Possible Cause Of Death Research Articles

A log-rank-type test to compare net survival distributions.

In population-based cancer studies, it is often interesting to compare cancer survival between different populations. However, in such studies, the exact causes of death are often unavailable or unreliable. Net survival methods were developed to overcome this difficulty. Net survival is the survival that would be observed if the disease under study was the only possible cause of death. The Pohar-Perme estimator (PPE) is a nonparametric consistent estimator of net survival. In this article, we present a log-rank-type test for comparing net survival functions (as estimated by PPE) between several groups. We put the test within the counting process framework to introduce the inverse probability weighting procedure as required by the PPE. We built a stratified version to control for categorical covariates that affect the outcome. We performed simulation studies to evaluate the performance of this test and worked an application on real data.

Prevalence and Perinatal Outcome of Singleton Term Breech Delivery in Mizan Aman General Hospital, South West, Ethiopia; A Three Year Retrospective Hospital based Study

Introduction: Breech deliveries have always been topical issues in obstetrics because of the very high perinatal mortality and morbidity. These are due to combination of trauma, birth asphyxia, prematurity and malformation. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective: To determine the perinatal outcome of singleton term breech deliveries and identify associated factors at Mizan Aman General Hospital. Methods: Hospital based cross-sectional study was conducted. Data on Socio-demographic, obstetric conditions and outcome of singleton breech deliveries of all pregnant women was collected from January 01, 2012 to December 31, 2014 GC. The collected Data was entered to SPSS version-20 for analysis. Descriptive statistics was run and the association between independent and dependent variables was measured using logistic regression model and p-value < 0.05 statistically significant. Result: During the 3 years study period, a total of 126 singleton term breech deliveries were recorded out of 3729 deliveries giving the prevalence of singleton breech deliveries in the hospital to be 3.4%. The perinatal outcome of breech deliveries were 104(88%) born alive and 14(12%) were dead indicating that the perinatal mortality rate to be 120 per 1000 term breech presentations. The possible causes of death for dead delivered fetus were entrapment of head 5(35.7%), prolapsed cord 4(28.6%), birth asphyxia 3(21.4%) and intrauterine death with unknown cause 2(14.3%). Birth weight greater than 3500 gm have 26% chance of fetal loss when compared with fetal weight 2500-3499 gm. Vaginal breech delivery have significant statistical association with perinatal loss than abdominal route. Conclusion and Recommendation: Perinatal mortality rate, of 120 per 1000 breech deliveries. Which indicate that breech vaginal delivery is associated with an increased perinatal mortality and morbidity than caesarean delivery. Birth weight ≥ 3500 gm increase risk perinatal loss than fetal weight between 2500-3500 gm.

210Po poisoning as possible cause of death: forensic investigations and toxicological analysis of the remains of Yasser Arafat

The late president of the Palestinian Authority, Yasser Arafat, died in November 2004 in Percy Hospital, one month after having experienced a sudden onset of symptoms that included severe nausea, vomiting, diarrhoea and abdominal pain and which were followed by multiple organ failure. In spite of numerous investigations performed in France, the pathophysiological mechanisms at the origin of the symptoms could not be identified. In 2011, we found abnormal levels of polonium-210 (210Po) in some of Arafat's belongings that were worn during his final hospital stay and which were stained with biological fluids. This finding led to the exhumation of Arafat's remains in 2012. Significantly higher (up to 20 times) activities of 210Po and lead-210 (210Pb) were found in the ribs, iliac crest and sternum specimens compared to reference samples from the literature (p-value <1%). In all specimens from the tomb, 210Po activity was supported by a similar activity of 210Pb. Biokinetic calculations demonstrated that a 210Pb impurity, as identified in a commercial source of 3MBq of 210Po, may be responsible for the activities measured in Arafat's belongings and remains 8 years after his death. The absence of myelosuppression and hair loss in Mr Arafat's case compared to Mr Litvinenko's, the only known case of malicious poisoning with 210Po, could be explained by differences in the time delivery-scheme of intake. In conclusion, statistical Bayesian analysis combining all the evidence gathered in our forensic expert report moderately supports the proposition that Mr Arafat was poisoned by 210Po.

