sudden death caused by the spontaneous rupture of the right ventricle in a woman with chronic Chagas disease].

    PubMed

    Tostes Júnior, S; Lopes, E R; Chapadeiro, E

    1990-01-01

    We report a case of sudden death from hemopericardium consequent to spontaneous rupture of the right ventricle in a 49-year-old chronic chagasic woman. To our knowledge, this is the third reported case of spontaneous cardiac rupture with chagasic cardiomyopathy. In our case we believe that the thinning of the anterior right ventricular wall, its large ray curvature and the increased ventricular pressure were factors favoring the rupture. There was no infarction and the chronic cardiopathy was significant. It caused the thinning of the rupture region through chronic myocarditis.

  9. Patient Education: Identifying Risks and Self-Management Approaches for Adherence and Sudden Unexpected Death in Epilepsy.

    PubMed

    Shafer, Patricia Osborne; Buchhalter, Jeffrey

    2016-05-01

    Patient education in epilepsy is one part of quality epilepsy care and is an evolving and growing field. Health outcomes, patient satisfaction, safety, patient/provider communication, and quality of life may all be affected by what people are taught (or not taught), what they understand, and how they use this information to make decisions and manage their health. Data regarding learning needs and interventions to address medication adherence and sudden unexpected death in epilepsy education can be used to guide clinicians in health care or community settings.

  10. Quantum-to-classical transition and entanglement sudden death in Gaussian states under local-heat-bath dynamics

    SciTech Connect

    Goyal, Sandeep K.; Ghosh, Sibasish

    2010-10-15

    Entanglement sudden death (ESD) in spatially separated two-mode Gaussian states coupled to local thermal and squeezed thermal baths is studied by mapping the problem to that of the quantum-to-classical transition. Using Simon's criterion concerning the characterization of classicality in Gaussian states, the time to ESD is calculated by analyzing the covariance matrices of the system. The results for the two-mode system at T=0 and T>0 for the two types of bath states are generalized to n modes, and are shown to be similar in nature to the results for the general discrete n-qubit system.

  11. Tools for risk stratification of sudden cardiac death: A review of the literature in different patient populations

    PubMed Central

    Ragupathi, Loheetha; Pavri, Behzad B.

    2014-01-01

    While various modalities to determine risk of sudden cardiac death (SCD) have been reported in clinical studies, currently reduced left ventricular ejection fraction remains the cornerstone of SCD risk stratification. However, the absolute burden of SCD is greatest amongst populations without known cardiac disease. In this review, we summarize the evidence behind current guidelines for implantable cardioverter defibrillator (ICD) use for the prevention of SCD in patients with ischemic heart disease (IHD). We also evaluate the evidence for risk stratification tools beyond clinical guidelines in the general population, patients with IHD, and patients with other known or suspected medical conditions. PMID:24568833

  12. How I was almost aborted: reflections on a prenatal brush with death.

    PubMed Central

    Berkowitz, J M

    1991-01-01

    After recently meeting with his biological parents, the author--a 29-year-old-married male--learned he had been an hour away from being aborted, being 'saved' only by extraordinary circumstances. In the paper the author reflects upon previous strong pro-choice beliefs and reasserts his commitment to a pro-choice philosophy, integrating his new personal experience. The paper pays particular attention to the biological mother's experience and how her fresh insights have reinforced the author's views on abortion. PMID:1941954

  13. Recent Iowa trends in sudden unexpected infant deaths: the importance of public health collaboration with medical examiners' offices.

    PubMed

    Harris, Meghan L; Massaquoi, David; Soyemi, Kenneth; Brend, Sarah M; Klein, Dennis; Pentella, Michael; Kraemer, John; Nashelsky, Marcus; Schmunk, Gregory; Smith, Tara; Pleva, Ariel

    2012-06-01

    During the winter in 2008, Iowa experienced an increase in sudden unexplained infant deaths (SUIDs). SUIDs and infectious causes of infant deaths generally average 3 monthly (SD = 1.0) in Iowa. However, in January 2008, 9 infant deaths were reported to the Iowa Department of Public Health and the Iowa Office of the State Medical Examiner. Between January and March of 2008, joint investigation of 22 SUIDs was conducted. The investigations required the involvement of multiple medical examiners from various jurisdictions, testing for pathogens at the University Hygienic Laboratory, epidemiologic support from the Iowa Department of Public Health, and consultation with the Centers for Disease Control and Prevention. The preliminary hypotheses for the increase in the infant mortality included viral respiratory disease and/or possible novel respiratory viral infections being the cause. Collaboration between public health and the medical examiner offices resulted in timely assessment of the cases. While no single causative agent was responsible for the increase seen in the number of infant deaths, respiratory pathogens played a role in the deaths of 15 of 22 children.

  14. [Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death].

    PubMed

    Zamarrón-de Lucas, Ester; García-Fernández, Eugenia; Carpio, Carlos; Alcolea, Sergio; Martínez-Abad, Yolanda; Álvarez-Sala, Rodolfo

    2016-06-17

    The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome.

  15. Sudden death due to catecholaminergic polymorphic ventricular tachycardia following negative stress-test outcome: genetics and clinical implications.

    PubMed

    D'Ovidio, Cristian; Carnevale, Aldo; Grassi, Vincenzo M; Rosato, Enrica; Del Olmo, Bernat; Coll, Monica; Campuzano, Oscar; Iglesias, Anna; Brugada, Ramon; Oliva, Antonio

    2017-04-13

    This paper discusses the case of a young boy who died suddenly during a football match. The victim's personal and family medical histories were negative for cardiac events. He had undergone a cardiological investigation some months before his death, enabling him to participate in competitive sports. Only post-mortem molecular analysis allowed for a clearer determination of the most plausible cause of death, which was identified as inherited arrhythmogenic heart disease, known as catecholaminergic polymorphic ventricular tachycardia. It was possible to detect a novel, previously undescribed, variant in the RYR2 gene. This case report highlights the importance of a meaningful forensic multidisciplinary investigation in such cases, and also discusses possible medical malpractice claims.

  16. Hepatic lipidosis and other test findings in two captive adult porcupines (Erethizon dorsatum) dying from a "sudden death syndrome".

    PubMed

    Barigye, Robert; Schamber, Ev; Newell, Teresa K; Dyer, Neil W

    2007-11-01

    Routine postmortem examination and histologic evaluation of tissue sections demonstrated hepatic lipidosis (HL) in 2 adult captive porcupines with a history of sudden death. The male porcupine had a markedly enlarged pale liver that microscopically showed large unilocular vacuoles within hepatocellular cytoplasm. The periparturient female had similar but less marked hepatic lesions and an incidental pulmonary mycosis. These findings suggest HL as an important differential of spontaneous death in captive porcupines. It is hypothesized that in addition to the widely documented causes, HL in captive porcupines may be specifically associated with nutritional imbalances caused by the feeding of unsuitable commercial diets. The possible association of the condition with dietary and other factors in captive porcupines needs to be thoroughly investigated.

  17. Sudden cardiac death in the soccer field: a retrospective study in young soccer players from 2000 to 2013.

    PubMed

    Davogustto, Giovanni; Higgins, John

    2014-11-01

    Soccer is the most popular sport in the world, with over 200 million active players. Sudden cardiac death (SCD) represents the most striking as well as the most common cause of death in the soccer field. Underlying cardiovascular pathologies predispose to life threatening ventricular arrhythmias and SCD in soccer players. Up to thousands to hundred thousands players might have an underlying condition that predisposes them for SCD. After several media striking SCD events in soccer players the Fédération Internationale de Football Association (FIFA) has made screening recommendations that are more thorough than the ones recommended for the American Heart Association and the European Society of Cardiology. We present a retrospective search through Internet databases that resulted in 54 soccer players with SCD events from 2000 until 2013. In this article, we will describe and discuss the conditions of those cases of SCD in order to provide more knowledge of the factors that may precipitate SCD in young soccer players.

  18. Reproductive Justice and the Pace of Change: Socioeconomic Trends in US Infant Death Rates by Legal Status of Abortion, 1960–1980

    PubMed Central

    Gruskin, Sofia; Singh, Nakul; Kiang, Mathew V.; Chen, Jarvis T.; Waterman, Pamela D.; Gottlieb, Jillian; Beckfield, Jason; Coull, Brent A.

    2015-01-01

    US infant death rates for 1960 to 1980 declined most quickly in (1) 1970 to 1973 in states that legalized abortion in 1970, especially for infants in the lowest 3 income quintiles (annual percentage change = −11.6; 95% confidence interval = −18.7, −3.8), and (2) the mid-to-late 1960s, also in low-income quintiles, for both Black and White infants, albeit unrelated to abortion laws. These results imply that research is warranted on whether currently rising restrictions on abortions may be affecting infant mortality. PMID:25713932

  19. Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young

    PubMed Central

    Methner, D. Nicole R.; Scherer, Steven E.; Welch, Katherine; Walkiewicz, Magdalena; Eng, Christine M.; Belmont, John W.; Powell, Mark C.; Korchina, Viktoriya; Doddapaneni, Harsha Vardhan; Muzny, Donna M.; Gibbs, Richard A.; Wolf, Dwayne A.; Sanchez, Luis A.; Kahn, Roger

    2016-01-01

    Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners’ and coroners’ offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents. PMID:27435932

  20. Long-term follow-up and sudden unexpected death in Gaucher disease type 3 in Egypt

    PubMed Central

    Blankenship, Derek

    2016-01-01

    Objective: To describe the long-term follow-up and distinct phenotype of a large cohort of patients with Gaucher disease type 3 on enzyme replacement therapy (ERT) in Egypt. Methods: A prospective cohort study of 78 patients on ERT who were followed for up to 9 years with yearly evaluations that included EEG and cognitive testing. Results: Of the patients, 73% were homozygous for the L444P GBA1 mutation; all but 7 were neurologically symptomatic. Supranuclear gaze palsy with variable but stable cognitive function was present in 91% of patients. Convergent strabismus and bulbar dysfunction were noted in 22% and 37%, respectively. Features of oppositional defiant disorder were present in 54% of patients. Twenty-three patients (30%) developed seizures while on ERT for 1–9 years. Of those, 12 patients (15%) died suddenly and unexpectedly at a mean age of 6.7 ± 5.0 years (range 1.5–18). Sudden death was usually associated with a seizure disorder or a terminal seizure, but 7 of 12 patients had a preceding normal EEG. An additional 11% had background slowing or epileptogenic activity on EEG without clinical seizures. There were 3 familial cases of sudden unexpected death. Conclusions: Despite having the most common GBA1 genotype known to be associated with neuronopathic Gaucher disease, patients with Gaucher disease type 3 in Egypt have a phenotype and a clinical outcome on ERT that are very different from those observed in other populations. Identifying putative modifying genes of this ethnic group is likely to lead to better therapy for neuronopathic Gaucher disease generally. PMID:27123474

  1. Identification of rare variants of DSP gene in Sudden Unexplained Nocturnal Death Syndrome in the southern Chinese Han population

    PubMed Central

    Zhao, Qianhao; Chen, Yili; Peng, Longlun; Gao, Rui; Liu, Nian; Jiang, Pingping; Liu, Chao; Tang, Shuangbo

    2016-01-01

    Sudden unexplained nocturnal death syndrome (SUNDS) is a perplexing disorder to both forensic pathologists and clinic physicians. Desmoplakin (DSP) gene was the first desmosomal gene linked to arrhythmogenic right ventricular cardiomyopathy (ARVC) which was associated with sudden death. To identify the genetic variants of the DSP gene in SUNDS in the southern Chinese Han population, we genetically screened the DSP gene in 40 sporadic SUNDS victims, 16 Brugada syndrome (BrS) patients and 2 Early Repolarization syndrome (ERS) patients using Next Generation Sequencing (NSG) and direct Sanger sequencing. A total of 10 genetic variants of the DSP gene were detected in 11 cases, comprised of two novel missense mutations (p.I125F and p.D521A) and eight previously reported rare variants. Of eight reported variants, two were previously considered pathogenic (p.Q90R and p.R2639Q), three were predicted in silico to bepathogenic (p.R315C, p.E1357D and p.D2579H), and the rest three were predicted to be benign (p.N1234S, p.R1308Q and p.T2267S). This is the first report of DSP genetic screening in Chinese SUNDS and Brugada syndrome. Our results implies that DSP mutations contribute to the genetic cause of some SUNDS victims and maybe a new susceptible gene for Brugada syndrome. PMID:26585738

  2. Genetic Structure and Molecular Variability Analysis of Citrus sudden death-associated virus Isolates from Infected Plants Grown in Brazil

    PubMed Central

    Matsumura, Emilyn Emy; Coletta Filho, Helvécio Della; de Oliveira Dorta, Silvia; Nouri, Shahideh; Machado, Marcos Antonio

    2016-01-01

    Citrus sudden death-associated virus (CSDaV) is a monopartite positive-sense single-stranded RNA virus that was suggested to be associated with citrus sudden death (CSD) disease in Brazil. Here, we report the first study of the genetic structure and molecular variability among 31 CSDaV isolates collected from both symptomatic and asymptomatic trees in CSD-affected areas. Analyses of partial nucleotide sequences of five domains of the CSDaV genomic RNA, including those encoding for the methyltransferase, the multi-domain region (MDR), the helicase, the RNA-dependent RNA polymerase and the coat protein, showed that the MDR coding region was the most diverse region assessed here, and a possible association between this region and virus adaption to different host or plant tissues is considered. Overall, the nucleotide diversity (π) was low for CSDaV isolates, but the phylogenetic analyses revealed the predominance of two main groups, one of which showed a higher association with CSD-symptomatic plants. Isolates obtained from CSD-symptomatic plants, compared to those obtained from asymptomatic plants, showed higher nucleotide diversity, nonsynonymous and synonymous substitution rates and number of amino acid changes on the coding regions located closer to the 5’ end region of the genomic RNA. This work provides new insights into the genetic diversity of the CSDaV, giving support for further epidemiological studies. PMID:27999249

  3. Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020).

