Young Victims Research Articles

Better outcomes from exercise-related out-of-hospital cardiac arrest in males and in the young: findings from the Swedish Registry of Cardiopulmonary Resuscitation

BackgroundSurvival from out-of-hospital cardiac arrest (OHCA) is higher if the arrest is witnessed and occurs during exercise, however, there is contradicting data on prognosis with regards to sex and age....

Prostitute or human trafficking victim? Police discernment of human trafficking

PurposeIn 2018, the National Human Trafficking hotline received 275 cases of human trafficking in Pennsylvania, a higher than average portion of the 10,949 human trafficking cases received for the USA. Whether human trafficking victims receive services or enter the criminal justice system as prostitution offenders depends on how police identify them, as police officers are usually the first to interact with human trafficking victims. Thus, understanding how police identify human trafficking is important. The purpose of the study is to explore Pennsylvania police perceptions of human trafficking.Design/methodology/approachScenarios were presented in a survey to 489 Pennsylvania police officers.FindingsPolice training improved officer identification of human trafficking (vs prostitution) involving older victims. Officers with more tenure were less likely to identify older victims of human trafficking than officers with less tenure. However, older officers were better able to successfully identify older (i.e. age 25 years) victims of human trafficking, but officer age had no effect on identifying younger (i.e. age 15 years) victims of human trafficking. The implications are discussed in the study.Originality/valueThe study contributes to the literature by testing (1) whether training affects police ability to identify human trafficking victims in a scenario, controlling for other factors and (2) whether victim age affects officer identification of human trafficking victims. More officers correctly identified younger victims of human trafficking when force was explicitly stated, but more officers misidentified younger victims when force was not explicitly stated and older victims when force was explicitly stated.

Genetic Variants Associated With Sudden Cardiac Death in Victims With Single Vessel Coronary Artery Disease and Left Ventricular Hypertrophy With or Without Fibrosis

Objective: Cardiac hypertrophy with varying degrees of myocardial fibrosis is commonly associated with coronary artery disease (CAD) related sudden cardiac death (SCD), especially in young victims among whom patterns of coronary artery lesions do not entirely appear to explain the cause of SCD. Our aim was to study the genetic background of hypertrophy, with or without fibrosis, among ischemic SCD victims with single vessel CAD.Methods: The study population was derived from the Fingesture study, consisting of all autopsy-verified SCDs in Northern Finland between the years 1998 and 2017 (n = 5,869). We carried out targeted next-generation sequencing using a panel of 174 genes associated with myocardial structure and ion channel function in 95 ischemic-SCD victims (mean age 63.6 ± 10.3 years; 88.4% males) with single-vessel CAD in the absence of previously diagnosed CAD and cardiac hypertrophy with or without myocardial fibrosis at autopsy.Results: A total of 42 rare variants were detected in 43 subjects (45.3% of the study subjects). Five variants in eight subjects (8.4%) were classified as pathogenic or likely pathogenic. We observed 37 variants of uncertain significance in 39 subjects (40.6%). Variants were detected in myocardial structure protein coding genes, associated with arrhythmogenic right ventricular, dilated, hypertrophic and left ventricular non-compaction cardiomyopathies. Also, variants were detected in ryanodine receptor 2 (RYR2), a gene associated with both cardiomyopathies and catecholaminergic polymorphic ventricular tachycardias.Conclusions: Rare variants associated with cardiomyopathies, in the absence of anatomic evidence of the specific inherited cardiomyopathies, were common findings among CAD-related SCD victims with single vessel disease and myocardial hypertrophy found at autopsies, suggesting that these variants may modulate the risk for fatal arrhythmias and SCD in ischemic disease.

Into great silence: Pierre Péju’s La Petite Chartreuse, a contemporary tale of secular pilgrimage

AbstractLa Petite Chartreuse (2002), penned by the prolific yet understudied novelist and essayist Pierre Péju, charts an unlikely relationship in the wake of a devastating accident. As he walks the Massif de la Chartreuse in the shadow of the Carthusian Grande Chartreuse, a solitary bookseller searches inner depths and mountainous heights before confronting his eponymous young victim’s death—and his own. Informed by the hermeneutical relationship between tale and travel, this chapter reads the novel as a contemporary conte (as theorized by Péju himself), as well as a secular pilgrimage (informed, notably, by Thomas Merton). I contend that Péju’s secular antihero, within (rather than in spite of) physically circumscribed conditions, paradoxically scales spiritual heights epitomized by these two wayfaring narrative traditions. His tale offers a defense and illustration of reading in the face of modernity’s acceleration and dematerialization, challenges contemporary unease before suffering, and belies personal and narrative expectations like progress and harmonious closure. Ultimately, I suggest that Péju plots a profoundly humanistic voyage unto death, as he defamiliarizes the very terrain of these travel genres.

