Death In Women Research Articles

Adiposity Throughout Adulthood and Risk of Sudden Cardiac Death in Women

ObjectivesThis study examined the association of BMI repeatedly measured over 32 years and BMI during early and mid-adulthood with risk of sudden cardiac death (SCD) in the Nurses’ Health Study. BackgroundSCD is often the first manifestation of coronary heart disease among women. Data regarding body mass index (BMI) and risk of SCD are limited and conflicting. MethodsWe prospectively followed 72,484 women free of chronic disease from 1980 to 2012. We ascertained adult height, current weight, and weight at age 18 years at baseline, and updated weight biennially. The primary endpoint was SCD (n = 445). ResultsWhen updated biennially, higher BMI was associated with greater SCD risk after adjusting for confounders (p linear trend <0.001). Compared with a BMI of 21.0 to 22.9 kg/m2, the multivariate relative risk (RR) of SCD was 1.46 (95% confidence interval [CI]: 1.05 to 2.04) for BMI 25.0 to 29.9 kg/m2, 1.46 (95% CI: 1.00 to 2.13) for BMI 30.0 to 34.9 kg/m2, and 2.18 (95% CI: 1.44 to 3.28) for BMI ≥35.0 kg/m2. Among women with a BMI ≥35.0 kg/m2, SCD remained elevated even after adjustment for interim development of coronary heart disease and other mediators (RR: 1.72; 95% CI: 1.13 to 2.60). In contrast, the association between BMI and fatal coronary heart disease risk was completely attenuated after adjustment for mediators. The magnitude of the association between BMI and SCD was greater when BMI was assessed at baseline or at age 18 years, at which time SCD risk remained significantly elevated at BMI ≥30 kg/m2 after adjustment for mediators. ConclusionsHigher BMI was associated with greater risk of SCD, particularly when assessed earlier in adulthood. Strategies to maintain a healthy weight throughout adulthood may minimize SCD incidence.

Mapping the Health Communication Infrastructure in Rural Senegal: an Assessment to Support Cervical Cancer Screening

Cervical cancer is the leading cause of women's cancer deaths in Senegal, but few medical personnel are trained to perform cervical cancer screening. In rural areas, the situation is worse. To remedy this, a collaborative of researchers and stakeholders trained local health-care workers in cervical cancer screening through the “training-of-trainers” method. However, lack of cancer screening knowledge, barriers, and a hard-to-reach population may jeopardize the collaborative's efforts. The purpose of this study is to map the health communication infrastructure by applying communication infrastructure theory to assess general health and cancer screening knowledge, as well as attitudes and barriers toward screening. Results from focus groups and interviews show that women have minimal knowledge of cervical cancer. Moreover, health workers report detrimental attitudes in menopausal women. Our findings identified routes for information dissemination and attitude change including community radio and local health talks.

Can Death of Women during Childbirth be Prevented- an Overview from Transcultural Perspective

Childbirth is an extremely complicated phenomenon and poses many challenges for the new mother. Support system from multiple levels is required for saving the mother and child's lives and achieving a positive outcome. Cultural beliefs play a key role during the antenatal phase. While many beliefs are helpful, there may be a few values and beliefs, which might be even be life-threatening. As healthcare professionals, it is important to understand them in order to provide care and intervene accordingly, in order to save lives. This paper will analyze a case study using transcultural theory.

Immunohistochemical study of tumor necrosis factor alpha ( TNF-α) in the tumor microenvironment sample of Iraqi breast cancer

Breast cancer is the most common malignant tumor and the leading cause of carcinoma death inwomen. The tumor microenvironment consist from cellular microenvironment, cytokines andchemokines. Its plays an important role in tumor development such as initiation, progression,metastasis and drug resistance. It is becoming increasingly apparent that the malignant tumorprogression is maintained by dynamic interplay between tumor cells and many distinct cell typesexisting in the adjacent microenvironment. Objective of this study is to detect of TNF-α in tumormicroenvironment in histological sections of breast cancer and compare it with that of benign breastlesions. This study included 32 patients with breast cancer and 21 patients with benign breast lesions,prognostic factors were registered including: age, histopathological subtype, degree ofdifferentiation&amp; stage of breast carcinoma. Results revealed positive expression of TNF-α in 20cases, while 12 cases were negative out of 32 samples of breast cancer. In benign lesions 11 cases werepositive, While 10cases were negative. Statistical analysis showed significant difference in rate ofTNF-α expression between malignant breast samples and benign samples(P ≤0.05).