    PubMed

    Kovacs, Kent; Václavík, Tomáš; Haight, Robert G; Pang, Arwin; Cunniffe, Nik J; Gilligan, Christopher A; Meentemeyer, Ross K

    2011-04-01

    Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and replacement on developed land in California communities using simulations of P. ramorum spread and infection risk over the next decade (2010-2020). An estimated 734 thousand oak trees occur on developed land in communities in the analysis area. The simulations predict an expanding sudden oak death (SOD) infestation that will likely encompass most of northwestern California and warrant treatment, removal, and replacement of more than 10 thousand oak trees with discounted cost of $7.5 million. In addition, we estimate the discounted property losses to single family homes of $135 million. Expanding the land base to include developed land outside as well as inside communities doubles the estimates of the number of oak trees killed and the associated costs and losses. The predicted costs and property value losses are substantial, but many of the damages in urban areas (e.g. potential losses from increased fire and safety risks of the dead trees and the loss of ecosystem service values) are not included.

  4. Identification of rare variants of DSP gene in sudden unexplained nocturnal death syndrome in the southern Chinese Han population.

    PubMed

    Zhao, Qianhao; Chen, Yili; Peng, Longlun; Gao, Rui; Liu, Nian; Jiang, Pingping; Liu, Chao; Tang, Shuangbo; Quan, Li; Makielski, Jonathan C; Cheng, Jianding

    2016-03-01

    Sudden unexplained nocturnal death syndrome (SUNDS) is a perplexing disorder to both forensic pathologists and clinic physicians. Desmoplakin (DSP) gene was the first desmosomal gene linked to arrhythmogenic right ventricular cardiomyopathy (ARVC) which was associated with sudden death. To identify the genetic variants of the DSP gene in SUNDS in the southern Chinese Han population, we genetically screened the DSP gene in 40 sporadic SUNDS victims, 16 Brugada syndrome (BrS) patients, and 2 early repolarization syndrome (ERS) patients using next generation sequencing (NSG) and direct Sanger sequencing. A total of 10 genetic variants of the DSP gene were detected in 11 cases, comprised of two novel missense mutations (p.I125F and p.D521A) and eight previously reported rare variants. Of eight reported variants, two were previously considered pathogenic (p.Q90R and p.R2639Q), three were predicted in silico to be pathogenic (p.R315C, p.E1357D and p.D2579H), and the rest three were predicted to be benign (p.N1234S, p.R1308Q, and p.T2267S). This is the first report of DSP genetic screening in Chinese SUNDS and Brugada syndrome. Our results imply that DSP mutations contribute to the genetic cause of some SUNDS victims and maybe a new susceptible gene for Brugada syndrome.

  5. Sudden and unexpected fetal death associated with agenesis of the arcuate nucleus in the medulla oblongata.

    PubMed

    Franciosi, Ralph A; Segura, Annette D

    2004-10-01

    Abnormalities have been reported in the medullary arcuate nucleus (ARCN) in unexpected late fetal death. They speculated that this developmental anomaly may underlie cardioventilatory abnormalities intrapartum and postpartum. This article describes a case of an unexpected late fetal death associated with absence of the ARCN.

  6. A Neonate with Susceptibility to Long QT Syndrome Type 6 who Presented with Ventricular Fibrillation and Sudden Unexpected Infant Death

    PubMed Central

    Sauer, Charles W.; Marc-Aurele, Krishelle L.

    2016-01-01

    Patient: Female, 19-day Final Diagnosis: 19 day old neonate with susceptibility to Long QT syndrome • ventricular fibrillation Symptoms: Cardiac arrest • cardiac arrhythmia • encephalopathy Medication: — Clinical Procedure: Cardioversion Specialty: Pediatrics and Neonatology Objective: Rare disease Background: This is a case of a neonate with susceptibility to long QT syndrome (LQTS) who presented with a sudden unexpected infant death. Experts continue to debate whether universal electrocardiogram (ECG) screening of all newborns is feasible, practical, and cost-effective. Case Report: A 19-day-old neonate was found unresponsive by her mother. ECG showed ventricular fibrillation and a combination of a lidocaine drip plus multiple defibrillations converted the rhythm to normal sinus. Unfortunately, MRI brain imaging showed multiple infarcts and EEG showed burst suppression pattern with frequent seizures; life supportive treatment was stopped and the infant died. Genetic testing revealed two mutations in the KCNE2 gene consistent with susceptibility to LQTS type 6. Conclusions: We believe this case is the first to demonstrate both a precipitating electrocardiographic and genetic cause of death for an infant with LQTS, showing a cause-and-effect relationship between LQTS mutation, ventricular arrhythmia, and death. We wonder whether universal ECG newborn screening to prevent LQTS death could have saved this baby. PMID:27465075

  7. A Neonate with Susceptibility to Long QT Syndrome Type 6 who Presented with Ventricular Fibrillation and Sudden Unexpected Infant Death.

    PubMed

    Sauer, Charles W; Marc-Aurele, Krishelle L

    2016-07-28

    BACKGROUND This is a case of a neonate with susceptibility to long QT syndrome (LQTS) who presented with a sudden unexpected infant death. Experts continue to debate whether universal electrocardiogram (ECG) screening of all newborns is feasible, practical, and cost-effective. CASE REPORT A 19-day-old neonate was found unresponsive by her mother. ECG showed ventricular fibrillation and a combination of a lidocaine drip plus multiple defibrillations converted the rhythm to normal sinus. Unfortunately, MRI brain imaging showed multiple infarcts and EEG showed burst suppression pattern with frequent seizures; life supportive treatment was stopped and the infant died. Genetic testing revealed two mutations in the KCNE2 gene consistent with susceptibility to LQTS type 6. CONCLUSIONS We believe this case is the first to demonstrate both a precipitating electrocardiographic and genetic cause of death for an infant with LQTS, showing a cause-and-effect relationship between LQTS mutation, ventricular arrhythmia, and death. We wonder whether universal ECG newborn screening to prevent LQTS death could have saved this baby.

  8. Cold spells and ischaemic sudden cardiac death: effect modification by prior diagnosis of ischaemic heart disease and cardioprotective medication

    PubMed Central

    Ryti, Niilo R. I.; Mäkikyrö, Elina M. S.; Antikainen, Harri; Junttila, M. Juhani; Hookana, Eeva; Ikäheimo, Tiina M.; Kortelainen, Marja-Leena; Huikuri, Heikki V.; Jaakkola, Jouni J. K.

    2017-01-01

    Sudden cardiac death (SCD) is the leading cause of death. The current paradigm in SCD requires the presence of an abnormal myocardial substrate and an internal or external transient factor that triggers cardiac arrest. Based on prior mechanistic evidence, we hypothesized that an unusually cold weather event (a cold spell) could act as an external factor triggering SCD. We tested potential effect modification of prior diagnoses and select pharmacological agents disrupting pathological pathways between cold exposure and death. The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged ≥35 in the Province of Oulu, Finland, were linked to 51 years of home-specific weather data. Based on conditional logistic regression, an increased risk of ischaemic SCD associated with a cold spell preceding death (OR 1.49; 95% CI: 1.06–2.09). Cases without a prior diagnosis of ischaemic heart disease seemed more susceptible to the effects of cold spells (OR 1.70; 95% CI: 1.13–2.56) than cases who had been diagnosed during lifetime (OR 1.14; 95% CI: 0.61–2.10). The use of aspirin, β-blockers, and/or nitrates, independently and in combinations decreased the risk of ischaemic SCD during cold spells. The findings open up new lines of research in mitigating the adverse health effects of weather. PMID:28106161

  9. Sudden death from toluene intoxication: a case report and review of literature.

    PubMed

    Prayulsatien, Weerapong

    2013-09-01

    Toluene is an aromatic hydrocarbon (C7H8) found in gasoline, acrylic paints, varnishes, lacquers, paint thinners, adhesives, and shoe polish. Toluene toxicity can occur from unintentional or deliberate inhalation of fumes, ingestion, or transdermal absorption. Unintentional exposure to high concentrations of toluene results in severe toluene intoxication. This is a report of toluene poisoning in a middle-age man found dead at home after varnish application by spray. There was no obvious external and internal cause of death. The blood test revealed the presence of toluene. The cause of death was diagnosed as cardiopulmonary failure caused by toluene, which is a rare case report in Thailand.

  10. Utility of T-wave amplitude as a non-invasive risk marker of sudden cardiac death in hypertrophic cardiomyopathy

    PubMed Central

    Sugrue, Alan; Killu, Ammar M; DeSimone, Christopher V; Chahal, Anwar A; Vogt, Josh C; Kremen, Vaclav; Hai, JoJo; Hodge, David O; Acker, Nancy G; Geske, Jeffrey B; Ackerman, Michael J; Ommen, Steve R; Lin, Grace; Noseworthy, Peter A; Brady, Peter A

    2017-01-01

    Objective Sudden cardiac arrest (SCA) is the most devastating outcome in hypertrophic cardiomyopathy (HCM). We evaluated repolarisation features on the surface electrocardiogram (ECG) to identify the potential risk factors for SCA. Methods Data was collected from 52 patients with HCM who underwent implantable cardioverter defibrillator (ICD) implantation. Leads V2 and V5 from the ECG closest to the time of ICD implant were utilised for measuring the Tpeak-Tend interval (Tpe), QTc, Tpe/QTc, T-wave duration and T-wave amplitude. The presence of the five traditional SCA-associated risk factors was assessed, as well as the HCM risk-SCD score. Results 16 (30%) patients experienced aborted cardiac arrest over 8.5±4.1 years, with 9 receiving an ICD shock and 7 receiving ATP. On univariate analysis, T-wave amplitude was associated with appropriate ICD therapy (HR per 0.1 mV 0.79, 95% CI 0.56 to 0.96, p=0.02). Aborted SCA was not associated with a greater mean QTc duration, Tpeak-Tend interval, T-wave duration, or Tpe/QT ratio. Multivariate analysis (adjusting for cardinal HCM SCA-risk factors) showed T-wave amplitude in Lead V2 was an independent predictor of risk (adjusted HR per 0.1 mV 0.74, 95% CI 0.57 to 0.97, p=0.03). Addition of T-wave amplitude in Lead V2 to the traditional risk factors resulted in significant improvement in risk stratification (C-statistic from 0.65 to 0.75) but did not improve the performance of the HCM SCD-risk score. Conclusions T-wave amplitude is a novel marker of SCA in this high risk HCM population and may provide incremental predictive value to established risk factors. Further work is needed to define the role of repolarisation abnormalities in predicting SCA in HCM.

  11. Serotoninergic receptor 1A in the sudden infant death syndrome brainstem medulla and associations with clinical risk factors.

    PubMed

    Machaalani, Rita; Say, Meichien; Waters, Karen A

    2009-03-01

    The immunoreactivity of the serotoninergic receptor subtype 1A (5HT(1A)R) was quantitatively analyzed in the human infant brainstem medulla (caudal and rostral levels). We hypothesized that immunoreactivity of 5HT(1A)R would be reduced in infants diagnosed with sudden infant death syndrome (SIDS). In particular that those infants with known clinical risk factors (including cigarette smoke exposure, bed sharing and sleep position) would have greater changes than those without clinical risks. Comparing SIDS (n = 67) to infants who died suddenly with another diagnosis (non-SIDS, n = 25), we found decreased 5HT(1A)R immunoreactivity in the majority of the nuclei studied at the rostral medulla level including dorsal motor nucleus of the vagus (DMNV), nucleus of the solitary tract, vestibular, and inferior olivary nucleus (ION). There was a significant relationship with all risk factors for 5HT(1A)R, especially for DMNV, suggesting that 5HT(1A)Rs are highly vulnerable to various insults within the SIDS DMNV. This study not only provides further evidence of abnormalities within the brainstem serotoninergic system of SIDS infants, but also shows that these changes may be associated with exposure to clinical risk factors.

  12. Who to target in sudden unexpected death in epilepsy prevention and how? Risk factors, biomarkers, and intervention study designs.

    PubMed

    Tomson, Torbjörn; Surges, Rainer; Delamont, Robert; Haywood, Serena; Hesdorffer, Dale C

    2016-01-01

    The risk of dying suddenly and unexpectedly is increased 24- to 28-fold among young people with epilepsy compared to the general population, but the incidence of sudden unexpected death in epilepsy (SUDEP) varies markedly depending on the epilepsy population. This article first reviews risk factors and biomarkers for SUDEP with the overall aim of enabling identification of epilepsy populations with different risk levels as a background for a discussion of possible intervention strategies. The by far most important clinical risk factor is frequency of generalized tonic-clonic seizures (GTCS), but nocturnal seizures, early age at onset, and long duration of epilepsy have been identified as additional risk factors. Lack of antiepileptic drug (AED) treatment or, in the context of clinical trials, adjunctive placebo versus active treatment is associated with increased risks. Despite considerable research, reliable electrophysiologic (electrocardiography [ECG] or electroencephalography [EEG]) biomarkers of SUDEP risk remain to be established. This is an important limitation for prevention strategies and intervention studies. There is a lack of biomarkers for SUDEP, and until validated biomarkers are found, the endpoint of interventions to prevent SUDEP must be SUDEP itself. These interventions, be they pharmacologic, seizure-detection devices, or nocturnal supervision, require large numbers. Possible methods for assessing prevention measures include public health community interventions, self-management, and more traditional (and much more expensive) randomized clinical trials.

  13. Clinical Cosmobiology - Sudden Cardiac Death and Daily / Monthly Geomagnetic, Cosmic Ray and Solar Activity - the Baku Study (2003-2005)

    NASA Astrophysics Data System (ADS)

    Stoupel, E.; Babayev, E. S.; Mustafa, F. R.; Abramson, E.; Israelevich, P.; Sulkes, J.