Using dental cementum increment analysis to estimate age and season of death in African Americans from an historical cemetery in Missouri

The Missouri River in Callaway County, Missouri, flooded in 1993, necessitating salvage excavations at old Shiloh Cemetery, which yielded 11 mostly complete skeletons of African American adolescents and 7 other individuals who died during the mid to late 1800s. The skeletons exhibit evidence of stress normal for the period but no indications of cause of death. The individuals’ unusual age distribution and proximity to one another raise the question of how they died. It is possible these individuals died from trauma or chronic or acute disease. Among the possible causes of death is one of the epidemics that swept across Missouri during the 1800s. In this study we counted tooth cementum annulations (TCA) to verify the skeletal age-at-death estimates and conducted dental cementum increment analysis (DCIA) to determine the season of death as a first step in understanding the history of the cemetery. TCA results confirmed that the 11 African-American individuals examined were teenagers. DCIA demonstrated that all of the individuals died between April and September. The burials, therefore, represent a section of a mixed-race cemetery, which included African American teenagers who died during the same season. Future research will attempt to identify whether this burial cohort died of chronic or acute disease, possibly of an epidemic of infectious disease.

Targeted next generation sequencing application in cardiac channelopathies: Analysis of a cohort of autopsy-negative sudden unexplained deaths

Genetic testing for cardiac channelopathies in sudden unexplained death (SUD) has developed substantially over the last years. The Next Generation Sequencing (NGS) technology provides an unprecedented opportunity to screen for genetic variations underlying arrhythmogenic genes in a short period of time at a low cost.The present study aimed to perform genetic testing with NGS technologies on the Ion Torrent Personal Genome Machine™ (Ion PGM™) sequencer, in targeting a total of 23 genes reported to be associated with inherited cardiac channelopathies in order to identify the possible cause of death in a cohort of post-mortem cases.The molecular analyses focused on 16 cases of SUD, aged less than 35 years old. In all cases, the cause of death could not be determined after a rigorous autopsy associated with histopathological and toxicological analyses according to the guidelines of the Association for European Cardiovascular Pathology. DNA was extracted from fresh frozen tissue.An average of 200 variants was identified per case. However, after the prioritization process using a new scoring program (VaRank) and after the conjunction of clinical data and molecular findings, four “likely pathogenic” variants (including two undescribed variants), were identified in three cases (18.75%) of our cohort in the genes KCNH2, ANK2, SCN5A and RYR2. One case, who died during psychiatric hospitalization after administration of a QT prolonging drug, showed a double “likely pathogenic” variant in Long QT genes (ANK2 and SCN5A) which may have predisposed to drug-induced cardiac arrhythmias.Our study illustrates that the NGS approach based on AmpliSeq™ libraries and Ion Torrent PGM™ sequencing may be an efficient approach, integrated to post-mortem examination. Given the massive amount of information generated by NGS, a rigorous filtration strategy of variants coupled with multidisciplinary collaboration is crucial to determine the potential pathogenic role of identified variants in the cause of death.

A novel coplanar probe design for fast scanning of edema in human brain tissue via dielectric measurements

As part of every standard forensic autopsy, the examination of the brain includes assessment with respect to possible edema. The quantification of edema is helpful to make a sound diagnosis in presence of multiple affections and multiple possible causes of death. The water content in certain brain regions is furthermore a promising marker to distinguish between causes of death with no visible evidence, such as suffocation, shaking impact syndrome and sudden infant death syndrome. However, in todays’ forensic medicine, no technique is available for the objective and exact quantification of edema. Therefore, the aim of this work is to develop a fast and easy-to-use measuring system for the accurate determination of the water content in human brain tissue that fits into the procedure of a routine autopsy. For our setups, the dependency between relative permittivity and water content is utilized. In former works, we presented measurements of human brain tissue using a coaxial measuring chamber and an open-ended coaxial probe. However, some drawbacks of the used methods emerged. Thus, a novel probe design using a coplanar transmission line has been developed, addressing the drawbacks of the formerly used methods. This new probe is easy to calibrate and allows fast and accurate sequential scanning for edema in human brain tissue.

A multistate additive relative survival semi-Markov model.

Medical researchers are often interested to investigate the relationship between explicative variables and times-to-events such as disease progression or death. Such multiple times-to-events can be studied using multistate models. For chronic diseases, it may be relevant to consider semi-Markov multistate models because the transition intensities between two clinical states more likely depend on the time already spent in the current state than on the chronological time. When the cause of death for a patient is unavailable or not totally attributable to the disease, it is not possible to specifically study the associations with the excess mortality related to the disease. Relative survival analysis allows an estimate of the net survival in the hypothetical situation where the disease would be the only possible cause of death. In this paper, we propose a semi-Markov additive relative survival (SMRS) model that combines the multistate and the relative survival approaches. The usefulness of the SMRS model is illustrated by two applications with data from a French cohort of kidney transplant recipients. Using simulated data, we also highlight the effectiveness of the SMRS model: the results tend to those obtained if the different causes of death are known.

