Death Victims Research Articles

Abstract 12452: Relation of T-Wave Morphology And P-Wave Morphology Parameters With Left Ventricular Fibrosis in Sudden Cardiac Death Victims

Introduction: T-wave morphology and P-wave morphology have been observed to have prognostic significance. However, data about their relation with arrhythmic substrate represented by left ventricular fibrosis are limited. Methods: We evaluated associations of T- and P-wave morphology parameters analyzed from the standard 12-lead ECGs with left ventricular fibrosis in 379 victims of unexpected sudden cardiac death who underwent medico-legal autopsy. Results: T-wave and P-wave area dispersion (TWAd, PWAd) (low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS, P_NonDipolarABS) (high values abnormal) all had a significant association with left ventricular fibrosis (p=0.008, p=0.011, p=0.027, p=0.005 between the groups with different stages of left ventricular fibrosis, respectively, post hoc Bonferroni p-values are shown in Figures). Conclusions: Abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.

Left ventricular non-compaction cardiomyopathy associated with the PRKAG2 mutation

Left ventricular non-compaction cardiomyopathy (LVNC) is one of the most common inherited cardiovascular diseases. The genetic backgrounds of most LVNC patients are not fully understood. We collected clinical data, family histories, and blood samples and performed genetic analysis using next-generation sequencing (NGS) from a Chinese family of 15 subjects. Clinically LVNC affected subjects showed marked cardiac phenotype heterogeneity. We found that these subjects with LVNC carried a missense heterozygous genetic mutation c.905G>A (p.R302Q) in γ2 subunit of AMP-activated protein kinase (PRKAG2) gene through NGS. Individuals without this mutation showed no symptoms or cardiac structural abnormalities related to LVNC. One subject was the victim of sudden cardiac death. To sum up, PRKAG2 mutation c.905G>A (p.R302Q) caused familial LVNC. Our results described a potentially pathogenic mutation associated with LVNC, which may further extend the spectrum of LVNC phenotypes related to PRKAG2 gene mutations.

Mitral valve abnormalities in decedents of sudden cardiac death due to hypertrophic cardiomyopathy and idiopathic left ventricular hypertrophy

Abstract Background The sole identification of left ventricular hypertrophy (LVH) in a young individual that died suddenly may often lead to an erroneous diagnosis of hypertrophic cardiomyopathy (HCM). Emerging data suggests that idiopathic LVH (ILVH) and HCM may be separate entities. Aim We aimed to report on the prevalence and nature of mitral valve (MV) abnormalities, in a cohort of sudden cardiac death (SCD) victims with a post-mortem examination consistent with HCM and ILVH. Methods We reviewed 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre between 1994 and 2020. SCD was defined as death from a cardiovascular cause within 12 hours of apparent well-being. HCM was defined by the presence of LVH, in the absence of abnormal loading conditions and characterised by myocyte disarray at histology. ILVH was defined as unexplained LVH (heart weight >500 g in males and >400 g in females) and left ventricular (LV) wall thickness >15mm, in the absence of myocardial disarray or secondary causes of LVH. The MV was examined for patency, circumference, thickening, nodularity, ballooning, bulging between cords, perforation, and the presence of impact lesions in the LV outflow tract (LVOT) and aortic outlet. Results Of the total cases of SCD, 264 (4%) were due to HCM (mean age 41±18 years, 78% males, LV maximal wall thickness 19±6 mm) (Figure 1). Ante-mortem symptoms were reported in 44 (17%) cases and for the majority (n=217, 82%) HCM was established at post-mortem. Death was attributed to ILVH in 253 (3%) cases (mean age 43±16 years, 80% males, LV maximal wall thickness 18±4 mm). MV abnormalities were found in 58 (22%) decedents with HCM (mean age 38±17 years; 72% males) and in 13 (5%) decedents with ILVH (mean age 55±15 years; 77% male), p<0.001. Amongst the 58 (22%) cases with HCM and MV abnormalities, 15 (6%) cases had multiple MV abnormalities. These included impact lesions associated with thickening of the anterior leaflet of the MV (n=39) and degenerative changes (n=34) such as bulging and ballooning; and thickening and nodularity. Decedents with HCM exhibiting MV abnormalities were younger than decedents with a normal MV (38±17 versus 45±19 years; p=0.08). Among the 253 decedents with ILVH, 13 (5%) cases exhibited MV abnormalities, which largely included degenerative changes (n=12). Among decedents with HCM and ILVH exhibiting MV abnormalities, the former was significantly younger (38±17 versus 55±15; p=0.001). Myocardial fibrosis was observed in 162 (61%) cases of HCM and 99 (39%) cases of ILVH, p<0.001. Conclusions MV abnormalities are over four-fold more common in individuals with HCM than those with ILVH and may be considered as additional macroscopic features to differentiate between these two entities. Furthermore, the inherent descriptive terminologies used when assessing the MV, support a greater emphasis on the standardisation and quantification of MV abnormalities as part of the autopsy in victims of SCD. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Acknowledgements: We thank the charitable organisation, Cardiac Risk in the Young (CRY) who fund and support the CRY Cardiovascular Pathology Unit and CRY database.