    2006-12-01

    Part of results of collaborative studies for revealing an influence of the periodical changes of solar, geomagnetic and cosmic ray activities on the sudden cardiac death (SCD) mortality is described in this paper. The data covering daily and monthly temporal distribution of SCD (788 patients in 36 months in 2003-2005), taken from all of emergency and first medical aid stations of grand Baku area, were analyzed and compared with certain cosmophysical parameters. It was obtained that SCD is higher on the highest and lowest daily levels of geomagnetic activity. Days with SCD are accompanied by higher cosmic ray (neutron) activity. The monthly number of SCD was inversely related to solar and geomagnetic activities while was positively linked with cosmic ray activity level. It was concluded that cosmic ray activity could be considered as one of regulating external/environmental factors in human homeostasis.

  14. Case of sudden death following rupture of thoracic aortic aneurysm during "a manual therapy" procedure in the spinal area.

    PubMed

    Kaczorowska, A; Dąbkowska, A

    2014-01-01

    The reported case concerns the rupture of an aneurysm located in the descending part of the thoracic aorta during the procedure of the so-called "spinal adjustment" performed by a chiropractor. A 45-year-old patient with no significant medical history of cardiovascular diseases visited, along with his wife, one of "manual therapy" practices because of back pain. During the procedure, the patient suddenly lost consciousness. Despite cardiopulmonary resuscitation and emergency assistance given by an ambulance team, the patient died. An autopsy revealed that the cause of death was increasing cardiorespiratory failure secondary to bleeding into the lumen of the left pleural cavity following the rupture of pathologically altered thoracic aortic wall.

  15. Cell and Gene Therapy for Genetic Diseases: Inherited Disorders Affecting the Lung and Those Mimicking Sudden Infant Death Syndrome

    PubMed Central

    Keeler, Allison M.

    2012-01-01

    Abstract Some of the first human gene therapy trials targeted diseases of the lung and provided important information that will continue to help shape future trials. Here we describe both cell and gene therapies for lung diseases such as cystic fibrosis and alpha-1 antitrypsin disorder as well as fatty acid oxidation disorders that mimic sudden infant death syndrome (SIDS). Human clinical gene therapy trials for cystic fibrosis and alpha-1 antitrypsin have been performed using a variety of vectors including adenovirus, adeno-associated virus, and nonviral vectors. No human clinical gene therapy trials have been performed for disorders of fatty acid oxidation; however, important proof-of-principle studies have been completed for multiple fatty acid oxidation disorders. Important achievements have been made and have yet to come for cell and gene therapies for disorders of the lung and those mimicking SIDS. PMID:22642257

  16. Cell and gene therapy for genetic diseases: inherited disorders affecting the lung and those mimicking sudden infant death syndrome.

    PubMed

    Keeler, Allison M; Flotte, Terence R

    2012-06-01

    Some of the first human gene therapy trials targeted diseases of the lung and provided important information that will continue to help shape future trials. Here we describe both cell and gene therapies for lung diseases such as cystic fibrosis and alpha-1 antitrypsin disorder as well as fatty acid oxidation disorders that mimic sudden infant death syndrome (SIDS). Human clinical gene therapy trials for cystic fibrosis and alpha-1 antitrypsin have been performed using a variety of vectors including adenovirus, adeno-associated virus, and nonviral vectors. No human clinical gene therapy trials have been performed for disorders of fatty acid oxidation; however, important proof-of-principle studies have been completed for multiple fatty acid oxidation disorders. Important achievements have been made and have yet to come for cell and gene therapies for disorders of the lung and those mimicking SIDS.

  17. Investigation of sudden death from Mycobacterium tuberculosis in a foreign-born worker at a resort hotel.

    PubMed

    Grabau, John C; Hughes, Stephen E; Rodriguez, Edwin M; Sommer, Jamie N; Troy, Eleanor T

    2004-01-01

    A 60 year-old man born in Central America died suddenly in the hallway of his residence on the grounds of a resort hotel where he worked as a dishwasher. The dishwashing station was in a large, poorly ventilated area where a substantial number of food service workers (cooks, wait staff, bus persons, dishwashers, supervisors, etc.) shared air space with the index patient. Several social contacts of the patient reported that he had been coughing for many months before his death. The County Department Of Health conducted a contact investigation, which identified 171 individuals in need of follow-up. Thirty-six percent of those tested in the first round were tuberculin skin test-positive; a second round of testing yielded a 15% (8 of 52) conversion rate.

  18. Nitrazepam-induced cricopharyngeal dysphagia, abnormal esophageal peristalsis and associated bronchospasm: probable cause of nitrazepam-related sudden death.

    PubMed

    Lim, H C; Nigro, M A; Beierwaltes, P; Tolia, V; Wishnow, R

    1992-09-01

    Nitrazepam was used in the treatment of resistant myoclonic epilepsy in 38 children. After the occurrence of nitrazepam-associated swallowing incoordination, high-peaked esophageal peristalsis and related bronchospasm in one patient, we initiated a prospective study of esophageal manometry using a station pull-through technique with a pediatric 4-channel continuous perfusing system. Three more patients were found to have delayed cricopharyngeal relaxation and high-peaked esophageal peristaltic waves. The initial patient developed severe respiratory distress and bronchospasm necessitating ventilatory support while on nitrazepam and improved dramatically with subsequent normal manometric study following nitrazepam discontinuation. Nitrazepam was reintroduced for its anticonvulsant and cognitive benefits and was tolerated at a reduced dosage. We postulate a central nervous system effect of nitrazepam promoting parasympathetic overactivity or vagotonia which can cause potentially fatal respiratory distress. Care must be exercised in nitrazepam use and esophageal manometry may be helpful in defining patients at greater risk for sudden death.

  19. Safe sleep practices and sudden infant death syndrome risk reduction: NICU and well-baby nursery graduates.

    PubMed

    Fowler, Aja J; Evans, Patricia W; Etchegaray, Jason M; Ottenbacher, Allison; Arnold, Cody

    2013-11-01

    Our primary objective was to compare parents of infants cared for in newborn intensive care units (NICUs) and infants cared for in well-baby ("general") nurseries with regard to knowledge and practice of safe sleep practices/sudden infant death syndrome risk reduction measures and guidelines. Our secondary objective was to obtain qualitative data regarding reasons for noncompliance in both populations. Sixty participants (30 from each population) completed our survey measuring safe sleep knowledge and practice. Parents of NICU infants reported using 2 safe sleep practices-(a) always placing baby in crib to sleep and (b) always placing baby on back to sleep-significantly more frequently than parents of well infants. Additional findings and implications for future studies are discussed.

  20. An Evidence-Based Infant Safe Sleep Program to Reduce Sudden Unexplained Infant Deaths.

    PubMed

    Zachritz, Whitney; Fulmer, Megan; Chaney, Nicole

    2016-11-01

    : Objective: The purpose of this project was to design, implement, and evaluate a safe sleep program for expectant mothers and the families of infants discharged from our hospital's neonatal intensive care unit (NICU). It was prompted by the sleep-related deaths of two infants in the community, both of whom had been discharged from our NICU.

  1. Mortality from Sudden Unexpected Death in Epilepsy (SUDEP) in a Cohort of Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Kiani, R.; Tyrer, F.; Jesu, A.; Bhaumik, S.; Gangavati, S.; Walker, G.; Kazmi, S.; Barrett, M.

    2014-01-01

    Background: People with intellectual disability (ID) and epilepsy are more likely to die prematurely than the general population. A significant number of deaths in people with epilepsy may be potentially preventable through better seizure control, regular monitoring and raising awareness among patients and carers. The aim of this project was to…

  2. A case-control study of sudden unexplained nocturnal death syndrome in the southern Chinese Han population.

    PubMed

    Zheng, Jinxiang; Huang, Erwen; Tang, Shuangbo; Wu, Qiuping; Huang, Lei; Zhang, Dongchuan; Quan, Li; Liu, Chao; Cheng, Jianding

    2015-03-01

    To study the epidemiological characteristics of sudden unexplained nocturnal death syndrome (SUNDS) in the southern Chinese Han population during 2007 to 2013, we gathered 879 SUNDS victims from Dongguan City and in the Longgang District in Shenzhen City as the case group then selected 879 all-cause death cases, adopting a 1:1 pair method, as the control group I and collected 8142 all-cause death cases from the Bao'an District in Shenzhen City as the control group II, simultaneously. Case information collected was statistically analyzed. The annual incidence of SUNDS is 1.02 and 2.23 per 100,000 person-years for Dongguan City and in the Longgang District, respectively. The number of male and female victims is drastically different, with a ratio of 13.92:1, whereas the incidence between the 2 sexes is significantly different (χ2 = 78.734, P < 0.01), with an odds ratio value of 11.32 (95% confidence interval, 5.75-22.28). The age of death of SUNDS cases ranges from 17 to 55 years with a median age of 35 years; furthermore, the difference of distribution of age of death between the SUNDS victims and the all-cause death population is significant (χ2 = 767.12, P < 0.001). The birthplace of SUNDS victims is distributed throughout 27 provinces of China, but the difference between the SUNDS victims and the all-cause death population is not significant (χ2 = 27.273, P > 0.05). The monthly incidence of SUNDS is relatively higher from March to June, whereas the difference of monthly distribution between SUNDS victims and all-cause death population is significant (χ2 = 9.869, P < 0.05), with an odds ratio value of 1.42 (95% confidence interval, 1.14-1.76). Although the majority of SUNDS occurred during midnight sleep, they were mostly discovered from 7 to 9 am once the inmates or spouses woke in the morning. A total of 97.74% of the SUNDS victims were blue-collar factory workers with a high-intensity labor and poor education background. This investigation confirmed the

  3. Abuse of alcohol in sudden out-of-hospital deaths in Finland.

    PubMed

    Perola, M; Vuori, E; Penttilä, A

    1994-04-01

    Alcoholism is known to be greatly underdiagnosed in death certificates, a fact that biases in estimates of alcohol-related mortality. An autopsy series of 1658 cases (920 with natural cause of death and 738 nonnatural) was reviewed to evaluate the extent of this bias, and also to see how well different sources of information served as indicators of alcoholism when alcohol-related disease diagnosed at autopsy was considered as a gold standard. A stepwise logistic regression model adjusted by age and sex showed police reports of individual's alcohol usage and blood alcohol concentration (BAC) of > 2.9/1000 at autopsy to be the two most significant predictors of chronic alcohol abuse (p < 0.0001). The specificities of these two parameters as predictors of chronic alcohol abuse were generally high and sensitivities low. The authors see high BAC (> 2.9/1000), due to its high specificity, as particularly suggestive of chronic heavy drinking. However, it is wise to use these parameters only as an aid in decision-making, not as sole indicators of alcoholism. Deaths associated with chronic heavy drinking were frequent, 50.5% of the total series (male 56.4%, female 37.1%). For all but one age-group (male 45-64 years), however, death certificates mentioned alcohol-related diseases in less than half of these cases. Especially evident underdiagnosis was found for female and males 65 years and older. These results indicate that alcoholism is frequent in such a highly selected population as a series of forensic autopsies and suggest that estimates of prevalence of alcoholism based only on review of death certificates are to be considered with great caution.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes

    PubMed Central

    Zorzi, Alessandro; Perazzolo Marra, Martina; Rigato, Ilaria; De Lazzari, Manuel; Susana, Angela; Niero, Alice; Pilichou, Kalliopi; Migliore, Federico; Rizzo, Stefania; Giorgi, Benedetta; De Conti, Giorgio; Sarto, Patrizio; Serratosa, Luis; Patrizi, Giampiero; De Maria, Elia; Pelliccia, Antonio; Basso, Cristina; Schiavon, Maurizio; Bauce, Barbara; Iliceto, Sabino; Thiene, Gaetano

    2016-01-01

    Background— The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. Methods and Results— We compared 35 athletes (80% men, age: 14–48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Conclusions— Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography. PMID:27390211

  5. Medullary serotonergic network deficiency in the sudden infant death syndrome: review of a 15-year study of a single dataset.

    PubMed

    Kinney, H C; Filiano, J J; White, W F

    2001-03-01

    The sudden infant death syndrome (SIDS) is the leading cause of postneonatal infant mortality in the United States today, despite a dramatic 38% decrease in incidence due to a national risk reduction campaign advocating the supine sleep position. Our research in SIDS brainstems, beginning in 1985 and involving a single, large dataset, has become increasingly focused upon a specific neurotransmitter (serotonin) and specific territories (ventral medulla and regions of the medullary reticular formation that contain secrotonergic neurons). Based on this research, we propose that SIDS, or a subset of SIDS, is due to a developmental abnormality in a medullary network composed of (at least in part) rhombic lip-derived, serotonergic neurons, including in the caudal raphé and arcuate nucleus (putative human homologue of the cat respiratory chemosensitive fields); and this abnormality results in a failure of protective responses to life-threatening stressors (e.g. asphyxia, hypoxia, hypercapnia) during sleep as the infant passes through a critical period in homeostatic control. We call this the medullary serotonergic network deficiency hypothesis. We review the triple-risk model for SIDS, the development of the dataset using tissue autoradiography for analyzing neurotransmitter receptor binding; age-dependent baseline neurochemical findings in the human brainstem during early life; the evidence for serotonergic, rhombic lip, and ventral medullary deficits in at least some SIDS victim; possible mechanisms of sudden infant death related to these deficits; and potential causes of the deficits in the medullary serotonergic network in SIDS victims. We conclude with a summary of future directions in SIDS brainstem research.

  6. GENERAL: Entanglement sudden death of two atoms interacting with a cavity via the two-photon process in a strong-driving-assisted system

    NASA Astrophysics Data System (ADS)

    Chen, Li; Shao, Xiao-Qiang; Zhang, Shou

    2009-11-01

    We examine the entanglement dynamics between two strongly driven atoms off-resonantly coupled with a single-mode cavity via the two-photon process with the help of negativity in two different types of initial states. The results show that entanglement sudden death may occur under both the above conditions and the sudden death effect can be monitored by modulating the atom-cavity detunings. Furthermore, we also find an atomic decoherence-free subspace so that the initial entanglement between two atoms remains invariable in application.

  7. Sudden Death From Ruptured Intracranial Vascular Malformations During Mechanical Asphyxia: A Domestic Violence Case Report.