Estimating Net Survival using a Life-Table Approach

Cancer registries are often interested in estimating net survival (NS), the probability of survival if the cancer under study is the only possible cause of death. Pohar Perme, Stare, and Estéve (2012, Biometrics 68: 113–120) proposed a new estimator of NS based on inverse probability weighting. They demonstrated that existing estimators of NS based on relative survival were biased, whereas the new estimator was unbiased. The new estimator was developed for continuous survival times, yet cancer registries often have only discrete survival times (for example, survival time in completed months or years). Therefore, we propose an approach to estimation for when survival times are discrete. In this article, we describe the stnet command for life-table estimation of NS, adapting the Pohar Perme estimation approach to life-table estimation. Estimates can be made using a period or hybrid approach in addition to the traditional cohort (or complete) approach, and age-standardized survival estimates are available.

The Potential Role of a Health and Demographic Surveillance System in Rural Northern Nigeria to Reduce Maternal and Child Deaths

There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.

Prirodna sredina i zdravlje

Natural environment conditions the life and work of people, relating directly to the health of the population. The aim is to indicate the type and extent of the influence of the natural environment on human health. We analyzed the data and literature in the area of health and the environment, in the part related to the impact of the environment on human health, with special emphasis on the aging process. Man changes environment with their activities while under the influence of the environment suffered minor or major changes. In this way each individual grows and matures, turning from purely biological in bio­social being. So, man is essentially a product of your environment. The point is that the human body constantly communicate with their environment and can only survive if its composition is maintained within narrow limits and balance with the environment. The imbalance man ­ natural environment allows the causes of the environment disturb the structure of the internal environment of man, leading to a number of acute and chronic diseases, respectively, to the possible causes of death.

The pathology of lethal exposure to the Riot Control Agents: Towards a forensics-based methodology for determining misuse

The aim of this is to review deaths associated with the use of Riot Control Agents (RCAs) and to assess how the presenting pathologies is such cases may better inform cause of death conclusions upon autopsy. We also sought to present which additional steps should be added to the Minnesota protocol and the European harmonization of medico-legal autopsy rules in suspected cases of deaths associated with the use of RCAs.We included 10 lethal cases in our study. In three cases, RCAs were found to be the sole cause of death, in three cases RCAs were ruled a secondary cause of death due asphyxia or asthma subsequent to exposure to RCAs and in four cases RCAs were contributory factors to death. In three cases the responsible agents were identified as Chloroacetophenone (CN), Chlorobenzylidene malononitrile (CS) and Oleoresin capsicum (OC) and in the remaining 7 cases, the agent was OC alone.As there are no specific findings in suspected cases of death associated with RCA use, establishing cause of death and whether RCAs are the sole cause or only a contributory factor will be based on the elimination of other possible causes of death. For this reason, a specifically structured autopsy is essential. This specifically structured autopsy should contain basic principles of the Minnesota Protocol and the European harmonization of medico-legal autopsy rules with the following additional steps taken: examination of clothing, eyes, and skin; examination of pharyngeal, tracheobronchial, and eusophegeal mucosas; and a thorough recording of the steps taken by the party conducting the arrest, including other possible causes of in-custody death, as well as a detailed medical history of the deceased.

Mortality and immunological recovery among older adults on antiretroviral therapy at a large urban HIV clinic in Kampala, Uganda.

We describe older (>50 years) HIV-infected adults after antiretroviral therapy (ART) initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pretreatment CD4. We also describe mortality on ART and its risk factors by age category including the contribution of poor immunological recovery at a large urban clinic in Kampala, Uganda. We performed a cohort analysis of adult (>18 years) HIV-infected patients who initiated ART between January 1, 2004 and January 3, 2012. Immunological response was evaluated using mixed-effects linear regression. We described mortality using Kaplan-Meier survival methods analyzing for risk factors of mortality using multivariate Weibull survival regression stratified by age category. Among 9806 individuals who initiated ART, mean age was 37 years (SD: 8.8), average follow-up 5.7 years (SD: 1.7), and median baseline CD4 was 115 cells per cubic millimeter (interquartile range: 42-184). Adults younger than 50 years had on average a higher CD4 increase of 45 cells per cubic millimeter (95% confidence interval: 17 to 72; P = 0.001) compared with counterparts aged 60 years and older. Mortality was highest among older adults compared with younger counterparts. Only CD4 count <100 cells per cubic millimeter after 1 year on ART and a CD4 count less than baseline were associated with a statistically significant higher rate of death among older adults. Older adults had a slower immunological response, which was associated with mortality, but this mortality was not typically associated with opportunistic infections. Future steps would require more evaluation of possible causes of death among these older individuals if survival on ART is to be further improved.