Post-mortem genetic investigation in sudden cardiac death victims: complete exon sequencing of forty genes using next-generation sequencing.

Sudden cardiac death (SCD) in young people is predominantly caused by genetic causes as cardiomyopathies. Hypertrophic cardiomyopathy is the most common genetic cardiovascular disease and is responsible for the major proportion of SCD in the young. The purpose of this study was to identify the genetic variants present in young SCD victims with HCM characteristics. From the Portuguese records of autopsies performed at the National Institute of Legal Medicine and Forensic Sciences, North Delegation, 16 young (16-50 years) SCD victims whose death was suspected to be a manifestation of HCM were selected. Using next-generation sequencing, the coding regions of 40 genes associated with HCM, candidates, or strongly related to HCM-phenocopies were investigated. The victims included in this study were all males, with a mean age of 33.4 ± 11.7 years, left ventricle mean thickness of 21.5 ± 6.28 mm, and the majority of deaths occurred during sleep (36%). A pathogenic or likely pathogenic variant was identified in six out of 16 (37.5%) victims, in the most common HCM genes (MYBPC3 and MYH7). Our results indicate that molecular autopsy of SCD victims contributes to a more precise identification of a cause of death, and this can be used in the prevention of SCD cases through family screening of first relatives who may carry the same pathogenic variant.

Supporting girls and young women victims of sexual harassment in schools: “me and you and everyone we know”

PurposeThis study aims to highlight an innovative project, across three European countries, namely, Italy, Sweden and Romania, that used pictorial designs to empower young women to demand the right to live without sexual harassment.Design/methodology/approach figures in terms of race and gender of young people were produced on cards, which allowed the imagination of the viewer to interpret and discuss these images freely. Other cards had definitions and scenarios. The cards generated discussion and comments both with the young participants and educational professionals.FindingsUsing the cards produced a rich set of responses from the students. Not all recognised that what was happening between young men and women was sexual harassment. There was a need to develop the concept of empathy and personal responsibility for behaviour and etiquette between the sexes. The response from professionals also varied in terms of sympathy and understanding.Research limitations/implicationsThe three countries had different degrees of openness to addressing sexual harassment of girls in schools. The results may not be generalisable to the UK and researchers would like to use the tool developed in other countries.Practical implicationsThe focus groups with young people in schools highlighted different attitudes towards sexual harassment in girls and young women, between the young women and young men, and the variations in the three countries. There was a need to educate professionals of the long-term impact of sexual violence and harassment.Social implicationsThe research revealed the importance of producing a tool (the cards), which enabled young people to discuss sexual harassment in a focused way. Young women will gain in confidence to challenge sexual and oppressive behaviour.Originality/valueThis paper gives a voice to young people to discuss an issue, sexual harassment, that is addressed to varying degrees in the countries involved. The competition for young people to produce posters led to some amazing creative ideas.

Prevalence and patterns of gender-based violence in Enugu, Nigeria: a cross-sectional study.

Introductiongender-based violence remains one of the most persistent human rights abuse in the world and with the emergence of the COVID-19 pandemic and its attendant mitigating protocols; Gender-based violence (GBV) could be on the rise with changes in its pattern and presentation. The aim of the study was to determine the prevalence and patterns of GBV among victims presenting in a tertiary health facility in South-East Nigeria during the first phase of the COVID-19 pandemic.Methodsthis was a retrospective cross-sectional study, among 710 victims of GBV, who reported and received care at the GBV unit in a tertiary hospital in Enugu, South-east Nigeria. A pro forma designed by the researchers was used to collect secondary data from GBV facility screening forms and folders of all patients that reported any form of GBV over a 3-year period (2018 - 2020).Resultsmajority (89.9%) of victims of GBV were females and over a half (51.4%) of the cases were in the age group 20-39 years. In total, 56.8% of the GBV cases had been sexually abused. The pattern of GBV over the three years period under study revealed an increase in proportion for both sexual and physical/emotional violence, with a peak in 2019 and a reduction of cases in 2020. Persons below 19 years of age were 23 times more likely to experience sexual violence, than those between 40-59 years of age (AOR: 23.332; 95% CI: 11.037 -49.325) p<0.001. Males were 11 times more likely to experience physical/emotional violence than females (AOR: 11.136; 95% CI: 4.685-26.471) p<0.001. Age, gender, urban dwelling and year of occurrence were significant predictors of GBV.ConclusionGBV is a cause for concern in Enugu Nigeria; affecting mainly young female victims in their prime. There is an increase in reported cases of GBV in Enugu Nigeria with sexual abuse being more prevalent.