    PubMed

    Wu, Xue-Mei; Zhang, Xu-Dong; Yun, Li-Bing; Liu, Min; Yi, Xu-Fu

    2017-03-01

    Smothering and manual strangulation are not uncommon in domestic violence against women; however, no report on the combination of mechanical asphyxia and intracranial vascular malformations has been previously published. We report a middle-aged woman who was smothered and manually strangled by her husband and subsequently died from subarachnoid hemorrhage due to ruptured intracranial vascular malformations, rather than direct mechanical asphyxiation. Smothering and manual strangulation are considered provocative conditions for rupture and contributory causes of death. In this case study, we underline the importance of meticulous autopsy in cases of mechanical asphyxia and intracranial hemorrhage. Exclusion of underlying diseases that may have caused or contributed to death is also required, despite serious asphyxiation signs and neck injuries. Postmortem angiography is a valuable complement to autopsy to detect vascular pathology, with good prospects for further development in China.

  8. Sudden death due to ventricular double rupture as a complication of inferior acute myocardial infarction

    PubMed Central

    Chen, Shi-Jian; Zhang, Chen; Meng, Qing-Tao; Peng, Yong; Chen, Mao

    2016-01-01

    Abstract Rationale: Ventricular double rupture (VDR) is a rare but lethal mechanical complication of acute myocardial infarction (AMI). The early identification and timely treatment of VDR remain challenging problems. We present a case of AMI with VDR and briefly review the characteristics and prognosis of this life-threatening disease. Patient concerns and Diagnoses: A 77-year-old male presented to our hospital with a 4-day history of severe dizziness, mild chest tightness, and dyspnea. An inferior AMI was diagnosed. Interventions and Outcomes: On the second hospital day, hypotension and a new cardiac murmur was found. The emergency echocardiographic study disclosed a ventricular septal defect. Soon after that the patient suddenly died of ventricular free-wall rupture. Lessons: In patients with AMI complicated by a septal perforation in the apical region, close to the septum-free wall junction, special attention should be paid to the great risk of VDR. Other high risk factors included advanced age, delayed reperfusion, and inferior infarction. Sufficient evaluation of the risk factors, close monitoring of vital signs, early identification of the specific symptoms, and timely treatment are the key points for the effective prediction and prevention of VDR. PMID:28033290

  9. Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina

    PubMed Central

    Naesgaard, Patrycja A.; León De La Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Brede, Cato; Staines, Harry; Nilsen, Dennis W. T.

    2012-01-01

    Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum. Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis. Results There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19–0.73), p = 0.004, 0.23 (95% CI, 0.08–0.67), p = 0.007, and 0.32 (95% CI, 0.11–0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10–0.54), p = 0.001, 0.18 (95% CI, 0.05–0.60), p = 0.006 and 0.25 (95% CI, 0.07–0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release. Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS. Trial registration ClinicalTrials.gov NCT01377402 PMID:22970121

  10. Fatalities after taking ibogaine in addiction treatment could be related to sudden cardiac death caused by autonomic dysfunction.

    PubMed

    Maas, U; Strubelt, S

    2006-01-01

    Ibogaine is the most important alkaloid of the Central African Iboga-shrub. It is the central drug in Gabonian initiation ceremonies in which it is used to cause a near-death experience. In Western countries it is used in private clinics to treat addiction. However, in the United States and most European countries it is classified as an illegal drug because at least eight persons have died after having taken Ibogaine. These fatalities occurred in most cases several days after ingestion or following the intake of very small doses. There is no conclusive explanation at the present time for these deaths. We hypothesize, that these deaths may be a result of cardiac arrhythmias, caused by a dysregulation of the autonomic nervous system. Ibogaine affects the autonomic nervous system by influencing several neurotransmitter-systems and the fastigial nucleus. The cerebellar nucleus responds to small doses with a stimulation of the sympathetic system, leading to a fight or flight reaction. High doses, however, lead to a vagal dominance: a "feigned death". The risk of cardiac arrhythmias is increased in situations of sympathetic stimulation or coincidence of a high parasympathetic tonus and a left-sided sympathetic stimulation. This could occur under influence of small doses of ibogaine and also at times of exhaustion with a high vagal tonus, when sudden fear reactions could cause a critical left-sided sympathetic stimulation. Gabonian healers prevent these risks by isolating their patients from normal life and by inducing a trance-state with right-hemispheric and vagal dominance for several days.

  11. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony

    PubMed Central

    Martens, Eimo; Sinner, Moritz F.; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M.; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan

    2014-01-01

    Aims Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6–128/100 000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. Methods and results In the district of Aurich (190 000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100 000/year) corresponded well with the average mortality rate in Germany (1030/100 000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100 000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100 000/year). Conclusion Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. PMID:25061228

  12. Sudden Unexpected Deaths and Vaccinations during the First Two Years of Life in Italy: A Case Series Study

    PubMed Central

    Traversa, Giuseppe; Spila-Alegiani, Stefania; Bianchi, Clara; Ciofi degli Atti, Marta; Frova, Luisa; Massari, Marco; Raschetti, Roberto; Salmaso, Stefania; Scalia Tomba, Gianpaolo

    2011-01-01

    Background The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. Methodology/Principal Findings The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999–2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1–23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0–1, 0–7, and 0–14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0–7 and 0–14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. Conclusions The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age. PMID:21298113

  13. Factors enhancing adherence of toxigenic Staphylococcus aureus to epithelial cells and their possible role in sudden infant death syndrome.

    PubMed

    Saadi, A T; Blackwell, C C; Raza, M W; James, V S; Stewart, J; Elton, R A; Weir, D M

    1993-06-01

    Toxigenic strains of Staphylococcus aureus have been suggested to play a role in sudden infant death syndrome (SIDS). In this study we examined two factors that might enhance binding of toxigenic staphylococci to epithelial cells of infants in the age range in which cot deaths are prevalent: expression of the Lewis(a) antigen and infection with respiratory syncytial virus (RSV). By flow cytometry we demonstrated that binding of three toxigenic strains of S. aureus to cells from nonsecretors was significantly greater than to cells of secretors. Pre-treatment of epithelial cells with monoclonal anti-Lewis(a) or anti-type-1 precursor significantly reduced bacterial binding (P < 0.01); however, attachment of the bacteria correlated only with the amount of Lewis(a) antigen detected on the cells (P < 0.01). HEp-2 cells infected with RSV bound significantly more bacteria than uninfected cells. These findings are discussed in context of factors previously associated with SIDS (mother's smoking, bottle feeding and the prone sleeping position) and a hypothesis proposed to explain some cases of SIDS.

  14. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    PubMed

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  15. Optimizing conditions of a cell-free toxic filtrate stem cutting assay to evaluate soybean genotype responses to Fusarium species that cause sudden death syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cell-free toxic culture filtrates from Fusarium virguliforme, the causal fungus of soybean sudden death syndrome (SDS), cause foliar symptoms on soybean stem-cuttings similar to those obtained from root inoculations in whole plants and those observed in production fields. The objectives of this stud...

  16. High Stakes Principalship--Sleepless Nights, Heart Attacks and Sudden Death Accountabilities: Reading Media Representations of the United States Principal Shortage.

    ERIC Educational Resources Information Center

    Thomson, Pat; Blackmore, Jill; Sachs, Judyth; Tregenza, Karen

    2003-01-01

    Subjects a corpus of predominantly United States news articles to deconstructive narrative analysis and finds that the dominant media representation of principals' work is one of long hours, low salary, high stress, and sudden death from high stakes accountabilities. Notes that the media picture may perpetuate the problem, and that it is at odds…

  17. Use of a wearable defibrillator in terminating tachyarrhythmias in patients at high risk for sudden death: results of the WEARIT/BIROAD.

    PubMed

    Feldman, Arthur M; Klein, Helmut; Tchou, Patrick; Murali, Srinivas; Hall, W Jackson; Mancini, Donna; Boehmer, John; Harvey, Mark; Heilman, M Stephen; Szymkiewicz, Steven J; Moss, Arthur J

    2004-01-01

    The automatic ICD improves survival in patients with a history of sudden cardiac arrest. However, some patients do not meet the guidelines for ICD implantation or are unable to receive an implantable device. This study tested the hypothesis that these patients could benefit from a wearable cardioverter defibrillator. Patients with symptomatic heart failure and an ejection fraction of <0.30 (WEARIT Study) or patients having complications associated with high risk for sudden death after a myocardial infarction or bypass surgery not receiving an ICD for up to 4 months (BIROAD Study) were enrolled into two studies. After a total of 289 patients had been enrolled in the trial (177 in WEARIT and 112 in BIROAD), prespecified safety and effectiveness guidelines had been met. Six (75%) of eight defibrillation attempts were successful. Six inappropriate shock episodes occurred during 901 months of patient use (0.67% unnecessary shocks per month of use). Twelve deaths occurred during the study 6 sudden deaths: 5 not wearing and 1 incorrectly wearing the device). Most patients tolerated the device although 68 patients quit due to comfort issues or adverse reactions. The results of the present study suggest that a wearable defibrillator is beneficial in detecting and effectively treating ventricular tachyarrhythmias in patients at high risk for sudden death who are not clear candidates for an ICD and may be useful as a bridge to transplantation or ICD in some patients.

  18. Back to Sleep: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) [and] Questions and Answers for Professionals on Infant Sleeping Position and SIDS.

    ERIC Educational Resources Information Center

    Health Resources and Services Administration (DHHS/PHS), Washington, DC. Maternal and Child Health Bureau.

    The "Back to Sleep" public health campaign, which recommends that infants be placed on their backs for sleeping help reduce the risk of Sudden Infant Death Syndrome (SIDS), was initiated in 1994. The campaign was led by the National Institute of Child Health and Human Development, and co-sponsored by the U.S. Public Health Service, the…

  19. Sudden death of a middle-aged man with an artificial vagina in situ

    PubMed Central

    Vidanapathirana, Muditha; Ruwanpura, Rohan P; Amararatne, Sriyantha RRG

    2016-01-01

    Artificial vaginas are designed to imitate the female sex organ. This is the first reported case in the forensic literature of a man being pronounced dead with an artificial vagina in situ. A middle-aged man was found unconscious in a bathroom when the door was forced open and was pronounced dead on admission. Autopsy revealed that the penis was inside an artificial vagina. There were no injuries, but there were left ventricular hypertrophy, myocardial fibrosis, and narrow coronaries. The cause of death was ascertained as ischemic heart disease due to coronary atherosclerosis and the comments included were no evidence of violence, and ischemic heart disease could have been precipitated due to abnormal sexual activity. If removal of artificial vagina was done before the admission, this circumstance could not have ascertained. Removal of such devices before admission to hospitals could be the reason why such incidents do not come to light. PMID:27857900

  20. Clinical and Pathologic Characteristics of Myocarditis as a Cause of Sudden Death

    DTIC Science & Technology

    2008-01-01

    and B ECHO Influenza Herpes  virus Mumps Rubella Rubeola Rickettsial Fungal Cryptococcus Protozoan Bacterial Legionella Clostridium Salmonella/Shigella... Polio Adenovirus Hepatitis B and C HIV Trypanosomiasis cruzi Toxoplasmosis gondi Spirochetal Borrelia burgdorferi N i f ti   M dition n ec ous yocar s...0.265 Prodromal symptoms Fever, headache, URI  symptoms 16/23 (69.6%) 13/23 (56.5%)   48/99 (48.5%) 0/99 (0.0%) 0.104 ɘ.001 Out of hospital death 5 (16.7

  1. SCD-HeFT: Use of RR Interval Statistics for Long-term Risk Stratification for Arrhythmic Sudden Cardiac Death

    PubMed Central

    Au-yeung, Wan-tai M.; Reinhall, Per; Poole, Jeanne E.; Anderson, Jill; Johnson, George; Fletcher, Ross D.; Moore, Hans J.; Mark, Daniel B.; Lee, Kerry L.; Bardy, Gust H.

    2015-01-01

    Background In the SCD-HeFT a significant fraction of the congestive heart failure (CHF) patients ultimately did not die suddenly from arrhythmic causes. CHF patients will benefit from better tools to identify if ICD therapy is needed. Objective To identify predictor variables from baseline SCD-HeFT patients’ RR intervals that correlate to arrhythmic sudden cardiac death (SCD) and mortality and to design an ICD therapy screening test. Methods Ten predictor variables were extracted from pre-randomization Holter data from 475 patients enrolled in the SCD-HeFT ICD arm using novel and traditional heart rate variability methods. All variables were correlated to SCD using Mann Whitney-Wilcoxon test and receiver operating characteristic analysis. ICD therapy screening tests were designed by minimizing the cost of false classifications. Survival analysis, including log-rank test and Cox models, was also performed. Results α1 and α2 from detrended fluctuation analysis, the ratio of low to high frequency power, the number of PVCs per hour and heart rate turbulence slope are all statistically significant for predicting the occurrences of SCD (p<0.001) and survival (log-rank p<0.01). The most powerful multivariate predictor tool using the Cox Proportional Hazards was α2 with a hazard ratio of 0.0465 (95% CI: 0.00528 – 0.409, p<0.01). Conclusion Predictor variables from RR intervals correlate to the occurrences of SCD and distinguish survival among SCD-HeFT ICD patients. We believe SCD prediction models should incorporate Holter based RR interval analysis to refine ICD patient selection especially in removing patients who are unlikely to benefit from ICD therapy. PMID:26096609

  2. Hydatid Disease Involved in the Heart, Liver, and Kidney That Caused Sudden Death: Case Report.

    PubMed

    Daş, Taner; Özer, Mehmet; Yağmur, Gülhan; Yildirim, Muzaffer; Özgün, Ayşe; Demirel, Hüsrev

    2015-12-01

    Hydatid disease is a parasitic infestation caused by ingestion of eggs of echinococcal species. For Echinococcus granulosus, the definitive host is the dog, and sheeps are the usual intermediate hosts. Humans are accidental intermediate hosts, infected by ingestion of food contaminated with eggs shed by dogs or foxes. The most common organs that hydatid disease encountered are the liver and lungs. Involvement of the kidney is rare and usually accompanies the other organ involvements. Cardiac involvement of echinococcosis is also very rare. We report the case of a 31-year-old woman with a 6-year history of asthma who collapsed after strenuous activity and died despite the interventions carried out. At autopsy, cystic masses were detected in the apex of the heart, in the right kidney, and in the liver. There were no macroscopic pathologic findings in the other organs. Microscopic examination revealed the diagnosis of hydatid cyst in the heart, right kidney, and liver besides medial hypertrophy of the lung vessels. Cause of death was attributed to hydatid cyst and its complications. Patients who have symptoms akin to asthma at clinical presentation have to be further investigated for organic cardiac and pulmonary diseases such as hydatid cyst, especially in endemic countries.