Obesity in young sudden cardiac death: rates, clinical features, and insights into people with body mass index >50kg/m2

Abstract Background Obesity is common in young sudden cardiac death (SCD) victims but it is unclear whether it is more common than in the general population. This study aimed to contextualize young SCD obesity rates, identifying clinical and pathologic features in WHO class II and III obesity. Methods A prospective state-wide out-of-hospital cardiac arrest registry included all SCDs in Victoria, Australia from 2019–2021. Body mass indices (BMIs) of patients 18–50 years were compared to age-referenced general population. Characteristics of SCD patients with WHO Class II obesity (BMI ≥30kg/m2) and non-obesity (BMI <30kg/m2) were compared. Clinical characteristics of people with BMI >50kg/m2 were assessed. Results 504 patients were included. Obesity was strongly over-represented in young SCD compared to the age-matched general population (55.0% vs 28.7%, p<0.0001). Obese SCD patients more frequently had hypertension, diabetes and obstructive sleep apnoea (p<0.0001, p=0.009 and p=0.001 respectively), ventricular fibrillation as their arrest rhythm (p=0.008) and left ventricular hypertrophy (LVH) (p<0.0001). Obese patients were less likely to have toxicology positive for illicit substances (22.0% vs 32.6%, p=0.008) or significant alcohol history (18.8% vs 26.9%, p=0.030). Patients with BMI >50 kg/m2 represented 8.5% of young SCD. LVH (n=26, 60.5%) was their predominant cause of death and only 10 (9.3%) patients died from coronary disease. Conclusion Over half of young Australian SCD patients are obese, with all obesity classes over-represented compared to the general population. Obese patients had more cardiac risk factors. Almost two thirds of patients with BMI>50 kg/m2 died with LVH, with fewer than 10% dying from coronary disease. Funding Acknowledgement Type of funding sources: None.

Different clinical and pathological profiles of sudden cardiac death victims caused by coronary artery dissection or myocardial infarction with non-obstructed coronary arteries

Abstract Background Spontaneous coronary artery dissection (SCAD) is a potential cause of acute coronary syndrome and sudden cardiac death (SCD). Coronary fibromuscolar dysplasia (FMD) has been correlated to SCAD occurrence.The prevalence of SCAD and FMD among SCD victims are unclear. Myocardial infarction with non-obstructed coronary arteries (MINOCA) could represent a cause of SCD. Since SCAD could clinically manifest as acute myocardial infarction, expert consensus documents have often considered SCAD as a subtype of MINOCA (1,2), but studies which address direct comparison between these two conditions are lacking. Purpose To assess characteristics of decedents with SCAD and/or FMD found at autopsy, and to compare their clinical and pathological profile with MINOCA SCD victims. Methods We reviewed a database of 5325 consecutive cases of SCDs referred to our cardiac pathology center between 1994 and July 2017. Results We identified 21 (0.4%) with SCAD and 37 (0.7%) victims with MINOCA (3), whereas FMD was found only in 2 (0.04%). SCAD decedents were females in 81%, versus 38% of MINOCA (p=0.02). No signs of coronary FMD were found among SCAD and MINOCA victims. Necrotic myocardium was identified in the totality of MINOCA and only in 8 (38%) of SCAD decedents (p<0.001). Pre-mortem cardiac symptoms were present in 100% of SCAD and 49% of MINOCA victims (p<0.001); illicit drug use was reported in none of SCAD versus 46% of MINOCA decedents (p=0.001). Conclusions SCAD is a rare cause of SCD. Compared to MINOCA, SCAD victims are more frequently females, always experienced pre-mortem cardiac symptoms and have no habit of substances abuse. At autopsy coronary FMD is not present among SCAD victims. SCAD and MINOCA shows different clinical and pathological profile. SCAD should not be considered a subtype of MINOCA. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cardiac Risk in the Young (CRY) and the Charles Wolfson Charitable Trust.