A Systematic Review and Meta-Analysis Examining Pneumonia-Associated Mortality in Dementia

Background: Although it is generally accepted that deaths associated with pneumonia are more common in patients with dementia, no comprehensive reviews on the subject have previously been published. Summary: Relevant studies were identified through a literature search of the PubMed, EMBASE, Scopus, and ISI Web of Science databases for publications up to August 2013. Studies were included if (1) a group of adult subjects with dementia and a (comparison) group composed of subjects without dementia were included, (2) the cause(s) of death was/were reported, and (3) pneumonia was identified as one of the possible causes of death. The occurrence of death due to pneumonia associated with dementia was expressed as an odds ratio (OR) with 95% confidence interval (CI). Thirteen studies were included. The odds of death resulting from pneumonia were significantly increased for persons with any form of dementia compared with those without dementia (OR = 2.22, 95% CI 1.44-3.42, p < 0.001). In a subgroup analysis, using the results from 8 studies that restricted inclusion to persons with Alzheimer's disease, the odds of death resulting from pneumonia were also significantly higher (OR = 1.70, 95% CI 1.12-2.58, p = 0.013). Key Messages: The odds of pneumonia-associated mortality were increased more than 2-fold for patients with dementia. © 2014 S. Karger AG, Basel

Identification and characterization of Highlands J virus from a Mississippi sandhill crane using unbiased next-generation sequencing

Advances in massively parallel DNA sequencing platforms, commonly termed next-generation sequencing (NGS) technologies, have greatly reduced time, labor, and cost associated with DNA sequencing. Thus, NGS has become a routine tool for new viral pathogen discovery and will likely become the standard for routine laboratory diagnostics of infectious diseases in the near future. This study demonstrated the application of NGS for the rapid identification and characterization of a virus isolated from the brain of an endangered Mississippi sandhill crane. This bird was part of a population restoration effort and was found in an emaciated state several days after Hurricane Isaac passed over the refuge in Mississippi in 2012. Post-mortem examination had identified trichostrongyliasis as the possible cause of death, but because a virus with morphology consistent with a togavirus was isolated from the brain of the bird, an arboviral etiology was strongly suspected. Because individual molecular assays for several known arboviruses were negative, unbiased NGS by Illumina MiSeq was used to definitively identify and characterize the causative viral agent. Whole genome sequencing and phylogenetic analysis revealed the viral isolate to be the Highlands J virus, a known avian pathogen. This study demonstrates the use of unbiased NGS for the rapid detection and characterization of an unidentified viral pathogen and the application of this technology to wildlife disease diagnostics and conservation medicine.

Francisella tularensis infection without lesions in gray tree squirrels (Sciurus griseus): a diagnostic challenge

Fifteen cases of Francisella tularensis infection (tularemia) were identified in western gray (Sciurus griseus) and eastern gray (Sciurus carolinensis) squirrels submitted to the Washington Animal Disease Diagnostic Laboratory between 2008 and 2011. All of the squirrels originated in Washington State, a geographical area with endemic tularemia in wildlife. Nine of the 15 squirrels with F. tularensis infection had gross (2/15) or microscopic (9/15) multifocal necrotizing lesions in the spleen, liver, or lymph nodes, typical of tularemia. Special stains did not reliably identify intralesional bacteria microscopically. Six of the 15 squirrels infected with F. tularensis lacked gross and microscopic lesions typical of tularemia. All 15 squirrels with F. tularensis infection were identified by polymerase chain reaction tests on the spleen, liver, or lymph node (including all 6 squirrels without typical tularemia lesions); 8 out of 9 squirrels were positive by direct fluorescent antibody test of tissues, and 5 out of 15 squirrels were positive by culture of tissues. The findings underscore the importance of considering tularemia as a possible cause of death when no lesions of tularemia can be identified at necropsy. Furthermore, the findings suggest the possibility of subclinical infections in gray squirrels, and the importance of molecular diagnostics for definitive diagnosis of F. tularensis infection in wild squirrels.