  3. Medullary mediation of the laryngeal adductor reflex: A possible role in sudden infant death syndrome.

    PubMed

    Wang, Xiaolu; Guo, Ruichen; Zhao, Wenjing; Pilowsky, Paul M

    2016-06-01

    The laryngeal adductor reflex (LAR) is a laryngeal protective reflex. Vagal afferent polymodal sensory fibres that have cell bodies in the nodose ganglion, originate in the sub-glottal area of the larynx and upper trachea. These polymodal sensory fibres respond to mechanical or chemical stimuli. The central axons of these sensory vagal neurons terminate in the dorsolateral subnuclei of the tractus solitarius in the medulla oblongata. The LAR is a critical, reflex in the pathways that play a protective role in the process of ventilation, and the sychronisation of ventilation with other activities that are undertaken by the oropharyngeal systems including: eating, speaking and singing. Failure of the LAR to operate properly at any time after birth can lead to SIDS, pneumonia or death. Despite the critical nature of this reflex, very little is known about the central pathways and neurotransmitters involved in the management of the LAR and any disorders associated with its failure to act properly. Here, we review current knowledge concerning the medullary nuclei and neurochemicals involved in the LAR and propose a potential neural pathway that may facilitate future SIDS research.

  4. Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location - moving the discussion forward.

    PubMed

    Ball, Helen L; Volpe, Lane E

    2013-02-01

    The notion that infant sleep environments are 'good' or 'bad' and that parents who receive appropriate instruction will modify their infant-care habits has been fundamental to SIDS reduction campaigns. However infant sleep location recommendations have failed to emulate the previously successful infant sleep position campaigns that dramatically reduced infant deaths. In this paper we discuss the conflict between 'safeguarding' and 'well-being', contradictory messages, and rejected advice regarding infant sleep location. Following a summary of the relevant background literature we argue that bed-sharing is not a modifiable infant-care practice that can be influenced by risk-education and simple recommendations. We propose that differentiation between infant-care practices, parental behaviors, and cultural beliefs would assist in the development of risk-reduction interventions. Failure to recognize the importance of infant sleep location to ethnic and sub-cultural identity, has led to inappropriate and ineffective risk-reduction messages that are rejected by their target populations. Furthermore transfer of recommendations from one geographic or cultural setting to another without evaluation of variation within and between the origin and destination populations has led to inappropriate targeting of groups or behaviors. We present examples of how more detailed research and culturally-embedded interventions could reorient discussion around infant sleep location.

  5. Decreased serotonergic receptor binding in rhombic lip-derived regions of the medulla oblongata in the sudden infant death syndrome.

    PubMed

    Panigrahy, A; Filiano, J; Sleeper, L A; Mandell, F; Valdes-Dapena, M; Krous, H F; Rava, L A; Foley, E; White, W F; Kinney, H C

    2000-05-01

    The sudden infant death syndrome (SIDS) is postulated to result from a failure of homeostatic responses to life-threatening challenges (e.g. asphyxia, hypercapnia) during sleep. The ventral medulla participates in sleep-related homeostatic responses, including chemoreception, arousal, airway reflex control, thermoregulation, respiratory drive, and blood pressure regulation, in part via serotonin and its receptors. The ventral medulla in humans contains the arcuate nucleus, in which we have shown isolated defects in muscarinic and kainate receptor binding in SIDS victims. We also have demonstrated that the arcuate nucleus is anatomically linked to the nucleus raphé obscurus, a medullary region with serotonergic neurons. We tested the hypothesis that serotonergic receptor binding is decreased in both the arcuate nucleus and nucleus raphé obscurus in SIDS victims. Using quantitative autoradiography, 3H-lysergic acid diethylamide (3H-LSD binding) to serotonergic receptors (5-HT1A-D and 5-HT2 subtypes) was measured blinded in 19 brainstem nuclei. Cases were classified as SIDS (n = 52), acute controls (infants who died suddenly and in whom a complete autopsy established a cause of death) (n = 15), or chronic cases with oxygenation disorders (n = 17). Serotonergic binding was significantly lowered in the SIDS victims compared with controls in the arcuate nucleus (SIDS, 6 +/- 1 fmol/mg tissue; acutes, 19 +/- 1; and chronics, 16 +/- 1; p = 0.0001) and n. raphé obscurus (SIDS, 28 +/- 3 fmol/mg tissue; acutes, 66 +/- 6; and chronics, 59 +/- 1; p = 0.0001). Binding, however, was also significantly lower (p < 0.05) in 4 other regions that are integral parts of the medullary raphé/serotonergic system, and/or are derived, like the arcuate nucleus and nucleus raphé obscurus, from the same embryonic anlage (rhombic lip). These data suggest that a larger neuronal network than the arcuate nucleus alone is involved in the pathogenesis of SIDS, that is, a network composed of inter

  6. Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents' and professionals' experiences

    PubMed Central

    Griffiths, Frances; Sidebotham, Peter

    2016-01-01

    Objectives Improvements in our understanding of the role of modifiable risk factors for sudden infant death syndrome (SIDS) mean that previous reassurance to parents that these deaths were unpreventable may no longer be appropriate. This study aimed to learn of bereaved parents' and healthcare professionals' experiences of understanding causes of death following detailed sudden unexpected death in infancy (SUDI) investigations. The research questions were: How do bereaved parents understand the cause of death and risk factors identified during detailed investigation following a sudden unexpected infant death? What is the association between bereaved parents' mental health and this understanding? What are healthcare professionals' experiences of sharing such information with families? Design This was a mixed-methods study using a Framework Approach. Setting Specialist paediatric services. Participants Bereaved parents were recruited following detailed multiagency SUDI investigations; 21/113 eligible families and 27 professionals participated giving theoretical saturation of data. Data collection We analysed case records from all agencies, interviewed professionals and invited parents to complete the Hospital Anxiety and Depression Scale (HADS) and questionnaires or in-depth interviews. Results Nearly all bereaved parents were able to understand the cause of death and several SIDS parents had a good understanding of the relevant modifiable risk factors even when these related directly to their actions. Paediatricians worried that discussing risk factors with parents would result in parental self-blame and some deliberately avoided these discussions. Over half the families did not mention blame or blamed no one. The cause of death of the infants of these families varied. 3/21 mothers expressed overwhelming feelings of self-blame and had clinically significant scores on HADS. Conclusions Bereaved parents want detailed information about their child's death. Our study

  7. Recognition of medium-chain acyl-CoA dehydrogenase deficiency in asymptomatic siblings of children dying of sudden infant death or Reye-like syndromes.

    PubMed

    Roe, C R; Millington, D S; Maltby, D A; Kinnebrew, P

    1986-01-01

    The medium-chain acyl-CoA dehydrogenase (MCAD) deficiency of mitochondrial beta oxidation has been identified in two asymptomatic siblings in a family in which two previous deaths had been recorded, one attributed to sudden infant death syndrome and the other to Reye syndrome. Recognition of this disorder in one of the deceased and in the surviving siblings was accomplished by detection of a diagnostic metabolite, octanoylcarnitine, using a new mass spectrometric technique. This resulted in early treatment with L-carnitine supplement in the survivors, which should prevent metabolic deterioration. Further studies suggest that breast-feeding may be protective for infants with MCAD deficiency. Families with children who have had Reye syndrome or in which sudden infant death has occurred are at risk for MCAD deficiency. We suggest that survivors and asymptomatic siblings should be tested for this treatable disorder.

  8. The protective effect of immunisation against diphtheria, pertussis and tetanus (DPT) in relation to sudden infant death syndrome.

    PubMed

    Essery, S D; Raza, M W; Zorgani, A; MacKenzie, D A; James, V S; Weir, D M; Busuttil, A; Hallam, N; Blackwell, C

    1999-08-01

    Epidemiological evidence indicates infants immunised against diphtheria, pertussis and tetanus (DPT) are at decreased risk of sudden infant death syndrome (SIDS). Asymptomatic whooping cough and pyrogenic toxins of Staphylococcus aureus have been implicated in the aetiology of SIDS. The objectives of the present study were: (1) to determine if the DPT vaccine induced antibodies cross-reactive with the staphylococcal toxins; (2) to determine if antibodies to the pertussis toxin (PT) and the staphylococcal toxins were present in the sera of women during late pregnancy; (3) to examine the effects of infant immunisation on levels of antibodies to PT and the staphylococcal toxins; (4) to assess the effects of changes in immunisation schedules in the UK on the incidence and age distribution of SIDS. Enzyme-linked immunosorbent assays (ELISA) were used to measure binding of rabbit or human IgG to the DPT vaccine, PT, toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxins A (SEA), B (SEB) and C (SEC). Neutralisation activity of anti-DPT serum was assessed by a bioassay for induction of nitric oxide from human monocytes by the staphylococcal toxins. Anti-DPT serum bound to the DPT vaccine, PT and each of the staphylococcal toxins. It also reduced the ability of the four toxins to induce nitric oxide from monocytes. In pregnant women, levels of IgG to PT, SEC and TSST-1 decreased significantly in relation to increasing weeks of gestation while antibodies to SEA and SEB increased. In infants' sera there were significant correlations between levels of IgG bound to DPT and IgG bound to PT, TSST-1 and SEC but not SEA or SEB. Antibody levels to the toxins in infants declined with age; sera from infants < or = 2 months of age had higher levels of IgG bound to the toxins than those older than 2 months. This pattern was observed for infants whose immunisation schedules began at 2 months of age or 3 months of age. The decrease in IgG bound to the toxins was, however

  9. Induced Abortion

    MedlinePlus

    ... Education & Events Advocacy For Patients About ACOG Induced Abortion Home For Patients Search FAQs Induced Abortion Page ... Induced Abortion FAQ043, May 2015 PDF Format Induced Abortion Special Procedures What is an induced abortion? What ...

  10. Near-Universal Prevalence of Pneumocystis and Associated Increase in Mucus in the Lungs of Infants With Sudden Unexpected Death

    PubMed Central

    Vargas, Sergio L.; Ponce, Carolina A.; Gallo, Miriam; Pérez, Francisco; Astorga, J.-Felipe; Bustamante, Rebeca; Chabé, Magali; Durand-Joly, Isabelle; Iturra, Pablo; Miller, Robert F.; Aliouat, El Moukthar; Dei-Cas, Eduardo

    2013-01-01

    Background. Pneumocystis without obvious accompanying pathology is occasionally reported in autopsied infant lungs. Its prevalence and significance are unknown. Interestingly, this mild infection induces a strong activation of mucus secretion–related genes in young immunocompetent rodents that has not been explored in infants. Excess mucus is induced by multiple airway offenders through nonspecific pathways and would explain a cofactor role of Pneumocystis in respiratory disease. We undertook characterization of the prevalence of Pneumocystis and associated mucus in infant lungs. Methods. Samples from 128 infants (mean age, 101 days) who died suddenly and unexpectedly in Santiago during 1999–2004 were examined for Pneumocystis using nested polymerase chain reaction (nPCR) amplification of the P. jirovecii mtLSU ribosomal RNA gene and immunofluorescence microscopy (IF). Pneumocystis-negative infants 28 days and older and their age-closest positives were studied for MUC5AC expression and Pneumocystis burden by Western blot and quantitative PCR, respectively. Results. Pneumocystis DNA was detected by nPCR in 105 of the 128 infants (82.0%) and Pneumocystis organisms were visualized by IF in 99 (94.3%) of the DNA-positive infants. The infection was commonest at 3–4 months with 40 of 41 (97.6%) infants of that age testing positive. MUC5AC was significantly increased in Pneumocystis-positive tissue specimens (P = .013). Death was unexplained in 113 (88.3%) infants; Pneumocystis was detected in 95 (84.0%) of them vs 10 of 15 (66.7%) with explained death (P = .28). Conclusions. A highly focal Pneumocystis infection associated to increased mucus expression is almost universally present in the lungs of infants dying unexpectedly in the community regardless of autopsy diagnosis. PMID:23074306

  11. Use of remotely sensed imagery to map Sudden Oak Death (Phytophthora ramorum) in the Santa Cruz Mountains

    NASA Astrophysics Data System (ADS)

    Gillis, Trinka

    This project sought a method to map Sudden Oak Death distribution in the Santa Cruz Mountains of California, a coastal mountain range and one of the locations where this disease was first observed. The project researched a method to identify forest affected by SOD using 30 m multi-spectral Landsat satellite imagery to classify tree mortality at the canopy-level throughout the study area, and applied that method to a time series of data to show pattern of spread. A successful methodology would be of interest to scientists trying to identify areas which escaped disease contagion, environmentalists attempting to quantify damage, and land managers evaluating the health of their forests. The more we can learn about the disease, the more chance we have to prevent further spread and damage to existing wild lands. The primary data source for this research was springtime Landsat Climate Data Record surface reflectance data. Non-forest areas were masked out using data produced by the National Land Cover Database and supplemental land cover classification from the Landsat 2011 Climate Data Record image. Areas with other known causes of tree death, as identified by Fire and Resource Assessment Program fire perimeter polygons, and US Department of Agriculture Forest Health Monitoring Program Aerial Detection Survey polygons, were also masked out. Within the remaining forested study area, manually-created points were classified based on the land cover contained by the corresponding Landsat 2011 pixel. These were used to extract value ranges from the Landsat bands and calculated vegetation indices. The range and index which best differentiated healthy from dead trees, SWIR/NIR, was applied to each Landsat scene in the time series to map tree mortality. Results Validation Points, classified using Google Earth high-resolution aerial imagery, were created to evaluate the accuracy of the mapping methodology for the 2011 data.

