Undetermined Cause Of Death Research Articles

Self-injurious unnatural death among Veterans with HIV.

People with HIV (PWH) are at an increased risk of suicide and death from unintentional causes compared with people living without HIV. Broadening the categorization of death from suicide to self-injurious unnatural death (SIUD) may better identify a more complete set of modifiable risk factors that could be targeted for prevention efforts among PWH. We conducted a nested case-control study using data from the Veterans Aging Cohort Study (VACS), a longitudinal, observational cohort of Veterans from 2006-2015. A total of 5036 Veterans with HIV, of whom 461 died by SIUD, were included in the sample. SIUD was defined using the International Classification of Disease 10 th revision cause of death codes. Cases ( n = 461) included individuals who died by SIUD (intentional, unintentional, and undetermined causes of death). Controls ( n = 4575) were selected using incidence density sampling, matching on date of birth ± 1 year, race, sex, and HIV status. SIUD and suicide was estimated using conditional logistic regression. A previous suicide attempt, a diagnosis of an affective disorder, recent use of benzodiazepines, psychiatric hospitalization, and living in the western US significantly increased the risk of suicide and SIUD. Risk factors that appear more important for SIUD than for suicide included a drug use disorder, alcohol use disorder, Hepatitis C, VACS Index 2.0, current smoking, and high pain levels (7-10). Limiting studies to known suicides obscures the larger public health burden of excess deaths from self-injurious behavior. Our findings demonstrate the benefit of expanding the focus to SIUD for the identification of modifiable risk factors that could be targeted for treatment.

Unexplained infant death in Houston, TX: A 17-year retrospective

SIDS/SUID (henceforth referred to as SIDS) is a leading cause of neonate death, taking the lives of ~10 infants every day in the US alone. SIDS is defined as the death of an infant for which no cause of death can be determined after a complete autopsy, death scene investigation, and medical history review, all of which makes SIDS a very diffcult disease to study. Death scene investigations have identified several contributing environmental factors. However, etiological investigation has been complicated by inconsistencies in classification of death by medical examiners or coroners and unreliable resources for law enforcement to complete death scene investigations, which leads to epidemiological studies often lacking rigor or suffcient data. Using data from Child Fatality Review Team (CFRT) of Harris County, the Medical Examiner’s Offce, and the Texas Department of State Health Services, we performed a retrospective analysis of 17-years of SIDS cases in Harris County, Texas. We applied a novel birth rate correction for SIDS rates over the first year of life. Associations were tested using a Tukey HSD and linear regression models with co-linear factors considered. To focus on biologically unexplained SIDS cases, we subsetted our dataset to only include SIDS and Undetermined causes of death. Our preliminary data includes 1,094 cases comprised of ~43% black, ~32% Hispanic, ~20% white, ~3% Asian, and ~0.4% unknown and 57% male infants. Distribution of death across the first 12 months of life shows a peak of death around 2 months of age. We do not see an association with month or season in the raw SIDS data nor when using our novel correction for birth rates. When we apply the standard per 1,000 live births normalization, we see a significant increase in Spring and Winter. We also report race-dependent significant differences in yearly and monthly case numbers, male-to-female ratios, and age at death and additional significant race-dependent associations between SIDS cases and adults diagnosed with asthma, income level, and overcrowding based on Zip Code. This dataset represents one of the most racially and socio-economically diverse in the United States. Our data suggests that standard trends may be driven by majority white datasets and that response to socioeconomic stress varies by race/ ethnicity, which leads to differences in risk between classically described minority groups. NIH: 1F32HL160073-01A1, R01HL130249 44617-S4. BCM McNair Scholar Program, March of Dimes Basil O'Connor Research Award, Parker B. Francis Fellowship, CJ Foundation for SIDS. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Assessment of Risk for Sudden Cardiac Death Among Adolescents and Young Adults After Receipt of COVID-19 Vaccine - Oregon, June 2021-December 2022.