High Field Magnetic Resonance Imaging of a Mummy from Ak-Alakha-3 Mound 1, Ukok Plateau, Gorny Altai: Findings and Interpretations

The availability of science-based methods has marked a new stage in the study of Pazyryk mummies. This article outlines the results of a magnetic resonance imaging examination of a mummy found in 1993 at Ak-Alakha-3 mound 1, the Ukok Plateau, Gorny Altai—so far the only undisturbed burial of a high-ranking Pazyryk woman discovered in permafrost. The MRI examination revealed several diseases that may have caused the woman's death, and yielded certain facts relevant to her lifestyle. These findings may have implications for the woman's special status as a person “chosen by spirits”, possibly a priestess.

Identification and characterization of small molecule human papillomavirus E6 inhibitors.

Cervical cancer is the sixth most common cancer in women worldwide and the leading cause of women’s death in developing countries. Nearly all cervical cancers are associated with infection of the human papillomavirus (HPV). This sexually transmitted pathogen disrupts the cell cycle via two oncoproteins: E6 and E7. Cells respond to E7-mediated degradation of pRB by upregulating the p53 tumor suppressor pathway. However, E6 thwarts this response by binding to the cellular E6-Associating Protein (E6AP) and targeting p53 for degradation. These two virus-facilitated processes pave the way for cellular transformation. Prophylactic HPV vaccines are available, but individuals already infected with HPV lack drug-based therapeutic options. To fill this void, we sought to identify small molecule inhibitors of the E6–E6AP interaction. We designed an ELISA-based high throughput assay to rapidly screen compound libraries, and hits were confirmed in several orthogonal biochemical and cell-based assays. Over 88,000 compounds were screened; 30 had in vitro potencies in the mid-nanomolar to mid-micromolar range and were classified as validated hits. Seven of these hits inhibited p53 degradation in cell lines with HPV-integrated genomes. Two compounds of similar scaffold successfully blocked p53 degradation and inhibited cell proliferation in cells stably transfected with E6. Together, these studies suggest that small molecules can successfully block E6-dependent p53 degradation and restore p53 activity. The compounds identified here constitute attractive starting points for further medicinal chemistry efforts and development into beneficial therapeutics.

Cause of Death in Women of Reproductive Age in Rural Nepal Obtained Through Community-Based Surveillance: Is Reducing Maternal Mortality the Right Priority for Women's Health Programs?

We used a community surveillance system to gather information regarding pregnancy outcomes and the cause of death for women of reproductive age (WRA) in Kanchanpur, Nepal. A total of 784 mother groups participated in the collection of pregnancy outcomes and mortality data. Of the 273 deaths among WRA, the leading causes of death reported were chronic diseases (94, 34.4%) poisoning, snake bites, and suicide (grouped together; 55, 20.1%), and accidents (29, 10.6%), while maternal mortality accounted for 7%. Nevertheless, the calculated maternal mortality ratio was quite high (259.3 per 100,000 live births).

Police investigations: discretion denied yet undeniably exercised

Police investigations involve determining whether a crime has been committed, and if so what type of crime, who has committed it and whether there is the evidence to charge the perpetrators. Drawing on fieldwork in Delhi and Mumbai, this paper explores how police investigations unfolded in the specific context of women's deaths by burning in India. In particular, it focuses on the use of discretion despite its denial by those exercising it. In India, there are distinctive statutes relating to women's suspicious deaths, reflecting the widespread expectation that the bride's family will pay a dowry to the groom's family and the tensions to which this may on occasion give rise in the early years of a marriage. Often, there are conflicting claims influencing how the woman's death is classified. These in turn affect police investigation. The nature and direction of police discretion in investigating women's deaths by burning reflect in part the unique nature of the legislation and the particular sensitivities in relation to these types of death. They also highlight processes that are liable to be at work in any crime investigation. It was found that police officers exercised unacknowledged discretion at seven specific points in the investigative process, with potentially significant consequences for the achievement of just outcomes: first response, recording the victim's ‘dying declaration’, inquest, registering of the ‘First Information Report’, collecting evidence, arrest and framing of the charges.

Incidence of and mortality from breast cancer among women in Poland in the years 2001-2010.