  12. Pulmonary neuroendocrine cells and neuroepithelial bodies in sudden infant death syndrome: potential markers of airway chemoreceptor dysfunction.

    PubMed

    Cutz, Ernest; Perrin, Donald G; Pan, Jie; Haas, Elisabeth A; Krous, Henry F

    2007-01-01

    Pulmonary neuroendocrine cells (PNEC), including neuroepithelial bodies (NEB), are amine- and peptide (for example, bombesin)-producing cells that function as hypoxia/hypercapnia-sensitive chemoreceptors that could be involved in the pathophysiology of sudden infant death syndrome (SIDS). We assessed morphometrically the frequency and size of PNEC/NEB in lungs of infants who died of SIDS (n = 21) and compared them to an equal number PNEC/NEB in lungs of age-matched control infants who died of accidental death or homicide, with all cases obtained from the San Diego SIDS/SUDC Research Project database. As a marker for PNEC/NEB we used an antibody against chromogranin A (CGA), and computer-assisted morphometric analysis was employed to determine the relative frequency of PNEC per airway epithelial area (% immunostained area, %IMS), the size of NEB, the number of nuclei/NEB, and the size of the NEB cells. The lungs of SIDS infants showed significantly greater %IMS of airway epithelium (2.72 +/- 0.28 [standard error of the mean, SEM] versus 1.88 +/- 0.24; P < 0.05) and larger NEB (1557 +/- 153 microm(2) versus 1151 +/- 106 microm(2); P < 0.05) compared to control infants. The size of NEB cells was also significantly increased in SIDS cases compared to the controls (180 +/- 6.39 microm(2) versus 157 +/- 8.0 microm(2); P < 0.05), indicating the presence of hypertrophy in addition to hyperplasia. Our findings support previous studies demonstrating hyperplasia of PNEC/NEB in lungs of infants who died of SIDS. These changes could be secondary to chronic hypoxia and/or could be attributable to maturational delay. Morphometric assessment and/or measurement of the secretory products of these cells (for example, CGA, bombesin) could provide a potential biological marker for SIDS.

  13. Serotonin and sudden death: differential effects of serotonergic drugs on seizure-induced respiratory arrest in DBA/1 mice.

    PubMed

    Faingold, Carl L; Kommajosyula, Srinivasa P; Long, X; Plath, Kristin; Randall, Marcus

    2014-08-01

    In the DBA/1 mouse model of sudden unexpected death in epilepsy (SUDEP), administration of a selective serotonin (5-HT) reuptake inhibitor (SSRI), fluvoxamine, completely suppressed seizure-induced respiratory arrest (S-IRA) at 30 min after administration (i.p.) in a dose-related manner without blocking audiogenic seizures (AGSz), but another SSRI, paroxetine, reduced S-IRA but with a delayed (24 h) onset and significant toxicity. A serotonin-norepinephrine reuptake inhibitor, venlafaxine, reduced S-IRA incidence, but higher doses were ineffective. A selective 5-HT7 agonist, AS-19, was totally ineffective in reducing S-IRA. In developing DBA/1 mice that had not previously experienced AGSz, administration of a nonselective 5-HT antagonist, cyproheptadine, induced a significantly greater incidence of S-IRA than that of saline. This study confirms that certain drugs that enhance the activation of 5-HT receptors are able to prevent S-IRA, but not all serotonergic drugs are equally effective, which may be relevant to the potential use of these drugs for SUDEP prevention. Serotonergic antagonists may be problematic in patients with epilepsy.

  14. A re-audit of the use of definitions of sudden infant death syndrome (SIDS) in peer-reviewed literature.

    PubMed

    Byard, Roger W; Lee, Vivian

    2012-11-01

    The use of different definitions of sudden infant death syndrome (SIDS) may make comparison of data among studies difficult. Fifty randomly selected papers dealing with SIDS that were published between 2010 and 2011 in peer-reviewed journals were reviewed to determine whether one of three internationally accepted definitions of SIDS had been either written in the text or referenced. A significant improvement in the use of definitions has occurred since 2005, with the percentage of papers either quoting or referencing a standard definition increasing by 26%, from 42 to 68%. The 1989 NICHD definition remained the most commonly used definition (35.1%) followed by the 2004 San Diego definition (26.3%). Although the percentage of papers where either no definition was provided or where an idiosyncratic or mis-cited definition was used fell 26%, from 58 to 32%, nearly one in three papers published on SIDS in peer-reviewed journals that were included in this study still did not cite a standard definition.

  15. Development and application of human virtual excitable tissues and organs: from premature birth to sudden cardiac death.

    PubMed

    Holden, Arun V

    2010-12-01

    The electrical activity of cardiac and uterine tissues has been reconstructed by detailed computer models in the form of virtual tissues. Virtual tissues are biophysically and anatomically detailed, and represent quantitatively predictive models of the physiological and pathophysiological behaviours of tissue within an isolated organ. The cell excitation properties are quantitatively reproduced by equations that describe the kinetics of a few dozen proteins. These equations are derived from experimental measurements of membrane potentials, ionic currents, fluxes, and concentrations. Some of the measurements were taken from human cells and human ion channel proteins expressed in non-human cells, but they were mostly taken from cells of other animal species. Data on tissue geometry and architecture are obtained from the diffusion tensor magnetic resonance imaging of ex vivo or post mortem tissue, and are used to compute the spread of current in the tissue. Cardiac virtual tissues are well established and reproduce normal and pathological patterns of cardiac excitation within the atria or ventricles of the human heart. They have been applied to increase the understanding of normal cardiac electrophysiology, to evaluate the candidate mechanisms for re-entrant arrhythmias that lead to sudden cardiac death, and to predict the tissue level effects of mutant or pharmacologically-modified ion channels. The human full-term virtual uterus is still in development. This virtual tissue reproduces the in vitro behaviour of uterine tissue biopsies, and provides possible mechanisms for premature labour.

  16. Impact of a simulated pathogen attack (Sudden Oak Death) on soil carbon storage in a northern temperate deciduous forest

    NASA Astrophysics Data System (ADS)

    Levy, J.; Schuster, W. S.; Griffin, K. L.

    2011-12-01

    The goal of this study was to identify the short-term impact of a mimicked pathogen attack (Sudden Oak Death) on soil carbon stocks in a northeastern forest. Tree girdling was used to simulate the attack and trees were girdled according to five treatments: control (C), girdling all non-oaks on a plot (NO), girdling half of the oak trees on a plot (O50), girdling all the oaks on the plot (OG), and girdling all trees on a plot (ALL). Forest floor litter and soil organic carbon (SOC) at depth intervals of 0-3, 3-6, 6-9, 9-15 and 15-30cm were measured three years after girdling. We found no changes across treatments in the forest floor litter carbon, total soil organic carbon, or carbon concentration through the profile. Contrary to a recently proposed hypothesis, our study does not support a short- term decline in the belowground carbon storage following a pest or pathogen attack. We propose that shifts in the source components of carbon within the belowground carbon pool could offset carbon losses resulting from altered decomposition rates.

  17. Serotonin Metabolites in the Cerebrospinal Fluid in the Sudden Infant Death Syndrome: In Search of a Biomarker of Risk

    PubMed Central

    Rognum, Ingvar J.; Tran, Hoa; Haas, Elisabeth A.; Hyland, Keith; Paterson, David S.; Haynes, Robin L.; Broadbelt, Kevin G.; Harty, Brian J.; Mena, Othon; Krous, Henry F.; Kinney, Hannah C.

    2015-01-01

    Clinical biomarkers are urgently needed in the sudden infant death syndrome (SIDS) to identify living infants at risk because it because it occurs without occurs without clinical warning. Previously, we reported multiple serotonergic (5-HT) abnormalities in nuclei of the medulla oblongata that help mediate protective responses to homeostatic stressors. Here we test the hypothesis that 5-HT-related measures are abnormal in the cerebrospinal fluid (CSF) of SIDS infants compared to autopsy controls, as a first step towards their assessment as diagnostic biomarkers of medullary pathology. Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), the degradative products of 5-HT and dopamine, respectively, were measured by high performance liquid chromatography in 57 SIDS and 29 non-SIDS autopsy cases. Tryptophan (Trp) and tyrosine (Tyr), the substrates of 5-HT and dopamine, respectively, were also measured. There were no significant differences in 5-HIAA, Trp, HVA, or Tyr levels between the SIDS and non-SIDS groups. These data preclude use of 5-HIAA, HVA, Trp or Tyr measurements as CSF biomarkers of 5-HT medullary pathology in infants at risk. They provide, however, important information about monoaminergic measurements in human CSF at autopsy and their developmental profile in infancy that is applicable to multiple pediatric disorders beyond SIDS. PMID:24423636

  18. Identification of Fusarium virguliforme FvTox1-Interacting Synthetic Peptides for Enhancing Foliar Sudden Death Syndrome Resistance in Soybean

    PubMed Central

    Wang, Bing; Swaminathan, Sivakumar; Bhattacharyya, Madan K.

    2015-01-01

    Soybean is one of the most important crops grown across the globe. In the United States, approximately 15% of the soybean yield is suppressed due to various pathogen and pests attack. Sudden death syndrome (SDS) is an emerging fungal disease caused by Fusarium virguliforme. Although growing SDS resistant soybean cultivars has been the main method of controlling this disease, SDS resistance is partial and controlled by a large number of quantitative trait loci (QTL). A proteinacious toxin, FvTox1, produced by the pathogen, causes foliar SDS. Earlier, we demonstrated that expression of an anti-FvTox1 single chain variable fragment antibody resulted in reduced foliar SDS development in transgenic soybean plants. Here, we investigated if synthetic FvTox1-interacting peptides, displayed on M13 phage particles, can be identified for enhancing foliar SDS resistance in soybean. We screened three phage-display peptide libraries and discovered four classes of M13 phage clones displaying FvTox1-interacting peptides. In vitro pull-down assays and in vivo interaction assays in yeast were conducted to confirm the interaction of FvTox1 with these four synthetic peptides and their fusion-combinations. One of these peptides was able to partially neutralize the toxic effect of FvTox1 in vitro. Possible application of the synthetic peptides in engineering SDS resistance soybean cultivars is discussed. PMID:26709700

  19. Expression of brain-derived neurotrophic factor and TrkB receptor in the sudden infant death syndrome brainstem.

    PubMed

    Tang, Samantha; Machaalani, Rita; Waters, Karen A

    2012-01-15

    This study compared the expression of BDNF (proBDNF and rhBDNF forms) and its receptor TrkB, in the medulla of sudden infant death syndrome (SIDS) infants and infants who died from known causes (non-SIDS). This study also evaluated these markers in association with SIDS clinical risk factors including, sleep position, cigarette smoke exposure and gender. Brainstem tissue was immunohistochemically stained and quantitative analyses were made for eight nuclei of the caudal and rostral medulla. Compared to non-SIDS, SIDS infants had lower rhBDNF in the caudal nucleus of the solitary tract and higher TrkB in the caudal dorsal motor nucleus of the vagus. Within the SIDS cohort, prone sleep position was associated with lower rhBDNF in the caudal arcuate nucleus, and cigarette smoke exposure was associated with lower rhBDNF and TrkB in the inferior olivary nucleus. Abnormal expression of BDNF and TrkB suggests that neuroprotective functions of the BDNF/TrkB system may be reduced in respiratory-related nuclei of SIDS infants.

  20. Lack of Association of the Serotonin Transporter Polymorphism With the Sudden Infant Death Syndrome in the San Diego Dataset

    PubMed Central

    Paterson, David S.; Rivera, Keith D.; Broadbelt, Kevin G.; Trachtenberg, Felicia L.; Belliveau, Richard A.; Holm, Ingrid A.; Haas, Elisabeth A.; Stanley, Christina; Krous, Henry F.; Kinney, Hannah C.; Markianos, Kyriacos

    2011-01-01

    Dysfunction of medullary serotonin (5-HT)-mediated respiratory and autonomic function is postulated to underlie the pathogenesis of the majority of sudden infant death syndrome (SIDS) cases. Several studies have reported an increased frequency of the LL genotype and L allele of the 5-HT transporter (5-HTT) gene promoter polymorphism (5-HTTLPR), which is associated with increased transcriptional activity and 5-HT transport in vitro, in SIDS cases compared with controls. These findings raise the possibility that this polymorphism contributes to or exacerbates existing medullary 5-HT dysfunction in SIDS. In this study, we tested the hypothesis that the frequency of LL genotype and L allele are higher in 179 SIDS cases compared with 139 controls of multiple ethnicities in the San Diego SIDS Dataset. We observed no significant association of genotype or allele with SIDS cases either in the total cohort or on stratification for ethnicity. These observations do not support previous findings that the L allele and/or LL genotype of the 5-HTTLPR are associated with SIDS. PMID:20661167

  1. Sudden death in epileptic rats exposed to nocturnal magnetic fields that simulate the shape and the intensity of sudden changes in geomagnetic activity: an experiment in response to Schnabel, Beblo and May

    NASA Astrophysics Data System (ADS)

    Persinger, M. A.; McKay, B. E.; O'Donovan, C. A.; Koren, S. A.

    2005-03-01

    To test the hypothesis that sudden unexplained death (SUD) in some epileptic patients is related to geomagnetic activity we exposed rats in which limbic epilepsy had been induced to experimentally produced magnetic fields designed to simulate sudden storm commencements (SSCs). Prior studies with rats had shown that sudden death in groups of rats in which epilepsy had been induced months earlier was associated with the occurrence of SSCs and increased geomagnetic activity during the previous night. Schnabel et al. [(2000) Neurology 54:903 908) found no relationship between SUD in human patients and geomagnetic activity. A total of 96 rats were exposed to either 500, 50, 10 40 nT or sham (less than 10 nT) magnetic fields for 6 min every hour between midnight and 0800 hours (local time) for three successive nights. The shape of the complex, amplitude-modulated magnetic fields simulated the shape and structure of an average SSC. The rats were then seized with lithium and pilocarpine and the mortality was monitored. Whereas 10% of the rats that had been exposed to the sham field died within 24 h, 60% of the rats that had been exposed to the experimental magnetic fields simulating natural geomagnetic activity died (P<.001) during this period. These results suggest that correlational analyses between SUD in epileptic patients and increased geomagnetic activity can be simulated experimentally in epileptic rats and that potential mechanisms might be testable directly.