English

A longitudinal study was conducted, from October 2008 to April 2009, on 188 kids born from flocks of 50 randomly selected households in Aneno and Edokontola villages in Adamitulu Jedokombolcha district, mid rift valley, Ethiopia. The aim of the study was to estimate pre-weaning mortality, identify associated factors and establish possible causes of death in goat kids. Data collected were used to evaluate the effect of sex, birth weight, parity, type of birth and some management practices on pre-weaning mortality. All the factors, except sex of the kid, significantly (at least P&lt;0.05) influenced the mortality of kids. Generally mortality increased (P&lt;0.05) with parity.&nbsp; There were more deaths in kids born in triplets than in twins and single litters. Management practices such as keeping new born kids with their doe near homestead, and separation of sick animals had significantly reduced (P&lt;0.001) pre-weaning kid mortality. Mismothering was the most frequently suspected cause of mortality followed by pneumonia, enzootic ataxia, diarrhea, goat pox and predators. The study revealed the existence of very high kid mortality in the study area. Supplementation of multiple-bearing pregnant does and nursing does with multiple litters may be considered to reduce pre-weaning kid lose.&nbsp; Key words: Adamitulu, Ethiopia, goat, kid, mortality, pre-weaning.

Risk factors for late death of patients with abdominal trauma after damage control laparotomy for hemostasis

IntroductionIn this study, we explored the possible causes of death and risk factors in patients who overcame the initial critical circumstance when undergoing a damage control laparotomy for abdominal trauma and succumbed later to their clinical course.MethodsThis was a retrospective study. We selected patients who fulfilled our study criteria from 2002 to 2012. The medical and surgical data of these patients were then reviewed. Fifty patients (survival vs. late death, 39 vs. 11) were enrolled for further analysis.ResultsIn a univariable analysis, most of the significant factors were noted in the initial emergency department (ED) stage and early intensive care unit (ICU) stage, while an analysis of perioperative factors revealed a minimal impact on survival. Initial hypoperfusion (pH, BE, and GCS level) and initial poor physiological conditions (body temperature, RTS, and CPCR at ED) may contribute to the patient’s final outcome. An analysis and summary of the causes of death were also performed.ConclusionsAccording to our study, the risk factors for late death in patients undergoing DCL may include both the initial trauma-related status and clinical conditions after DCL. In our series, the cause of death for patients with late mortality included the initial brain insult and later infectious complications.

Maternal mortality in Central Province, Kenya, 2009-2010.

IntroductionMaternal mortality for Kenya was 488/100,000 live births in 2009. Maternal mortality estimate for Central Province is unknown. We retrospectively reviewed data between 1st July 2009 and 30th June 2010 to estimate the hospital based maternal mortality ratio, characterize deaths by time, place and person and describe possible causes of deaths in Central province, Kenya.MethodsWe abstracted data using a standard form from maternal death notification and review forms and the district reproductive health reports. Data was entered and analyzed using Microsoft Excel.ResultsThere were 89,512 live births and 111 deaths. The facility-based maternal mortality ratio was 124/100,000 live births. Seventy-three (66%) deaths had been audited. Thirty seven (33%) were aged 25 to 34 years. The mean age was 31years (±6). Thirty seven (33%) had a parity of less or equal to 2. Most case deaths (19%, n = 21) had attended 2 or less antenatal visits. The main gestation was below 37 weeks with 48% (n = 53). The main mode of delivery was vaginal (26%, n = 29). Majority (35%, n = 32) case deaths had delivered a live birth. Thirty seven (33%) mothers had been stable on admission. The main reason for admission waslabor with 12% (n = 13). Thirty-eight (34%) died within 24 hours after admission. Majority (27%, n = 30) were admitted antepartum but 39% (n = 43) were postpartum at the time of death. Thirty-five (32%) died of hemorrhage and 8(7%) Eclampsia.ConclusionMaternal mortality is of public health importance in the region. Most deaths occurred within 24 hours after admission. Third delay was important. Bleeding and Eclampsia were the main causes of death. A third (34%) of notified deaths were not reviewed.

Hepatic Portal Venous Gas in a Patient with Penetrating Injuries

Hepatic portal venous gas (HPVG) refers to the branching area of low attenuation extending to within 2 cm of the liver capsule in computed tomography scan. The most common causes of HPVG are mesenteric ischaemia in adults and necrotising enterocolitis in infants. HPVG in trauma patients is mostly reported in cases of blunt abdominal trauma. We present a deceased patient who had chest and abdominal wall penetrating injuries with concomitant hypovolemic shock. A computed tomography scan revealed HPVG and pulmonary artery air emboli. The mechanism of the presentation of HPVG in this patient and the possible cause of death would be discussed. (Hong Kong j.emerg.med. 2013;20:382-384)

Atrial fibrillation: A kiss of death?

Atrial fibrillation: A kiss of death?