IntroductionBreast cancer is the most common malignant tumour among women. About 15,000 new cases of breast cancer are diagnosed and more than 5,000 women die in Poland every year. The aim of this study was to analyse the incidence and mortality rate of breast cancer among women in Poland in the years 2001-2010.Material and methodsAnalysed data concerning the incidence of and mortality from cancer among women were obtained from the National Cancer Registry.ResultsThe number of new cases reported in 2010 exceeded that reported in 2001 by 3,666. The mortality from breast cancer among women increased by 15.1% by 2009, to subsequently drop by 0.3% in 2010. The standardized incidence rate increased by 7.4 and the standardized mortality rate fell by 1.3 in 2001-2010.ConclusionsIn the years 2001-2010 the incidence of breast cancer in women in Poland rose by 30.3%, with an increase of 7.4 in the incidence rate. The highest rise in the incidence and mortality of women due to breast cancer in Poland is reported in the Lodz voivodeship. In the years 2001-2009 the number of women's deaths due to breast cancer increased slightly, while the mortality rate dropped.

Profile of Deaths of Women with in Seven Years of Marriage in Agartala, Tripura

Epidemiological and medico legal including forensic pathology and toxicological aspects of deaths of females within seven years of marriage were studied in Agartala, Tripura during a period spanning from 1st March 2013 to 28th February 2014. Total numbers of female deaths were 308, out of which 55 numbers of deaths occurred within seven years of marriage. In this present study, out of all the autopsies conducted within the study period in females, 17.85% of deaths occurred within seven years of marriage. The majority of the victims were Hindu housewives with low socioeconomic status with little or no education at all. Burning has been the most common mode of death. Most of the cases occurred in a very young age group (<20 years) and within the 2nd year of marriage. The maximum numbers of cases were reported to be in arranged marriage couples who live in a joint family with the in laws and bear no issues.

Profile and Pattern of Incidence of Women Death during the Year 2011 (Jan-Dec) in BTGH (Basaveswar Teaching and Government Hospital), Gulbarga, Karnataka - A Retrospective Study

In 1998, India was the only country in the world where fire (burns) was classified among the 15 leading causes of death. High mortality in young married women from burns has already become an alarming and contentious medical problem in India. The incidences of burn mortality by age, sex, residence, marital status; manner and reasons have been reported from the different (urban and rural) parts of India. From a total of 43/88 female cases that were autopsied at BTGH were studied during the period from Jan 2011 to Dec 2011 at Dept of Forensic Medicine and Toxicology M. R. Medical College Gulbarga. The data was analyzed with regard to age, marital status, religion, mode of infliction, cause and manner of death. The cases represented approximately 50% of all autopsies done during the same period. The age ranged from 3 yrs to 60 yrs, with mean age 27 yrs & standard deviation 10.85 31 (72%) cases are due to burns, 7 (16%) are due to O.P.poisoning, 5 (12%) are due to other causes like hanging, fall from height, RTA, etc. 29 (67%) were married and 14 (33%) unmarried. Among 43 female cases, 38 (88%) are Hindus and 5 (12%) are Muslims. All the victims were hospitalized in BTGH after the incident and in majority of them cause of death was septicemia.

Predicting and Communicating the Risk of Recurrence and Death in Women With Early-Stage Breast Cancer: A Systematic Review of Risk Prediction Models

It is a challenge for oncologists to distinguish patients with breast cancer who can forego adjuvant systemic treatment without negatively affecting survival from those who cannot. Risk prediction models (RPMs) have been developed for this purpose. Oncologists seem to have embraced RPMs (particularly Adjuvant!) in clinical practice and often use them to communicate prognosis to patients. We performed a systematic review of published RPMs and provide an overview of the prognosticators incorporated and reported clinical validity. Subsequently, we selected the RPMs that are currently used in the clinic for a more in-depth assessment of clinical validity. Finally, we assessed lay comprehensibility of the reports generated by RPMs. Pubmed, EMBASE, and Web of Science were searched. Two reviewers independently selected relevant articles and extracted data. Agreement on article selection and data extraction was achieved in consensus meetings. We identified RPMs based on clinical prognosticators (N = 6) and biomolecular features (N = 14). Generally predictions from RPMs seem to be accurate, except for patients ≤ 50 years or ≥ 75 years at diagnosis, in addition to Asian populations. RPM reports contain much medical jargon or technical details, which are seldom explained in lay terms. The accuracy of RPMs' prognostic estimates is suboptimal in some patient subgroups. This urgently needs to be addressed. In their current format, RPM reports are not conducive to patient comprehension. Communicating survival probabilities using RPM might seem straightforward, but it is fraught with difficulties. If not done properly, it can backfire and confuse patients. Evidence to guide best communication practice is needed.