Impact of prison security level on mortality

Impact of prison security level on mortality

Social Disparities among Sudden Death victims with HIV.

Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15-5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08-33.7) or divorced (aOR: 4.71, 95% CI: 1.04-21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.

Pertanggungjawaban Pidana bagi Anak Pengendara Mobil yang Menyebabkan Kematian Pengguna Jalan (Studi Putusan No. 26/PID.Sus-Anak/2019/PN.Jayapura)

Legal responsibility between adults and children is certainly different. Children violate legal provisions, they must still be held legally responsible by taking into account the best interests of the child. Diversion is the right treatment to be applied to children as a crime in accordance. In the case in Decision No. 26/PID.Sus-Anak/2019/PN.Jayapura there was a child as the perpetrator of a traffic accident, resulting in the victim's death. The judge instead imposed a sentence of 1 year against the perpetrator. Based on this, of course it becomes a legal problem and should be explored regarding the judge's consideration in the decision. The appropriate form of criminal liability should also be explored. This type of research is normative juridical, with a statutory, conceptual, and regulatory approach, and uses the literature study method. The results showed that the judge handed down the decision based on the consideration that the perpetrator's actions complied with Article 310 Paragraph (4) UU LLAJ. The form of criminal responsibility for children as perpetrators is to pay attention to the UU SPPA, which is in the form of diversion in accordance with the UUPA. Restorative values are put forward in handling the case, for the sake of the child's psyche and survival, losses that can still be handled properly, and also minimize the emergence of community or other criminal acts committed by children as perpetrators which is certainly disturbing. Parents have an important role in this.

A case study: High resolution optical mapping of a 19 year old male victim of sudden cardiac death during a marathon

Fifty thousand athletes suffer sudden cardiac death every year due to ventricular fibrillation (VF). Most sudden cardiac deaths of young patients have unexplained origin due to the absence of structural or electrical disease. Purkinje network is essential for a normal heart function, however, its role during electrical pathologies remains unclear. A case study to investigate the electrophysiological properties and the Purkinje network role in a 19 years old male after suffering a fatal sudden cardiac arrest during a marathon event. A coronary-perfused left ventricular preparation was imaged using high resolution optical mapping of epicardial and endocardial surfaces using a voltage-sensitive dye, Di-4-ANEPPS. Activation time, repolarization time and action potential duration were assessed during paced activity through the His bundle and endocardial and epicardial surfaces. Conduction system activation origins were identified as distant endocardial origins during His bundle pacing. Short-coupled S1S2S3S4 pacing was used to determine effective refractory period (ERP). Pacing protocols were repeated in the presence of isoprenaline (ISO) at 100 nM, 500 nM and 1 μM to mimic stress conditions. No changes in total activation time are observed during myocardial pacing cycle lengths of 667ms in control (63ms) and under ISO (up to 64ms). In contrary, His-ventricle delay during conduction system pacing was shorted from 61ms in control to 42ms, 44ms and 16ms under 100 nM, 500 nM and 1 μM of ISO respectively. Under His pacing, local APD gradients are observed near Purkinje-muscle junctions under ISO (from 3ms/mm and 3 ms/mm to 40ms/mm and 41ms/mm). ERP under His pacing was 55ms shorter than endocardial pacing. 82% of the ectopy origins observed have less than 4 mm distance from the PMJs. Repeated focal activations were observed during VF and 76% of them had less than 4 mm distance from PMJs. No structural abnormalities were identified under 9.4 T MRI. Conduction system electrical abnormalities play a role in arrhythmogenicity and maintenance of VF in this patient during sudden cardiac death.

Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry)

Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

Surveillance for Violent Deaths - National Violent Death Reporting System, 42 States, the District of Columbia, and Puerto Rico, 2019.

PROFILE OF SEXUAL VIOLENCE CASE AGAINST CHILDREN EXAMINED IN LANGSA GENERAL HOSPITAL IN 2019 – 2020

Background: News regarding violence against children spread in the mass media is enough to make people surprised. Cases of violence against children are still an iceberg phenomenon. This is because most children who are victims of sexual violence are reluctant to report it. In 2016, KPAI recorded 120 cases of violence against children. Then in 2017, there were 116 cases. Children are very vulnerable to threats of sexual violence due to their need of protection from adults. Almost all perpetrators of sexual violence against children are carried out by those closest to them and are usually favored, such as family members, relatives, neighbors, friends of fathers or mothers or peers. Methods: This research is descriptive with a cross sectional approach which aims to determine the profile of cases of sexual violence against children examined in Langsa General Hospital in 2019 - 2020 which was carried out in Langsa Hospital, Langsa City from August 2021 to October 2021. The population of this study was all data of cases of violence against children examined at the Forensic and Medicolegal Installation of Langsa Hospital in Langsa City in 2019 to 2020 with a sample of all data on cases of sexual violence against children examined at the Forensic and Medicolegal Installation of Langsa General Hospital in 2019 to 2021 using the method of total sampling. The inclusion criteria were data examined at the Forensic and Medicolegal Installation of Langsa General Hospital in Cases of Sexual Violence against Children in Langsa City in 2019 to 2020 which includes gender, education, type of tear, relationship between victim and perpetrator. The exclusion criteria were the Examined Data In the Forensic and Medicolegal Installation of Langsa Hospital in cases of violence against children in Langsa City, in 2019 to 2020 victims of abuse, victims of traffic accidents, victims of death. In this study, the variables studied were: (1). Gender (2). Education (3). Type of tear (4). Relationship between the victim and the perpetrator. Conclusion: Most victims of sexual violence were 88.5% female (23 cases), 65.38% (17 cases) in school category with the type of tear that was 34.8% old tear (8 cases), and the relationship between the victim and the perpetrators in the known category was 88.5% (23 cases).

Psychological Support for Mothers Victims of Perinatal Death by Caregivers: Case of the Regional Hospital Center (RHC) of Yamoussoukro

The loss of a baby during the perinatal period leads to a real grieving process for mothers since they establish an attachment bond with their baby before birth. If relatives and environment bereaved underestimate this particular type of bereavement and its potential impact, this should not be the case for nursing staff. And yet, in African maternities, there are very few psychological support for mothers who are victims of perinatal death. Perinatal bereavement deserves to be analyzed in all its complexity. The aim of this study is to show the importance of psychological support for mothers who are victims of perinatal death in the prevention of negative impact on the mental health of mothers.
 Quantitative and qualitative data are collected on a sample of 55 selected mothers through a purposive non-probability sampling strategy.
 Quantitative data are processed with SPSS 20 software. Text processing as well as tables and graphs were produced with Word 2016 and Excel 2016 software. The results indicate on the one hand that the psychological support provided by the nursing staff reduces the harmful effects of perinatal bereavement on mothers and on the other hand, the need for the establishment of a support protocol for couples in health facilities.
 Keywords: perinatal death, bereavement, mothers, psychological support.

Analisis Karakteristik Perjalanan dan Moda Transportasi Pelajar di Kota Padang untuk Mengurangi Angka Kecelakaan Lalulintas

Motorcyclists involved in 74% road traffic accidents (RTA) in Indonesia and the majority were students. WHO reported that 74% of RTA death victims were motorcyclists. This research aimed at analysing student trip and mode characteristics by using Revealed Preference survey. Majority of students were found using motorcycles due to travel time and cost. Average travel and waiting times are 18.5 and 0.1 minutes. Average travel cost varies between Rp.3750-Rp.4950. The ratio between students categorized as captive and choice users are 75%;25%. Majority of students depart before 07.00 AM and end their trips before 3 PM. In order to encourgae students to shift to public transport, the Trans Padang service is recommended to be integrated with parking facilities which is the direction of the future research.