COVID-19 vaccination has been associated with myocarditis in adolescents and young adults, and concerns have been raised about possible vaccine-related cardiac fatalities in this age group. In April 2021, cases of myocarditis after COVID-19 vaccination, particularly among young male vaccine recipients, were reported to the Vaccine Adverse Event Reporting System. To assess this possibility, investigators searched death certificates for Oregon residents aged 16-30 years who died during June 2021-December 2022 for cardiac or undetermined causes of death. For identified decedents, records in Oregon's immunization information system were reviewed for documentation of mRNA COVID-19 vaccination received ≤100 days before death. Among 1,292 identified deaths, COVID-19 was cited as the cause for 30. For 101 others, a cardiac cause of death could not be excluded; among these decedents, immunization information system records were available for 88, three of whom had received an mRNA COVID-19 vaccination within 100 days of death. Of 40 deaths that occurred among persons who had received an mRNA COVID-19 vaccine dose, three occurred ≤100 days after vaccination. Two of these deaths were attributed to chronic underlying conditions; the cause was undetermined for one. No death certificate attributed death to vaccination. These data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons. COVID-19 vaccination is recommended for all persons aged ≥6 months to prevent COVID-19 and complications, including death.

Ethanol and Higher Alcohols' Production in Fungal and Bacterial Laboratory Cultures and Significance for Forensic Samples.

Ethanol can be produced by many microorganisms that colonize a dead body. Ethanol's concentration depends on the congener higher alcohols, 1-propanol, isobutanol, 2-methyl-1-butanol, 3-methyl-1-butanol, and 1-butanol, as previous research has shown. This correlation is expressed by mathematical models which estimate the concentration of microbial ethanol. The aim of this contribution was to study the ethanol and higher alcohols' production in various laboratory bacterial and fungal cultures and the applicability of the bacterial and fungal models (which concern the bacteria E. coli, S. aureus, K. pneumoniae, and E. faecalis, and the fungus C. albicans) in these samples, as well as in blood samples from autopsy cases, with the overall objective of investigating the models' applicability in routine casework. The bacteria and fungus were cultured in conventional culture media and in denatured human blood cultures under various conditions. The alcohols' concentrations were determined using a head space-gas chromatography-flame ionization detector (HS-GC-FID). The previously reported bacterial and yeast models were applied in the cultured samples and in blood from 122 autopsy cases. Our results showed that 1-propanol was not produced by C. albicans and E. faecalis under certain conditions. Also, 1-butanol was not produced by C. albicans, E. faecalis, and K. pneumonia under certain conditions. Furthermore, the bacterial models were applicable in postmortem samples irrespective of the microbes that were possibly activated in the sample, while the EC models showed the best applicability among all the bacterial and yeast models. The best applicability of the bacterial models was observed in autopsy blood with 0.10 g/L < BAC < 1.0 g/L in cases of violent and undetermined causes of death and in cases with putrefaction. Finally, the yeast models were applicable in limited, possibly special, autopsy cases. In conclusion, it could be inferred that the source of ethanol in any given postmortem blood sample is likely microbial if either most bacterial models or at least one model from each distinct bacterial species is successfully applicable.

2000 Cause of death amongst frail and non-frail older people post-hospital admission in northern Tanzania

Abstract Introduction Verbal autopsy (VA) is a tool used to determine cause of death (COD) in regions lacking routine medical certification. Automated algorithms are widely used to interpret VA data. This study aimed to investigate potential differences in COD between frail and non-frail older people in northern Tanzania. Method This work forms part of a longitudinal study investigating the clinical outcomes of 308 consecutive adults aged ≥60 years following admission to four hospitals in northern Tanzania. Frailty status was established on admission using the Clinical Frailty Scale (CFS) and dichotomised with CFS ≥5 indicating frailty. For participants who passed away in the 10-12 months following admission, VA data were collected through telephone interview using the 2022 World Health Organization (WHO) VA instrument. COD estimates were established using the SmartVA-Analyze program, implementing the Tariff 2.0 Method. Results After a mean follow-up period of 10.8 (±0.9) months, VA data were available for 69 participants. At admission screening, 51 (73.9%) were frail, while 18 (26.1%) were non-frail. SmartVA produced COD estimates for 42 (60.9%) participants, while 27 (39.1%) remained undetermined. Cause Specific Mortality Fractions (CSMFs) for non-communicable disease were higher for those with frailty than the non-frail group (70.6% vs. 54.0%, respectively). An undetermined COD was more likely in those with frailty. Of the 27 undetermined COD, 22 (81.5%) were attributed to frail individuals and 5 (18.5%) to non-frail. These undetermined COD represent 43.1% of frailty-related deaths and 27.8% of non-frailty-related deaths. Conclusions Older people with frailty living in Tanzania are more likely to die from non-communicable diseases compared to non-frail older people. Although employing SmartVA to analyse VA data from this population was feasible, it faced challenges ascribing COD to all participants. This limitation may be due to the multi-morbidity often present in older populations where multiple factors combine to cause mortality.