Sudden death of a young woman attributed to diabetic ketoacidosis

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.

Abstract B6: Cadherin switching, multicellular aggregate dynamics and metastatic success

Abstract Epithelial Ovarian Carcinoma (EOC) is the fifth leading cause of women's cancer-related death and deadliest of all gynecological cancers with 22,240 new and 14,230 fatal cases predicted in 2013 (American Cancer Society Estimates, 2013), primarily due to detection at late metastatic, prognostically poor stages of the disease. As opposed to other malignancies, EOC metastasis occurs by shedding of cancer cells from the primary tumor directly into the peritoneal cavity where they form multicellular aggregates (MCAs). These metastatic units along with single cells travel with the peritoneal fluid flow, adhere to peritoneum, migrate through mesothelial cell layer into submesothelial matrix wherein they subsequently proliferate into secondary tumor masses. The contribution of MCA dynamics to metastatic success is largely unknown. A feature that distinguishes EOC from most other carcinomas is an increase of E-cadherin (Ecad) expression at early stages of metastasis, frequently together with conserved expression of N-cadherin (Ncad). Our human tumor tissue array dual label immunofluorescence microscopy data confirm simultaneous expression of both cadherins in the majority of ovarian cancer tissues. Two patterns of expression are observed: “mixed cadherin” in which distinct cells within the same tumor express E- or N-Cad and “hybrid cadherin” wherein single tumor cells simultaneously express both cadherins. The mechanisms regulating initial cell detachment, MCA generation, survival in ascitic fluid and secondary anchorage and the role of cadherin dynamics in these steps remain poorly understood. Our research has revealed striking cadherin-dependent differences in cell-cell interactions, MCA formation, aggregate surface morphology and inner ultrastructure. In particular, mesenchymal-type DOV13 and SKOV3 (Ncad+) cells formed stable, highly cohesive smooth solid spheroids, while epithelial-type OvCa433 and OvCa429 (Ecad+) cells generated less adhesive cell clusters, loosely conglomerated and covered by uniform microvilli. To recapitulate the “hybrid cadherin” phenotype observed in human tumors, OvCa433 cells (Ecad) were transfected with the CDH2 (Ncad) gene to generate hybrid cadherin cells, leading to relevant changes in MCA surface morphology with increased superficial lamellipodia and filopodia, resembling the intermediate phenotype of true hybrid OvCa432 and OVCAR3 (Ecad+/Ncad+) aggregates. Alternatively, generation of “mixed cadherin” MCAs using fluorescently tagged cell populations revealed a sorting rather than mixing phenotype, with cells sorting into individual MCAs rather than generating heterogeneous Ecad/Ncad clusters. However, cell lines with common cadherin profiles [OvCa433/OvCa429 (Ecad/Ecad); DOV13/SKOV3 (Ncad/Ncad)] readily formed homogeneous aggregates. Interestingly, hybrid OvCa433 cells (Ecad/Ncad) formed heterogeneous MCAs with DOV13 (Ncad). Our data support the hypothesis that cadherin switching may regulate MCA dynamics and thereby affect metastatic unit cohesivity, survival, and ultimate metastatic success. Citation Format: Yuliya Klymenko, M. Sharon Stack. Cadherin switching, multicellular aggregate dynamics and metastatic success. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr B6.

Global mortality trends and patterns in older women

To describe mortality patterns in women older than 50 years in light of the growth, seen in almost all countries, in the absolute number of females in this age group and in the proportion of the female population comprising older women. National death record data and World Health Organization estimates of life expectancy and causes of death in women older than 50 years were analysed. Projections of trends in mortality, by cause, at older ages were also made. In both developed and developing countries, the leading causes of death among older women were cardiovascular diseases and cancers. In countries with death registration data, cardiovascular and (to a lesser extent) cancer mortality appears to have declined in older women in recent decades and this decline has resulted in improved life expectancy at age 50. If these trends continue, deaths in older women are still expected to increase in number because of population growth and ageing. Noncommunicable diseases, especially cardiovascular diseases and cancers, are expected to cause an increasing share of women's deaths in low- and middle-income countries owing to the ageing of the population and to reductions in child and maternal deaths. Health systems must adjust accordingly, perhaps by drawing on lessons from high-income countries that have succeeded in reducing mortality from noncommunicable diseases.