Discrimination of white automotive paint samples using ATR-FTIR and PLS-DA for forensic purposes.

The consequences of a hit-and-run car crash are significant and may include serious injuries to the victims, health system overload and even victim's death. The vehicle and driver identification are often challenging for local law enforcement. The aim of this study was to develop a methodology to discriminate between automotive paint samples according to the make of the vehicle and its color shade. 143 white samples (collected at traffic accident scenes) were analyzed in situ by Fourier transform infrared spectroscopy with attenuated total reflectance (ATR-FTIR) and coupled microscopy. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were performed for data analysis. The samples were split into three groups: calibration set, validation set and external test set. The figures of merit were calculated to assess the quality of the model. Sensitivity, specificity, and efficiency rates were, respectively, 98,9%, 98.4% and 98.6%, for the calibration set. For the validation group, the classification accuracy was 100%. Correct classification rates for the internal validation set and external test set were 100% and 79.1% respectively. The technique is clean, fast, relatively low-cost, and non-destructive. Damaged regions of the samples were avoided by using the attached microscope. Limiting the age of the samples to a maximum of 10 years was enough to avoid misclassifications due to the natural degradation and weathering of the sample. Since the external test group is formed by underrepresented classes, its correct classification rate (79.1%) can be potentially improved at any time, by including and analyzing more samples.

Myocardial Inflammation and Sudden Death in the Inherited Cardiomyopathies.

The best studied of the inherited cardiomyopathies-hypertrophic (HCM), dilated (DCM) and arrhythmogenic (ACM)-present overlapping clinical phenotypes with varying, often unrecognized, risk of sudden death. Risk assessment is informed by patient sex and by the specific disease-causing variant. HCM and arrhythmogenic right ventricular cardiomyopathy (ARVC) remain important causes of sudden death. A phenotype mimicking DCM in patients with inherited ACM is associated with premature sudden death in families with overlapping DCM and ACM phenotypes. The role of inflammation as a determinant of disease development and progression and sudden death is poorly understood but potentially important. Sudden death registries report myocarditis as the cause in 5% to 13%; examination of 30 hearts from victims of ARVC sudden death found focal myocarditis in areas of myocyte necrosis in 20 (67%). The link to specific disease-causing variants remains to be explored, including genetic determinants of the immune response. Clinical and experimental studies support immune- and autoimmune-mediated disease in DCM and ACM. Immunosuppression in biopsy-proven noninfectious myocarditis and inflammatory DCM is a treatment option. Recognition of ACM requires greater focus on distinguishing ACM from DCM. The potential to recognize disease before adverse events and to characterize patients who may benefit from immunosuppression or device therapy highlights the importance of more comprehensive genetic and immunologic characterization of patients with myocarditis and in those with a family history or clinical presentation of an inherited cardiomyopathy. This review will examine from a predominantly clinical perspective the potential importance of myocardial inflammation as a determinant of sudden death in inherited HCM, DCM, and ACM.

La mort subite de l’adulte : les 10 ans du Centre d’Expertise Mort Subite (CEMS) de Paris

The aim of our study was to highlight the epidemiological difference in adult sudden death between males and females. The type of pathologies found in adult victims of sudden death was compared to control cases in order to determine the most significant pathologies involved in sudden death.Among all autopsies performed between 1995 and 2009, 534 adult cases of sudden death and 154 cases who violently died were respectively selected. For each case, a complete autopsy was carried out, including systematic histological examination of all major organs.The sudden death population was composed of 369 males and 165 females. There was no statistical difference regarding age between males and female. Sudden death took place more often at home in women than in men (p < 0.0001). A stressful event was more frequently found in men than in women (p = 0.03). Deaths caused by cardiovascular diseases were more frequent in males than in females, especially Coronary Artery Disease (CAD) (p < 0.0001). Cardiomyopathy was more often the cause of death in women, particularly Arrythmogenic Right Ventricular Cardiomyopathy (ARVC). Cardiac pathologies were found in 45% of the control cases. CAD and ARVC were statistically more frequent in the sudden death group than in the control group.According to our study, profile of sudden death is different between males and females. Those data seem to be important for clinicians involved in prevention programs of sudden death, as they can adapt their screening according to the gender.