The importance of fetal autopsy: An institutional review and development of best practices for reporting size and estimating gestational age at demise.

Fetal and neonatal autopsy offers critical insight into disease processes and clinical decision-making in reproductive medicine. Elucidating the cause of death and gaining a deeper understanding of the entities leading to fetal demise aids in anticipatory guidance for physicians and patients. Accurate assessment of growth and dating of fetuses is an important aspect of classifying pathology in the fetal and neonatal population. This study aims to optimize the autopsy approach to sizing and dating discrepancies, in addition to exploring the current trends in causes of stillbirth, with respect to placental, fetal/neonatal, and maternal factors, and rates of cases that remain undetermined after autopsy. A single-institution retrospective review of autopsy reports from mid-2008 through 2021 revealed 243 complete perinatal autopsy examinations. Placental cause of demise was identified in 46% of cases. Cause of demise was undetermined in 22% of cases. Evaluation of a subset of cases exposed minimal to no reporting of size and/or dating discrepancies in almost half of cases with undetermined cause of death. "Best practice" suggestions for sizing and dating fetuses/neonates in the postmortem period have been developed to aid in delivering clear, consistent reports. Because fetal and neonatal autopsy is an invaluable tool for understanding the factors that contribute to stillbirth, it is important to use appropriate sizing and dating methods and consistent language to deliver proper patient education and clinical guidance.

Causes of death of patients with non-valvular atrial fibrillation in Asians.

The aim of this study was to determine the causes of death among Asian non-valvular atrial fibrillation (AF) patients who were registered in a nationwide AF registry, and to investigate the differences in the causes of death in AF patients compared between those who were taking and not taking oral anticoagulant (OAC). The COhort of antithrombotic use and Optimal INR Level in patients with non-valvular Atrial Fibrillation in Thailand (COOL-AF) study enrolled non-valvular AF patients from 27 centers in Thailand during 2014-2017 to create the COOL-AF Thailand registry. Cause of death was classified as cardiovascular (CV) death, non-CV death, or undetermined cause of death. All events were evaluated and verified by an independent adjudication committee. There was a total of 3,405 patients (mean age: 67.8 years, 41.8% female), and the mean follow-up duration was 31.8±8.7 months. Three hundred and eighty patients (11.2%) died during follow-up. CV death, non-CV death, and undetermined cause accounted for 121 (31.8%), 189 (49.7%), and 70 (18.4%) patients, respectively. Of those with a known cause of death, heart failure (10%), intracranial hemorrhage (ICH; 10%), sudden cardiac death (6.8%), and ischemic stroke (5.8%) were the most often observed causes of death. Concerning non-CV death, infection/sepsis (27.7%), cancer (5.5%), respiratory (5.2%), and major bleeding (4.5%) were the most prevalent causes of death. The use and type of OAC were found to be major determinants of ICH and major bleeding incidence. Death due to ischemic stroke was responsible for only 4.7% of all deaths in Asian AF patients. Non-CV death, such as infection/sepsis or malignancy, was more far more prevalent than CV death in Asian AF patients. An improved integrated care approach is needed to reduce the prevalence of non-CV death in Asian AF patients.

O PAPEL DA PERÍCIA MÉDICO-LEGAL EM COMPLICAÇÕES CIRÚRGICAS: RELATOS DE CASOS DE EMBOLIA GORDUROSA E LIPOABDOMINOPLASTIA

In these days, lipoabdominoplasty is an increasingly common surgery, but it is not free from complications, some of them serious which can lead to deaths with unclear causes. In the case of a fatal outcome, the practice of necropsy is used to elucidate cases of deaths of undefined causes. Fat embolism secondary to intraoperative surgical procedures is found to be the main reason for some of these deaths, such as those described in this report. Forensic expertise is an essential investigative step in understanding the causality of possible malpractice of some surgeons in aesthetic procedures and the outcome of undetermined causes of death.

Border Crosser Deaths in the Arizona-Mexico Desert: Data on Remains 2001-2020.