Using Current Smoking Prevalence to Project Lung Cancer Morbidity and Mortality in Georgia by 2020

IntroductionTobacco use is the leading preventable cause of disease and premature death in the United States. In Georgia, approximately 18% of adults smoke cigarettes, and 87% of men’s lung cancer deaths and 70% of women’s lung cancer deaths are due to smoking. From 2004–2008, the age-adjusted lung cancer incidence rate in Georgia was 112.8 per 100,000 population, and the mortality rate was 88.2 per 100,000 population.MethodsThe Georgia Behavioral Risk Factor Surveillance System Survey was used to estimate trends in current adult smoking prevalence (1985–2010). Georgia smoking–attributable cancer mortality was estimated using a method similar to the Centers for Disease Control and Prevention’s Smoking-Attributable Morbidity, Mortality, and Economic Costs application. Data on cancer incidence (1998–2008) were obtained from the Georgia Comprehensive Cancer Registry, and data on cancer deaths (1990–2007) were obtained from the Georgia Department of Public Health Vital Records Program.ResultsFrom 1985 through 1993, the prevalence of smoking among Georgians declined by an average of 3% per year in men and 0.2% in women. From 2001 through 2008, lung cancer incidence rates declined in men and increased in women. Lung cancer mortality rates declined in men and women from 2000 through 2007. By 2020, Georgia lung cancer incidence rates are projected to decrease for men and increase for women. Lung cancer mortality is projected to decrease for both men and women.ConclusionThe lung cancer mortality rates projected in this study are far from meeting the Healthy People 2020 goal (46 per 100,000 population). Full implementation of comprehensive tobacco-use control programs would significantly reduce tobacco-use–related morbidity and mortality.

Abstract 548: CXCR2 controls breast cancer metastasis and chemoresistance through PI3K/AKT and COX-2 signalings.

Abstract Background: Breast cancer is the chief culprit leading to woman's death. The major cause is the chemoresistance and distant metastasis before or after surgery and standard treatment. Recent studies suggest that chemokines and their receptors may play important roles in breast cancer metastasis and chemoresistance. Purpose: The chemokine receptor CXCR2 is associated with tumor development in many cancers. Although IL-8 and Gro-alpha as the major ligands contribute to breast cancer progression, the function of their receptor CXCR2 in breast cancer is elusive. In this study, we investigated the role of CXCR2 in breast cancer metastasis and chemoresistance. Experimental design:Human breast cancer cell lines including MCF-7 and SKBR-3 (low metastasis), MDA-MB-231 (medium metastasis), MDA-MB-231HM (high lung metastasis), MDA-MB-231BO (high bone metastasis), and MDA-MB-231/Gem (Gemcitabine-resistant) were used to investigate cell proliferation, migration, invasion, colony formation, apoptosis, and tumorigenesis by MTT, scratch-wound, transwell, soft agar, flow cytometery, and animal assays after CXCR2 or its associated proteins were over expressed or silenced/inhibited. Protein expression in cell lines and tissues was examined by either Western blot, ELISA, immunofluorescence, or immunohistochemical staining. Results: CXCR2 expression was higher in chemoresistant breast cancer cell lines, high-metastatic cell lines and breast cancer tissues than in chemosensitive cell lines, low-metastatic cell lines, and breast cancer tissues. Overexpression of CXCR2 promoted cell proliferation, migration, invasion, cell anti-apoptosis, tumor formation, metastasis, and chemoresistance, but silencing of CXCR2 inhibited those activities both in vitro and in vivo. Mechanism studies revealed that CXCR2 suppresses AKT1 to promote breast cancer metastasis and chemoresistance through cyclooxygenase-2 (COX-2; PTGS2) to regulate caveolin-1, MMP2, MMP9, E-cardherin, and beta-catenin, which can be inversed by knock down of CXCR2 or COX-2, and over expression of AKT1 and P85alpha. Additionally, over expression of CXCR2 and COX-2, or silencing of PI3K/AKT1 inhibits p53 phosphorylation (Serine 15) and E2F1 expression, but activates MDM2, Bcl-xL and Bcl-2, leading to increased anti-apoptosis. Tissue microarray analysis from 300 breast cancer patients also indicated that over expression of CXCR2 is associated with enhanced COX2 expression and reduced AKT1 expression in metastatic and chemoresistant breast carcinomas (P &amp;lt; 0.001), which may be used to predict breast cancer development. Conclusions: Our results suggest that CXCR2 controls breast cancer metastasis and chemoresistance through regulating COX-2 and AKT1. Thus, antagonists of CXCR2 and COX-2 may be used synergistically to treat breast cancer patients particularly with high metastasis and chemoresistance. Citation Format: Han Xu, Fengjuan Lin, Ziliang Wang, Jiao Meng, Huizhen Sun, Zihao Qi, Yan Wang, Zhouluo Ou, Zhimin Shao, Genhong Di, Gong Yang. CXCR2 controls breast cancer metastasis and chemoresistance through PI3K/AKT and COX-2 signalings. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 548. doi:10.1158/1538-7445.AM2013-548 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.