  2. Differences in African-American Maternal Self-Efficacy Regarding Practices Impacting Risk for Sudden Infant Death.

    PubMed

    Mathews, Anita; Oden, Rosalind; Joyner, Brandi; He, Jianping; McCarter, Robert; Moon, Rachel Y

    2016-04-01

    Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths, including accidental suffocation, account for ~4000 US deaths annually. Parents may have higher self-efficacy with regards to preventing accidental suffocation than SIDS. The objective of this study was to assess self-efficacy in African-American mothers with regards to safe sleep practices and risk for SIDS and accidental suffocation. As part of randomized clinical trial in African-American mothers of newborn infants, mothers completed a baseline survey about knowledge of and attitudes towards safe sleep recommendations, current intent, self-efficacy, and demographics. Tabular and adjusted, regression-based analyses of these cross-sectional data evaluated the impact of the message target (SIDS risk reduction vs. suffocation prevention) on perceived self-efficacy. 1194 mothers were interviewed. Mean infant age was 1.5 days. 90.8 % of mothers planned to place their infant supine, 96.7 % stated that their infant would sleep in the same room, 3.6 % planned to bedshare with the infant, and 72.9 % intended to have soft bedding in the crib. Mothers were more likely to believe that prone placement (70.9 vs. 50.5 %, p < 0.001), bedsharing (73.5 vs. 50.1 %, p < 0.001), and having soft bedding in the sleep area (78.3 vs. 59.5 %, p < 0.001) increased their infant's risk for suffocation than it did for SIDS. Mothers had higher self-efficacy, viz. increased confidence that their actions could keep their infant safe, with regards to suffocation than SIDS (88.0 vs. 79.4 %, p < 0.001). These differences remained significant when controlled for sociodemographics, grandmother in home, number of people in home, and breastfeeding intention. Maternal self-efficacy is higher with regards to prevention of accidental suffocation in African-Americans, regardless of sociodemographics. Healthcare professionals should discuss both SIDS risk reduction and prevention of accidental suffocation when advising African

  3. Sudden Infant Death Syndrome

    MedlinePlus

    ... are awake and someone is watching Having your baby sleep in your room for at least the first ... soft objects and loose bedding away from your baby's sleep area Breastfeeding your baby Making sure that your ...

  4. [Forensic medical expertise of sudden cardiac death from alcoholic cardiomyopathy in the subjects having a low ethanol concentration in the blood and urine].

    PubMed

    Sokolova, O V; Petrova, Yu A

    2015-01-01

    The objective of the present study was to evaluate the cases of sudden cardiac death from alcoholic cardiomyopathy of the subjects having a low ethanol concentration in the blood and urine; the second objective was the statistical analysis of the data thus obtained. It was shown that sudden cardiac death from alcoholic cardiomyopathy occurs in the men more frequently than in the women despite rather low ethanol levels in the blood and urine of both genders or even in the cases of complete absence of ethanol in these fluids. It is concluded that ethanol concentration in the blood and urine of the subjects who died from the alcohol-induced heart injury depends on their age and sex.

  5. Usefulness of Cardiac Sympathetic Nerve Imaging Using (123)Iodine-Metaiodobenzylguanidine Scintigraphy for Predicting Sudden Cardiac Death in Patients With Heart Failure.

    PubMed

    Kasama, Shu; Toyama, Takuji; Kurabayashi, Masahiko

    2016-01-01

    The autonomic nervous system plays an important role in the human heart. Activation of the cardiac sympathetic nervous system is a cardinal pathophysiological abnormality associated with the failing human heart. Myocardial imaging using (123)I-metaiodobenzylguanidine (MIBG), an analog of norepinephrine, can be used to investigate the activity of norepinephrine, the predominant neurotransmitter of the sympathetic nervous system. Many clinical trials have demonstrated that (123)I-MIBG scintigraphic parameters predict cardiac adverse events, especially sudden cardiac death, in patients with heart failure. In this review, we summarize results from published studies that have focused on the use of cardiac sympathetic nerve imaging using (123)I-MIBG scintigraphy for risk stratification of sudden cardiac death in patients with heart failure.

  6. Computational cardiology and risk stratification for sudden cardiac death: one of the grand challenges for cardiology in the 21st century.

    PubMed

    Hill, Adam P; Perry, Matthew D; Abi-Gerges, Najah; Couderc, Jean-Philippe; Fermini, Bernard; Hancox, Jules C; Knollmann, Bjorn C; Mirams, Gary R; Skinner, Jon; Zareba, Wojciech; Vandenberg, Jamie I

    2016-12-01

    Risk stratification in the context of sudden cardiac death has been acknowledged as one of the major challenges facing cardiology for the past four decades. In recent years, the advent of high performance computing has facilitated organ-level simulation of the heart, meaning we can now examine the causes, mechanisms and impact of cardiac dysfunction in silico. As a result, computational cardiology, largely driven by the Physiome project, now stands at the threshold of clinical utility in regards to risk stratification and treatment of patients at risk of sudden cardiac death. In this white paper, we outline a roadmap of what needs to be done to make this translational step, using the relatively well-developed case of acquired or drug-induced long QT syndrome as an exemplar case.

  7. Patient-centred care of patients with ventricular arrhythmias and risk of sudden cardiac death: What do the 2015 European Society of Cardiology guidelines add?

    PubMed

    Norekvål, Tone M; Kirchhof, Paulus; Fitzsimons, Donna

    2017-03-01

    Nurses and allied professionals are at the forefront of care delivery in patients with arrythmogenic risk and have a responsibility to deliver care that is focused on their individual needs. The 2015 European Society of Cardiology guideline on prevention of ventricular arrhythmia and sudden cardiac death heralds a step-change in patient and family focus and interdisciplinary involvement. This development reflects a recognition within the European Society of Cardiology that chronic care of patients with cardiovascular conditions can be improved by involving all stakeholders, making use of multidisciplinary interventions, and placing the patient at the centre of the care process. In this article, taskforce contributors discuss the latest evidence and highlight some of the most pertinent issues for nurses involved in patient-centred care of patients and families with ventricular arrhythmias and/or risk of sudden death.

  8. Computational cardiology and risk stratification for sudden cardiac death: one of the grand challenges for cardiology in the 21st century

    PubMed Central

    Perry, Matthew D.; Abi‐Gerges, Najah; Couderc, Jean‐Philippe; Fermini, Bernard; Hancox, Jules C.; Knollmann, Bjorn C.; Mirams, Gary R.; Skinner, Jon; Zareba, Wojciech; Vandenberg, Jamie I.

    2016-01-01

    Abstract Risk stratification in the context of sudden cardiac death has been acknowledged as one of the major challenges facing cardiology for the past four decades. In recent years, the advent of high performance computing has facilitated organ‐level simulation of the heart, meaning we can now examine the causes, mechanisms and impact of cardiac dysfunction in silico. As a result, computational cardiology, largely driven by the Physiome project, now stands at the threshold of clinical utility in regards to risk stratification and treatment of patients at risk of sudden cardiac death. In this white paper, we outline a roadmap of what needs to be done to make this translational step, using the relatively well‐developed case of acquired or drug‐induced long QT syndrome as an exemplar case. PMID:27060987

  9. Animal models used to test the interactions between infectious agents and products of cigarette smoked implicated in sudden infant death syndrome.

    PubMed

    Sayers, N M; Drucker, D B

    1999-08-01

    Animal test systems are reviewed that have relevance to sudden infant death syndrome (SIDS) are reviewed. These test interactions between infectious agents (or their toxins) and products of cigarette smoke. Infectious agents implicated in SIDS include members of the enterobacteria and clostridia, Staphylococcus aureus and Streptococcus pyogenes. Smoking is thought to be the single most preventable cause of SIDS. Tobacco smoke contains many extremely toxic products including cyanide and nicotine. Many animal test systems are available to examine the potency of bacterial toxins and smoke-derived components. These include mice, hamsters, rats and chick embryos. Such systems reveal synergy between bacterial toxins, especially endotoxin and superantigens. They have also demonstrated potentiation of low levels of bacterial toxin by low levels of both nicotine and its primary metabolite, cotinine. These findings suggest a possible causal explanation for the fact that passive exposure to cigarette smoke is a risk factor in sudden infant death syndrome.

  10. Abortion in Indonesia.

    PubMed

    Sedgh, Gilda; Ball, Haley

    2008-09-01

    Each year in Indonesia, millions of women become pregnant unintentionally, and many choose to end their pregnancies, despite the fact that abortion is generally illegal. Like their counterparts in many developing countries where abortion is stigmatized and highly restricted, Indonesian women often seek clandestine procedures performed by untrained providers, and resort to methods that include ingesting unsafe substances and undergoing harmful abortive massage. Though reliable evidence does not exist, researchers estimate that about two million induced abortions occur each year in the country and that deaths from unsafe abortion represent 14-16% of all maternal deaths in Southeast Asia. Preventing unsafe abortion is imperative if Indonesia is to achieve the fifth Millennium Development Goal of improving maternal health and reducing maternal mortality. Current Indonesian abortion law is based on a national health bill passed in 1992. Though the language on abortion was vague, it is generally accepted that the law allows abortion only if the woman provides confirmation from a doctor that her pregnancy is life-threatening, a letter of consent from her husband or a family member, a positive pregnancy test result and a statement guaranteeing that she will practice contraception afterwards. This report presents what is currently known about abortion in Indonesia. The findings are derived primarily from small-scale, urban, clinic-based studies of women's experiences with abortion. Some studies included women in rural areas and those who sought abortions outside of clinics, but none were nationally representative. Although these studies do not give a full picture of who is obtaining abortions in Indonesia or what their experiences are, the evidence suggests that abortion is a common occurrence in the country and that the conditions under which abortion takes place are often unsafe.

  11. Landscape Epidemiology and Control of Pathogens with Cryptic and Long-Distance Dispersal: Sudden Oak Death in Northern Californian Forests

    PubMed Central

    Filipe, João A. N.; Cobb, Richard C.; Meentemeyer, Ross K.; Lee, Christopher A.; Valachovic, Yana S.; Cook, Alex R.; Rizzo, David M.; Gilligan, Christopher A.

    2012-01-01

    Exotic pathogens and pests threaten ecosystem service, biodiversity, and crop security globally. If an invasive agent can disperse asymptomatically over long distances, multiple spatial and temporal scales interplay, making identification of effective strategies to regulate, monitor, and control disease extremely difficult. The management of outbreaks is also challenged by limited data on the actual area infested and the dynamics of spatial spread, due to financial, technological, or social constraints. We examine principles of landscape epidemiology important in designing policy to prevent or slow invasion by such organisms, and use Phytophthora ramorum, the cause of sudden oak death, to illustrate how shortfalls in their understanding can render management applications inappropriate. This pathogen has invaded forests in coastal California, USA, and an isolated but fast-growing epidemic focus in northern California (Humboldt County) has the potential for extensive spread. The risk of spread is enhanced by the pathogen's generalist nature and survival. Additionally, the extent of cryptic infection is unknown due to limited surveying resources and access to private land. Here, we use an epidemiological model for transmission in heterogeneous landscapes and Bayesian Markov-chain-Monte-Carlo inference to estimate dispersal and life-cycle parameters of P. ramorum and forecast the distribution of infection and speed of the epidemic front in Humboldt County. We assess the viability of management options for containing the pathogen's northern spread and local impacts. Implementing a stand-alone host-free “barrier” had limited efficacy due to long-distance dispersal, but combining curative with preventive treatments ahead of the front reduced local damage and contained spread. While the large size of this focus makes effective control expensive, early synchronous treatment in newly-identified disease foci should be more cost-effective. We show how the successful

  12. Cost-effectiveness of Project ADAM: a project to prevent sudden cardiac death in high school students.

    PubMed

    Berger, S; Whitstone, B N; Frisbee, S J; Miner, J T; Dhala, A; Pirrallo, R G; Utech, L M; Sachdeva, R C

    2004-01-01

    Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.

  13. Prenatal nicotine-exposure alters fetal autonomic activity and medullary neurotransmitter receptors: implications for sudden infant death syndrome.

    PubMed

    Duncan, Jhodie R; Garland, Marianne; Myers, Michael M; Fifer, William P; Yang, May; Kinney, Hannah C; Stark, Raymond I

    2009-11-01

    During pregnancy, exposure to nicotine and other compounds in cigarette smoke increases the risk of the sudden infant death syndrome (SIDS) two- to fivefold. Serotonergic (5-HT) abnormalities are found, in infants who die of SIDS, in regions of the medulla oblongata known to modulate cardiorespiratory function. Using a baboon model, we tested the hypothesis that prenatal exposure to nicotine alters 5-HT receptor and/or transporter binding in the fetal medullary 5-HT system in association with cardiorespiratory dysfunction. At 87 (mean) days gestation (dg), mothers were continuously infused with saline (n = 5) or nicotine (n = 5) at 0.5 mg/h. Fetuses were surgically instrumented at 129 dg for cardiorespiratory monitoring. Cesarean section delivery and retrieval of fetal medulla were performed at 161 (mean) dg for autoradiographic analyses of nicotinic and 5-HT receptor and transporter binding. In nicotine-exposed fetuses, high-frequency heart rate variability was increased 55%, possibly reflecting increases in the parasympathetic control of heart rate. This effect was more pronounced with greater levels of fetal breathing and age. These changes in heart rate variability were associated with increased 5-HT(1A) receptor binding in the raphé obscurus (P = 0.04) and increased nicotinic receptor binding in the raphé obscurus and vagal complex (P < 0.05) in the nicotine-exposed animals compared with controls (n = 6). The shift in autonomic balance in the fetal primate toward parasympathetic predominance with chronic exposure to nicotine may be related, in part, to abnormal 5-HT-nicotine alterations in the raphé obscurus. Thus increased risk for SIDS due to maternal smoking may be partly related to the effects of nicotine on 5-HT and/or nicotinic receptors.