Increased enforcement at U.S.-Mexico border-crossing sites may lead migrants to cross in remote desert areas. We reviewed data on migrants' bodies found along the Arizona-Mexico border from 2001 to 2020. We analyzed causes of death, condition of bodies, age, and sex, and the relationship of deaths to enforcement (arrests) by U.S. Border Patrol. From 2001-2020, 3,378 border-crosser bodies were found in the desert. As enforcement increased, bodies were found in more remote areas and later stages of decomposition. Skeletonized bodies increased from 19% in 2001-2004 to 49.1% in 2017-2020. When the cause of death could be identified, exposure to the elements was the most common cause. Abrupt increases in arrests and deaths over the immediately preceding period of 2013-2016 occurred in 2017-2020. Undetermined cause of death and increased skeletonization became more common, indicating bodies are discovered later. Enforcement does not decrease individuals crossing the border; rather, individuals cross in more remote areas.

Autopsies judiciaires et expertises anatomopathologiques complémentaires : état des pratiques sur le ressort de la cour d’appel de Montpellier. Étude rétrospective de 630 autopsies

In France, pathological examination is not systematically required in forensic autopsies. The factors affecting the decision to carry out a pathological expertise have not yet been defined. The aim of this study was to describe in which conditions a pathological expertise was required after forensic autopsy by the high court of Montpellier. This study included and analyzed retrospectively all of the autopsy elements, of all forensic autopsies carried out over a year. These elements were classified: pre-autopsy, per-autopsy, and post-autopsy. A pathological expertise was required in 19.2% of 630 cases, among which 31% in a context of undetermined cause of death and in 14% of cases of determined causes of death. The forensic practitioner recommended a pathological expertise in 10 to 31% of autopsies. Overall, 64 pathological examinations were realized out of 121 recommended examinations (52.9%), this rate varied from 25 to 73% depending on the court. The magistrate tended to favor anatomopathological expertise in cases of determined causes of death, and in certain manner of death (80% homicide versus 35% natural). The pathologist's expertise enabled to change the cause of death in 22% of cases and the manner of death in 19%. The pathological approach was a major asset in the 65% of unknown manner of deaths and in the 20% of natural, whereas the expertise did not help in cases of homicides, suicides and accidents. The cause of death was modified in 5.6% of initially determined causes of death, against 42.9% in case of initially unknown cause. The use of pathologic examination in forensic autopsies is scarce and uneven. The factors resulting to its request are not directly linked to its scientific assets. A conjoint work between forensic and pathologist practitioners would be beneficial.

Carbon monoxide related deaths in Jeddah, Saudi Arabia: A forensic carboxyhemoglobin autopsy-based study

Carbon monoxide (CO) poisoning is a prevalent global cause of death. This is the first epidemiological study investigating the relationship between CO poisoning (silent killer) and the cause of death in autopsy forensic samples received from 2009 to 2020 at the Poison Control and Forensic Medical Chemistry Center, Jeddah, Saudi Arabia. MethodsThe cause of death was classified based on the carboxyhemoglobin saturation level (COHb) in the postmortem blood samples. In 170 post-mortem cases, the level of COHb was positive. The double-wavelength spectrophotometric method was used to quantify the COHb and the samples were confirmed by another spectrophotometer techniques AVOXmeter 4000 system. ResultsJust more than half (58%) of the deaths were due to CO intoxication, and the median level of the COHb in the postmortem blood samples was 56%. The study confirmed that the cause of the death in 15% of the sample were classified as CO-related intoxication (median COHb 21%), and 27% had no relation with CO intoxication or undetermined cause of death (COHb level ≤ 10%). The manner of death was classified as accidental, suicidal, homicidal, natural or unknown cause of death. The majority (72%) of the causes of death was accidental death, 10% due to suicide, 4% to homicide and 5% to natural death with no relationship to CO poisoning. The manner of deaths were unknown in 15 cases due to a lack of information. ConclusionAlthough CO poisoning globally appears to decline, the rate in Jeddah remained stable through the study period. Safety and preventive educational interventions are required to reduce CO poisoning.

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

BackgroundThe majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.MethodWe conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.ResultsOf the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.ConclusionStandardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.

Frequency, Regional Variation, and Predictors of Undetermined Cause of Death in Cardiometabolic Clinical Trials: A Pooled Analysis of 9259 Deaths in 9 Trials.