Smoking, Smoking Cessation, and Risk of Sudden Cardiac Death in Women

Few prospective studies have examined quantitative cigarette consumption and smoking cessation on sudden cardiac death (SCD) risk with long-term follow-up. We prospectively examined the association between cigarette smoking and smoking cessation on the risk of SCD among 101 018 women participating in the Nurses' Health Study without known coronary heart disease, stroke, and cancer at baseline 1980. During 30 years of follow-up, we identified 351 SCD events. Compared with never smokers, current smokers had a 2.44-fold (95% CI, 1.80-3.31) increased risk of SCD after controlling for coronary risk factors. In multivariable analyses, quantity of cigarettes smoked daily (P value for trend, <0.0001) and smoking duration (P value for trend, <0.0001) were linearly associated with SCD risk among current smokers. Small-to-moderate amounts of cigarette consumption (1-14 per day) were associated with a significant 1.84-fold (95% CI, 1.16-2.92) increase in SCD risk and every 5 years of continued smoking was associated with an 8% increase in SCD risk (hazard ratio, 1.08; 95% CI, 1.05-1.12; P<0.0001). The SCD risk linearly decreased over time after quitting and was equivalent to that of a never smoker after 20 years of cessation (P value for trend, <0.0001). In this large prospective cohort of women without coronary heart disease at baseline, a strong dose-response relationship between cigarette smoking and SCD risk was observed, and smoking cessation significantly reduced and eventually eliminated excess SCD risk. This suggests efforts to prevent SCD among women should include aggressive strategies for smoking cessation.

Statins Don't Prevent Stroke, Death in Women

Statins Don't Prevent Stroke, Death in Women

Fatal agranulocytosis associated with psychotropic medication use

A patient's death due to severe hematologic adverse effects of the concomitant use of four psychotropic medications is reported. A 40-year-old Caucasian woman with a 9-year history of depression and anxiety (managed with alprazolam) was admitted to a psychiatric hospital for the treatment of acute psychotic symptoms. After nine days, the patient was discharged home on a regimen of lamotrigine, mirtazapine, quetiapine, and venlafaxine. Five weeks later, the development of severe ocular cellulitis, severe oral thrush, and febrile neutropenia necessitated the woman's urgent rehospitalization; on admission, her white blood cell count was 600 cells/mm(3), her absolute neutrophil count was 18 cells/mm(3), and microbial pathogens were isolated in peripheral blood and tracheal aspirate cultures. Despite treatment with antibiotics and filgrastim, the patient developed multiorgan dysfunction and died five days later from septic shock. The woman's concomitant use of multiple psychotropics and the late recognition of drug-induced agranulocytosis likely contributed to her severe symptoms and ultimate death. The application of the Naranjo scale to this case yielded a score of 6, indicating a probable adverse drug reaction. Although hematologic adverse effects have been reported with the use of each of the four drugs implicated in the woman's death, this is thought to be the first report of fatal agranulocytosis associated with any of the drugs. A 40-year old woman with a history of acute psychotic symptoms developed agranulocytosis and neutropenia after starting therapy that included lamotrigine, mirtazapine, quetiapine, and venlafaxine.