  14. Undetected cardiac lesions cause unexpected sudden cardiac death during occasional sport activity. A report of 80 cases.

    PubMed

    Tabib, A; Miras, A; Taniere, P; Loire, R

    1999-06-01

    The retrospective analysis of 1500 forensic autopsies after sudden cardiac death showed that 80 (77 men, three women) had died following sport, for which they had been inadequately trained. The chosen sport (both dynamic and static), and the cardiac pathology discovered during autopsy make it possible to divide the population into two groups. Group 1 were those under 30 years of age (27 cases) engaged in jogging, gymnastics, rugby, tennis and boxing who suffered from hypertrophic cardiomyopathy (29.6%), arrhythmogenic right ventricular cardiomyopathy (25.9%), non-atherosclerotic (14. 8%), aortic stenosis (7.4%), atrial septal defect (3.7%), stenosing coronary atherosclerosis (3.7%), and structural abnormalities of the His bundle (3.7%). Group 2 were those over 30 years of age (53 cases), engaged in swimming, cycling, jogging and football. The cardiac lesions responsible were stenosing atherosclerotic coronary disease (49%), non-atherosclerotic coronary disease (1.8%), hypertrophic cardiomyopathy (20%), obstructive cardiomyopathy (4.8%), structural abnormalities of the His bundle (7.4%), myocardic bruise scar (4%), and arrhythmogenic right ventricular cardiomyopathy (3. 7%). In both groups, dilated cardiomyopathy occurred with identical frequency (11%).Conclusions The lesions discovered are the same as those identified in professional athletes, when the body tries to avoid mortal rhythmic decompensation in the case of an over-loading volume and tension during an ill-adapted effort. Forensic autopsy should establish these anomalies because the transmissible genetic characteristics of some of them could underline the need for check-ups in other members of the family.

  15. Contributions of Fusarium virguliforme and Heterodera glycines to the Disease Complex of Sudden Death Syndrome of Soybean

    PubMed Central

    Westphal, Andreas; Li, Chunge; Xing, Lijuan; McKay, Alan; Malvick, Dean

    2014-01-01

    Background Sudden death syndrome (SDS) of soybean caused by Fusarium virguliforme spreads and reduces soybean yields through the North Central region of the U.S. The fungal pathogen and Heterodera glycines are difficult to manage. Methodology/Principal Findings The objective was to determine the contributions of H. glycines and F. virguliforme to SDS severity and effects on soybean yield. To quantify DNA of F. virguliforme in soybean roots and soil, a specific real time qPCR assay was developed. The assay was used on materials from soybean field microplots that contained in a four-factor factorial-design: (i) untreated or methyl bromide-fumigated; (ii) non-infested or infested with F. virguliforme; (iii) non-infested or infested with H. glycines; (iv) natural precipitation or additional weekly watering. In years 2 and 3 of the trial, soil and watering treatments were maintained. Roots of soybean ‘Williams 82’ were collected for necrosis ratings at the full seed growth stage R6. Foliar symptoms of SDS (area under the disease progress curve, AUDPC), root necrosis, and seed yield parameters were related to population densities of H. glycines and the relative DNA concentrations of F. virguliforme in the roots and soil. The specific and sensitive real time qPCR was used. Data from microplots were introduced into models of AUDPC, root necrosis, and seed yield parameters with the frequency of H. glycines and F. virguliforme, and among each other. The models confirmed the close interrelationship of H. glycines with the development of SDS, and allowed for predictions of disease risk based on populations of these two pathogens in soil. Conclusions/Significance The results modeled the synergistic interaction between H. glycines and F. virguliforme quantitatively in previously infested field plots and explained previous findings of their interaction. Under these conditions, F. virguliforme was mildly aggressive and depended on infection of H. glycines to cause highly

  16. Prenatal nicotine-exposure alters fetal autonomic activity and medullary neurotransmitter receptors: implications for sudden infant death syndrome

    PubMed Central

    Duncan, Jhodie R.; Garland, Marianne; Myers, Michael M.; Fifer, William P.; Yang, May; Stark, Raymond I.

    2009-01-01

    During pregnancy, exposure to nicotine and other compounds in cigarette smoke increases the risk of the sudden infant death syndrome (SIDS) two- to fivefold. Serotonergic (5-HT) abnormalities are found, in infants who die of SIDS, in regions of the medulla oblongata known to modulate cardiorespiratory function. Using a baboon model, we tested the hypothesis that prenatal exposure to nicotine alters 5-HT receptor and/or transporter binding in the fetal medullary 5-HT system in association with cardiorespiratory dysfunction. At 87 (mean) days gestation (dg), mothers were continuously infused with saline (n = 5) or nicotine (n = 5) at 0.5 mg/h. Fetuses were surgically instrumented at 129 dg for cardiorespiratory monitoring. Cesarean section delivery and retrieval of fetal medulla were performed at 161 (mean) dg for autoradiographic analyses of nicotinic and 5-HT receptor and transporter binding. In nicotine-exposed fetuses, high-frequency heart rate variability was increased 55%, possibly reflecting increases in the parasympathetic control of heart rate. This effect was more pronounced with greater levels of fetal breathing and age. These changes in heart rate variability were associated with increased 5-HT1A receptor binding in the raphé obscurus (P = 0.04) and increased nicotinic receptor binding in the raphé obscurus and vagal complex (P < 0.05) in the nicotine-exposed animals compared with controls (n = 6). The shift in autonomic balance in the fetal primate toward parasympathetic predominance with chronic exposure to nicotine may be related, in part, to abnormal 5-HT-nicotine alterations in the raphé obscurus. Thus increased risk for SIDS due to maternal smoking may be partly related to the effects of nicotine on 5-HT and/or nicotinic receptors. PMID:19729586

  17. Acute hemorrhagic myocardial necrosis and sudden death of rats exposed to a combination of ephedrine and caffeine.

    PubMed

    Nyska, Abraham; Murphy, Elizabeth; Foley, Julie F; Collins, Bradley J; Petranka, John; Howden, Reuben; Hanlon, Paul; Dunnick, June K

    2005-02-01

    Because of possible side effects of herbal medicines containing ephedrine and guarana-derived caffeine, including increased risk of stroke, myocardial infarction, and sudden death, the Food and Drug Administration recently banned the sale of ephedra-containing products, specifically over-the-counter dietary supplements. We report cardiac in 7- and 14-week-old male F344 rats exposed by gavage to ephedrine(25 mg/kg) and caffeine (30 mg/kg) administered in combination for one or two days. The ephedrine-caffeine dosage was approximately 12- and 1.4-fold, respectively, above average human exposure, based on a mg/m2 body surface-area comparison. Several (5/7) of the exposed 14-week-old rats died or were sacrificed in extremis 4-5 h after the first dosing. In these hearts, changes were observed chiefly in the interventricular septum but also left and right ventricular walls. Massive interstitial hemorrhage, with degeneration of myofibers, occurred at the subendocardial myocardium of the left ventricle and interventricular septum. Immunostaining for cleaved caspase-3 and hyperphosphorylated H2A.X, a histone variant that becomes hyperphosphorylated during apoptosis, indicated multifocal generalized positive staining of degenerating myofibers and fragmenting nuclei, respectively. The Barbeito-Lopez trichrome stain revealed generalized patchy yellow myofibers consistent with degeneration and/or coagulative necrosis. In ephedrine-caffeine-treated animals terminated after the second dosing, foci of myocardial degeneration and necrosis were already infiltrated by mixed inflammatory cells. The myocardial necrosis may occur secondarily to intense diffuse vasoconstriction of the coronary arterial system with decreased myocardial perfusion. Our work shows the direct relationship between combined ephedrine and caffeine exposure and cardiac pathology.

  18. The Alteration of Neonatal Raphe Neurons by Prenatal-Perinatal Nicotine. Meaning for Sudden Infant Death Syndrome.

    PubMed

    Cerpa, Verónica J; Aylwin, María de la Luz O; Beltrán-Castillo, Sebastián; Bravo, Eduardo U; Llona, Isabel R; Richerson, George B; Eugenín, Jaime L

    2015-10-01

    Nicotine may link maternal cigarette smoking with respiratory dysfunctions in sudden infant death syndrome (SIDS). Prenatal-perinatal nicotine exposure blunts ventilatory responses to hypercapnia and reduces central respiratory chemoreception in mouse neonates at Postnatal Days 0 (P0) to P3. This suggests that raphe neurons, which are altered in SIDS and contribute to central respiratory chemoreception, may be affected by nicotine. We therefore investigated whether prenatal-perinatal nicotine exposure affects the activity, electrical properties, and chemosensitivity of raphe obscurus (ROb) neurons in mouse neonates. Osmotic minipumps, implanted subcutaneously in 5- to 7-day-pregnant CF1 mice, delivered nicotine bitartrate (60 mg kg(-1) d(-1)) or saline (control) for up to 28 days. In neonates, ventilation was recorded by head-out plethysmography, c-Fos (neuronal activity marker), or serotonin autoreceptors (5HT1AR) were immunodetected using light microscopy, and patch-clamp recordings were made from raphe neurons in brainstem slices under normocarbia and hypercarbia. Prenatal-perinatal nicotine exposure decreased the hypercarbia-induced ventilatory responses at P1-P5, reduced both the number of c-Fos-positive ROb neurons during eucapnic normoxia at P1-P3 and their hypercapnia-induced recruitment at P3, increased 5HT1AR immunolabeling of ROb neurons at P3-P5, and reduced the spontaneous firing frequency of ROb neurons at P3 without affecting their CO2 sensitivity or their passive and active electrical properties. These findings reveal that prenatal-perinatal nicotine reduces the activity of neonatal ROb neurons, likely as a consequence of increased expression of 5HT1ARs. This hypoactivity may change the functional state of the respiratory neural network leading to breathing vulnerability and chemosensory failure as seen in SIDS.

  19. iASPP, a previously unidentified regulator of desmosomes, prevents arrhythmogenic right ventricular cardiomyopathy (ARVC)-induced sudden death.

    PubMed

    Notari, Mario; Hu, Ying; Sutendra, Gopinath; Dedeić, Zinaida; Lu, Min; Dupays, Laurent; Yavari, Arash; Carr, Carolyn A; Zhong, Shan; Opel, Aaisha; Tinker, Andrew; Clarke, Kieran; Watkins, Hugh; Ferguson, David J P; Kelsell, David P; de Noronha, Sofia; Sheppard, Mary N; Hollinshead, Mike; Mohun, Timothy J; Lu, Xin

    2015-03-03

    Desmosomes are anchoring junctions that exist in cells that endure physical stress such as cardiac myocytes. The importance of desmosomes in maintaining the homeostasis of the myocardium is underscored by frequent mutations of desmosome components found in human patients and animal models. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a phenotype caused by mutations in desmosomal components in ∼ 50% of patients, however, the causes in the remaining 50% of patients still remain unknown. A deficiency of inhibitor of apoptosis-stimulating protein of p53 (iASPP), an evolutionarily conserved inhibitor of p53, caused by spontaneous mutation recently has been associated with a lethal autosomal recessive cardiomyopathy in Poll Hereford calves and Wa3 mice. However, the molecular mechanisms that mediate this putative function of iASPP are completely unknown. Here, we show that iASPP is expressed at intercalated discs in human and mouse postmitotic cardiomyocytes. iASPP interacts with desmoplakin and desmin in cardiomyocytes to maintain the integrity of desmosomes and intermediate filament networks in vitro and in vivo. iASPP deficiency specifically induces right ventricular dilatation in mouse embryos at embryonic day 16.5. iASPP-deficient mice with exon 8 deletion (Ppp1r13l(Δ8/Δ8)) die of sudden cardiac death, displaying features of ARVC. Intercalated discs in cardiomyocytes from four of six human ARVC cases show reduced or loss of iASPP. ARVC-derived desmoplakin mutants DSP-1-V30M and DSP-1-S299R exhibit weaker binding to iASPP. These data demonstrate that by interacting with desmoplakin and desmin, iASPP is an important regulator of desmosomal function both in vitro and in vivo. This newly identified property of iASPP may provide new molecular insight into the pathogenesis of ARVC.

  20. Phenotypic diversification is associated with host-induced transposon derepression in the sudden oak death pathogen Phytophthora ramorum.

    PubMed

    Kasuga, Takao; Kozanitas, Melina; Bui, Mai; Hüberli, Daniel; Rizzo, David M; Garbelotto, Matteo

    2012-01-01

    The oomycete pathogen Phytophthora ramorum is responsible for sudden oak death (SOD) in California coastal forests. P. ramorum is a generalist pathogen with over 100 known host species. Three or four closely related genotypes of P. ramorum (from a single lineage) were originally introduced in California forests and the pathogen reproduces clonally. Because of this the genetic diversity of P. ramorum is extremely low in Californian forests. However, P. ramorum shows diverse phenotypic variation in colony morphology, colony senescence, and virulence. In this study, we show that phenotypic variation among isolates is associated with the host species from which the microbe was originally cultured. Microarray global mRNA profiling detected derepression of transposable elements (TEs) and down-regulation of crinkler effector homologs (CRNs) in the majority of isolates originating from coast live oak (Quercus agrifolia), but this expression pattern was not observed in isolates from California bay laurel (Umbellularia californica). In some instances, oak and bay laurel isolates originating from the same geographic location had identical genotypes based on multilocus simples sequence repeat (SSR) marker analysis but had different phenotypes. Expression levels of the two marker genes analyzed by quantitative reverse transcription PCR were correlated with originating host species, but not with multilocus genotypes. Because oak is a nontransmissive dead-end host for P. ramorum, our observations are congruent with an epi-transposon hypothesis; that is, physiological stress is triggered on P. ramorum while colonizing oak stems and disrupts epigenetic silencing of TEs. This then results in TE reactivation and possibly genome diversification without significant epidemiological consequences. We propose the P. ramorum-oak host system in California forests as an ad hoc model for epi-transposon mediated diversification.