Modern cardiometabolic clinical trials often include cardiovascular death as a component of a composite primary outcome, requiring central adjudication by a clinical events committee to classify cause of death. However, sometimes the cause of death cannot be determined from available data. The US Food and Drug Administration has indicated that this circumstance should occur only rarely, but its prevalence has not been formally assessed. Data from 9 global clinical trials (2009-2017) with long-term follow-up and blinded, centrally adjudicated cause of death were used to calculate the proportion of deaths attributed to cardiovascular, noncardiovascular, or undetermined causes by therapeutic area (diabetes mellitus/pre-diabetes mellitus, stable atherosclerosis, atrial fibrillation, and acute coronary syndrome), region of patient enrollment, and year of trial manuscript publication. Patient- and trial-level variables associated with undetermined cause of death were identified using a logistic model. Across 127 049 enrolled participants from 9 trials, there were 9259 centrally adjudicated deaths: 5012 (54.1%) attributable to cardiovascular causes, 2800 (30.2%) attributable to noncardiovascular causes, and 1447 (15.6%) attributable to undetermined causes. There was variability in the proportion of deaths ascribed to undetermined causes by trial therapeutic area, region of enrollment, and year of trial manuscript publication. On multivariable analysis, acute coronary syndrome or atrial fibrillation trial (versus atherosclerotic vascular disease or diabetes mellitus/pre-diabetes mellitus), longer time from enrollment to death, more recent trial manuscript publication year, enrollment in North America (versus Western Europe), female sex, and older age were associated with greater likelihood of death of undetermined cause. In 9 cardiometabolic clinical trials with long-term follow-up, approximately 16% of deaths had undetermined causes. This provides a baseline for quality assessment of clinical trials and informs operational efforts to potentially reduce the frequency of undetermined deaths in future clinical research.

Decreasing use of autopsy for stillbirths and infant deaths: missed opportunity.

We assessed whether the tendency towards decreasing use of fetal and infant autopsy was associated with a greater proportion of deaths in which the cause is never found. We computed autopsy rates over time for 13,466 stillbirths and 16,880 infant deaths in Quebec, Canada, 1981-2015. We assessed the proportion of deaths with an undetermined cause and determined the relationship with non-autopsy over time. Autopsy rates declined by 29% for stillbirths and 36% for infant deaths during the study. The proportion of non-autopsied cases with an undetermined cause of death increased only for stillbirths, however. Among non-autopsied stillbirths, the risk of having an undetermined cause of death was 1.64 times higher in 2005-2015 compared with 1981-1992 (95% confidence interval 1.25, 2.15). Greater use of autopsy has potential to minimize the number of stillbirths with an undetermined cause of death, and may be helpful for prevention.

Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young.

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.

Unnatural Deaths Among Children and Adolescents in Isfahan Province, Iran: A Forensic Epidemiology Study of Postmortem Data.

The issue of child and adolescent injury and violence is often absent from discussions and is largely invisible in public health policies. The purpose of this study was to describe the frequency and pattern of unnatural deaths during childhood and adolescence in Isfahan province in Iran. This retrospective, descriptive study involved unnatural deaths among individuals under the age of 20 years who died from unnatural causes as determined by a forensic autopsy at the Legal Medicine Center of Isfahan. During the study period, 8,010 unnatural deaths occurred, 1,222 of which were individuals under 20 years old. All 1,222 of these unnatural deaths were identified through autopsy. Among the 1,222 cases, 895 (73.2%) were male, and 327 were female (26.8%). Accidental deaths were found to be the most frequent manner of death comprising 1,029 (83.96%) cases, followed by suicide (120, 9.82%), undetermined cause of death (39, 3.19%), and homicide (9, 2.86%) cases. Road traffic accidents were the number 1 cause of death (597, 49%), followed by burns (122, 10%) and hanging (90, 7.4%). Injuries and violence that occur during childhood and adolescence represent a global public health problem, especially in low- and middle-income regions, and require urgent action.

Inequality in Fetal Autopsy in Canada.

Inequality in use of fetal autopsy is poorly understood, despite the importance of autopsy in establishing the cause of stillbirth for future prevention. We examined fetal autopsy rates between linguistic minorities in Quebec, Canada, and assessed trends over three decades. Using registry data on 11,992 stillbirths from 1981-2011, we calculated fetal autopsy rates for Francophones, Anglophones, and Allophones by decade. We found lower fetal autopsy rates for Allophones (54.4%) than Francophones (68.5%) and Anglophones (63.4%), but rates decreased over time for all language groups. After 2000, Allophones had 25% higher risk of non-autopsy relative to Francophones, with 8.8 fewer autopsies for every 100 stillbirths. Allophones who were not autopsied had 32% higher risk of having an undetermined cause of death. Inequality in use of fetal autopsy may be widespread for minorities in Canada. Efforts to decrease stillbirth in minorities may require policies to increase autopsy rates.