ICP-MS Multi-Elemental Analysis of the Human Meninges Collected from Sudden Death Victims in South-Eastern Poland.

Metals perform many important physiological functions in the human body. The distribution of elements in different tissues is not uniform. Moreover, some structures can be the site of an accumulation of essential or toxic metals, leading to multi-directional intracellular damage. In the nervous system, these disorders are especially dangerous. Metals dyshomeostasis has been linked to a variety of neurological disorders which end up leading to permanent injuries. The multi-elemental composition of the human brain is still the subject of numerous investigations and debates. In this study, for the first time, the meninges, i.e., the dura mater and the arachnoid, were examined for their elemental composition by means of inductively coupled plasma mass spectrometry (ICP-MS). Tissue samples were collected post mortem from those who died suddenly as a result of suicide (n = 20) or as a result of injuries after an accident (n = 20). The interactions between 51 elements in both groups showed mainly weak positive correlations, which dominated the arachnoid mater compared to the dura mater. The study showed differences in the distribution of some elements within the meninges in the studied groups. The significant differences concerned mainly metals from the lanthanide family (Ln), macroelements (Na, K, Ca, Mg), a few micronutrients (Co), and toxic cadmium (Cd). The performed evaluation of the elemental distribution in the human meninges sheds new light on the trace metals metabolism in the central nervous system, although we do not yet fully understand the role of the human meninges.

BLACKSPOT IDENTIFICATION USING AEK AND BKA METHODS ON NATIONAL ROAD IN JAVA ISLAND

Traffic accidents tend to increase and are still the main problem in the implementation of road transportation in Indonesia, especially on the island of Java. Based on the results of the population census, in 2016, 2017 and 2018 the average population on the island of Java reached 148 million people. As much as 56.1% of the total population in Indonesia is concentrated on the island of Java. This has an impact on increasing mobilization and the need for transportation so that traffic accidents tend to increase. Based on secondary data from the Korlantas Polri, the number of accidents increased by 5% from 2016 to 2018. The lack of handling and repairs in traffic accident-prone locations is one of the causes of frequent traffic accidents. Therefore, greater attention is needed on locations where traffic accidents often occur in order to reduce the number of traffic accidents every year. This study aims to identify LRK on national roads in Java with a frequency of 2 events per year, analyze the characteristics of accidents using the Accident Equivalent Rate and Upper Control Limit method. Data on victims of Death (D), Serious Injury (SI), Minor Injury (MI) and Material Losses (ML) in 2016, 2017 and 2018 were obtained from the Korlantas Polri. Based on these data, the AEK value is calculated and analyzed to obtain LRK using the BKA method. The results of the analysis show that the total LRK in Java is 1301 LRK in 2016, 1278 LRK in 2017 and 1309 LRK in 2018 so that there are 1296 LRK on average per year. Analysis of traffic accident data using the AEK and BKA methods in 2016 obtained the highest AEK value found in the province of East Java with an AEK value of 277024 events; Central Java with an AEK value of 183813 events and West Java with an AEK value of 139677 events, therefore there are 3 provinces with the highest number of Accident Prone Location (LRK) in Java, namely East Java, Central Java and West Java.

Investigating the Source of Fatal Pulmonary Thromboembolism in a Coronial Postmortem Population.

The incidence of how often a deep vein thrombosis is found in the calves of the legs at coronial postmortem examination is unclear. This study retrospectively examined postmortem examination reports from Australian Coronial investigations of sudden death resulting from pulmonary thromboembolism to determine the likelihood of dissection of the deep veins of calves of the legs revealing the source of a pulmonary thromboembolism. From 450 cases taken from the National Coronial Information System (NCIS) for 2016, the postmortem reports of 327 cases were reviewed to provide demographic details of victims of sudden death from pulmonary thromboembolism. In 235 cases, it was possible to determine in 76.6% a thrombus had been found in the deep veins of the calves of the legs after dissection. In 141 cases, it was documented that both sides had been examined. From these, it was determined there was no statistically significant difference in the prevalence of thrombus in either side. However, it was shown that the presence of an abnormality of a lower limb (such as leg or hip infection, burns, surgery and nonoperated fractures, or a larger circumference) increased the likelihood that a deep vein thrombus would be found on that side.