Mortality from undetermined causes of death in Russia and in selected countries

Deaths due to injuries and poisoning which experts cannot identify, such as homicide, suicide or accident, are registered in statistical databases as deaths due to an event of undetermined intent. The proportion of such deaths can indicate the quality of statistics on causes of death, above all of statistics on intentional self-harm and assaults. In Russia, the proportion of deaths due to events of undetermined intent among other external causes has been growing for almost four decades. Such a trend was observed in the past during periods of growing mortality from external causes. Yet the steady and long decline in mortality from external causes in Russia that began in 2003 has not stopped the trend. The displacement of other external causes continues, though mortality from events of undetermined intent has exceeded both suicide and homicide mortality, and its proportion has increased tenfold, reaching very high levels relative to those of other countries. In several studies done in Russia over the past decade, scholars have argued that such a high proportion essentially results from the manipulation of statistics on mortality from external causes, the so-called conversion of socially important causes of death to a latent form.&#x0D; The factors behind the persistent rise of the proportion of deaths due to events of undetermined intent (EUI) are analysed on the basis of a review of relevant research and long-term trends in mortality from external causes in Russia and selected developed countries. This makes it possible to expand the contextual framework of the discussion about the factors of the persistent growth of this “technical” indicator and about the hypothesis of the “natural” character of such dynamics.

FINDINGS IN RELATIVES OF VICTIMS OF SUDDEN UNEXPLAINED DEATH

Purpose: To review findings in close relatives of victims of sudden unexplained death (SUD) with “undetermined cause of death” or newly identified cardiomyopathy.MethodMedical examiners advised families of victims of SUD to contact our cardiology clinic for evaluation.ResultsBetween March 2010 and October 2013, medical examiners identified 27 SUD victims probably resulting from cardiac arrhythmia (17 male, age 2 - 64, mean 38 years, 5 under 18 years) with unrevealing autopsy results (16), RV cardiomyopathy (8) and LV cardiomyopathy (3).Families of 15 deceased (10 male, age 2 - 52, mean 31 years, 5 under 18 years) sought clinical evaluation. Four deceased collapsed with exertion (3 unrevealing autopsy, 1 RV cardiomyopathy) and 11 died in sleep or at rest (6 unrevealing autopsy, 3 RV cardiomyopathy, 2 LV cardiomyopathy). Subsequently, 33 family members (8 males, age 0.2 - 67, mean 27 years, 11 under 18 years, 31 first degree relatives) were evaluated in the clinic with diagnostic tests appropriate for suspected familial disorder. One 64 year old woman was diagnosed with hypertrophic cardiomyopathy; autopsy in a 39 year old son showed hypertrophic cardiomyopathy. Two patients had borderline QT intervals of less than 500 ms and 2 had frequent premature ventricular beats (“undetermined cause of death” in the related deceased). One patient had mild segmental left ventricular dysfunction by MRI (RV cardiomyopathy in the deceased brother).ConclusionClinical evaluation of SUD victims’ relatives referred by medical examiners is effective in diagnosing arrhythmogenic conditions in other family members. Purpose: To review findings in close relatives of victims of sudden unexplained death (SUD) with “undetermined cause of death” or newly identified cardiomyopathy. MethodMedical examiners advised families of victims of SUD to contact our cardiology clinic for evaluation. Medical examiners advised families of victims of SUD to contact our cardiology clinic for evaluation. ResultsBetween March 2010 and October 2013, medical examiners identified 27 SUD victims probably resulting from cardiac arrhythmia (17 male, age 2 - 64, mean 38 years, 5 under 18 years) with unrevealing autopsy results (16), RV cardiomyopathy (8) and LV cardiomyopathy (3).Families of 15 deceased (10 male, age 2 - 52, mean 31 years, 5 under 18 years) sought clinical evaluation. Four deceased collapsed with exertion (3 unrevealing autopsy, 1 RV cardiomyopathy) and 11 died in sleep or at rest (6 unrevealing autopsy, 3 RV cardiomyopathy, 2 LV cardiomyopathy). Subsequently, 33 family members (8 males, age 0.2 - 67, mean 27 years, 11 under 18 years, 31 first degree relatives) were evaluated in the clinic with diagnostic tests appropriate for suspected familial disorder. One 64 year old woman was diagnosed with hypertrophic cardiomyopathy; autopsy in a 39 year old son showed hypertrophic cardiomyopathy. Two patients had borderline QT intervals of less than 500 ms and 2 had frequent premature ventricular beats (“undetermined cause of death” in the related deceased). One patient had mild segmental left ventricular dysfunction by MRI (RV cardiomyopathy in the deceased brother). Between March 2010 and October 2013, medical examiners identified 27 SUD victims probably resulting from cardiac arrhythmia (17 male, age 2 - 64, mean 38 years, 5 under 18 years) with unrevealing autopsy results (16), RV cardiomyopathy (8) and LV cardiomyopathy (3). Families of 15 deceased (10 male, age 2 - 52, mean 31 years, 5 under 18 years) sought clinical evaluation. Four deceased collapsed with exertion (3 unrevealing autopsy, 1 RV cardiomyopathy) and 11 died in sleep or at rest (6 unrevealing autopsy, 3 RV cardiomyopathy, 2 LV cardiomyopathy). Subsequently, 33 family members (8 males, age 0.2 - 67, mean 27 years, 11 under 18 years, 31 first degree relatives) were evaluated in the clinic with diagnostic tests appropriate for suspected familial disorder. One 64 year old woman was diagnosed with hypertrophic cardiomyopathy; autopsy in a 39 year old son showed hypertrophic cardiomyopathy. Two patients had borderline QT intervals of less than 500 ms and 2 had frequent premature ventricular beats (“undetermined cause of death” in the related deceased). One patient had mild segmental left ventricular dysfunction by MRI (RV cardiomyopathy in the deceased brother). ConclusionClinical evaluation of SUD victims’ relatives referred by medical examiners is effective in diagnosing arrhythmogenic conditions in other family members. Clinical evaluation of SUD victims’ relatives referred by medical examiners is effective in diagnosing arrhythmogenic conditions in other family members.

Medicolegal autopsies in children: Experience of a department of Legal Medicine in Brazil

Purposes: The purpose of this study was to determine the pattern of mortality in children’s Federal District. Knowledge of the epidemiology of injuries is essential for planning, implementation and evaluation of preventive measures. Methods: We analyzed the forensic examination documents of all children under 12 years sent to the IML-DF, during 2010. The data analyzed included age, gender, cause of death (i.e.natural or external), mechanism of death (traffic accident, asphyxia, firearm injuries, poisoning, heat injuries) and the medical cause of death. Results: A large number of children (n = 123 total; n = 71 males, n = 52 females) were examined in the IML-DF, Brasilia, Brazil. Mean age was 37.96 months, with a median of 12 months, and 21% of children were younger than 1 month. There were 62 cases (33 males and 29 female) classified as natural deaths. The average age for natural deaths was 18.72 months. Most cases of natural death occurred in the first year of life (n = 50), being prevalent in the first month of life (n = 24). Among the 62 cases analyzed, six were stillborns, 13 suffered intrauterine fetal distress (e.g. placental insufficiency, prematurity and meconium aspiration), 36 had lung problems (e.g. Acute respiratory distress syndrome (ARDS), bronchopneumonia, pulmonary hemorrhage, interstitial pneumonitis and infant respiratory distress syndrome (IRDS)), five had neurologicalproblems (e.g. hydrocephalus, hydranencephaly,convulsive seizures and meningitis) and two had undetermined cause of death. There were also isolated cases of heart disease, leukemia, diabetic ketoacidosis, peritonitis causedby acute appendicitisand amniotic bandsyndrome. There were 61 cases of deaths from external causes, as a consequence of the following: blunt instrument, firearm, physical agent (i.e.heat), physicochemical agent (i.e.asphyxia) and chemical agent (i.e.poisoning). Conclusions: The profile of deaths from external causesin this developing country follows a trend similar to trends reported in the literature for other developing countries. The majority of deaths are accidental, with traffic accidents being the most frequent cause, followed by asphyxia (i.e.aspiration of gastric contents and drownings). Sporadic cases of poisoning, injuries from firearms, accidents and fires also occur.