Traumatic Diaphragmatic Injury at Gabriel Toure University Hospital, Mali

Traumatic diaphragmatic injury (TDI) is rare and is most often the result of a traffic road accident (TRA) or an assault. We initiated this study with the aims of determining the epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure University Hospital. This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5% of thoraco-abdominal traumas. The average age was 31.69 years with a sex ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%. Penetrating injuries accounted for 78.3% of cases. The parietal lesion was thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients, showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases). Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of cases. The surgical procedure consisted of reduction of the herniated viscera in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable sutures in 82.6% (36 cases). Chest tube drainage was performed in 73.9%. The average length of hospital stay was 9.8 days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare but its frequency is increasing in our country. It most often affects the young man victim of assault or TRA. This type of trauma is rarely isolated; you have to think about it in case of any thoraco-abdominal trauma. The treatment is surgical. The prognosis depends on the severity of the associated lesions.

Explaining Online Fraud Victimization of Older Adults via Cyber Routines and Lifestyles

Research examining age differences in affect reactivity (i.e. how much affective experiences change in response to stressors) has produced mixed results, suggesting that there are areas of relative strength and weakness in regulatory processes across age-groups. The present study’s goals were to examine potential age-group differences in affect reactivity and subjective task-appraisals across repeated exposures to a psychosocial laboratory stressor. In the Health and Daily Experiences (HEADE) study, younger (18-35 years old; n=107) and older adults (60-90 years old; n=90) were exposed to the Trier Social Stress Test on three occasions in a laboratory setting over a five-day period. Current affective experiences and task-appraisals were assessed at each session using validated self-report scales, with current affective experiences measured at baseline and task periods to determine affect reactivity. Repeated measures ANOVA analyses were conducted to examine age-group differences in affect reactivity and task-appraisals across sessions. In support of our hypotheses, younger adults showed greater reductions in their negative affect reactivity over time compared to older adults [F(2, 390)= 8.18, p<.001]. Additionally, younger adults’ appraisals of task-difficulty decreased [F(2, 384)= 14.79, p<.001] and appraisals of task-performance increased [F(2,384)= 13.39, p<.001] across sessions, while older adults’ task-appraisals remained stable. Age-group differences in negative affect reactivity and task-difficulty appraisals were not evident for the first session and only emerged after repeated exposure to the stressors. These results highlight the importance of identifying age-related vulnerabilities in adapting to repeated stressors, with implications for designing effective interventions aimed at improving health and well-being for older adults.

Predictors of Skeptical Responses to Disclosures of Childhood Sexual Abuse.

Victims of Childhood Sexual Abuse (CSA) may be met with skeptical responses when they disclose their experience. The fear of such a response means that most victims delay telling anyone about the abuse. The aim of this study was to explore how contextual factors of abuse such as victim gender and age, perpetrator gender, and victim-perpetrator relationship affect a response to CSA. Further, we explored what personality traits may predict a skeptical response. An online questionnaire with 357 undergraduate students asked participants to read a vignette describing CSA, and to indicate the extent to which they believed the vignette, whether they blamed the victim or perpetrator, and what punishment they would recommend for the perpetrator. Results indicated that older victims were less likely to be believed and more likely to be blamed than younger victims. Further, we found more blame was placed on a perpetrator of intrafamilial abuse compared with extrafamilial abuse, but only if the perpetrator was male. Female perpetrators were punished less harshly than male perpetrators, but female intrafamilal perpetrators received harsher punishment than female extrafamilial perpetrators. No such effect was found for male perpetrators. Openness to Experience was associated with a more supportive response to CSA, as was Agreeableness. Implications and future directions are discussed.

Sudden Cardiac Death

Background: Sudden cardiac death (SCD) remains a major open clinical and public health problem, with an estimated 300,000 deaths per year in the United States. The possibility of identifying potential SCD victims is limited by the large size of the large number of SCD victims and the apparent time-dependent risk of sudden death. The latter refers to the tendency of SCDs to detect other cardiovascular events during the most dangerous period of 6–18 months following a major cardiovascular event and the risk of subsequent collapse. The combination of time and lake size provides the basis for future research to find more vulnerable people. Pathologically, SCD can be seen as an interaction between some electrophysiological events that causes abnormalities in cardiac structure, temporal dysfunction, and malignant arrhythmias. Structural deformities represent an anatomical matrix of chronic risk and include the effects of electrophysiological anatomical abnormalities such as coronary artery disease, left ventricular hypertrophy, myopathic ventricles, and bypass leaflets in the myocardium.&#x0D; Conclusion: Macroscopic cardiac features are common in about one-third of young SCD victims. However, in 79% of them, histological studies reveal hidden pathological features such as local myocarditis, heart disease and motor system disorders. A total of 16 (6%) victims had no evidence of systemic heart disease and the mechanism of SCD was not described.

Factors associated with police shooting mortality: A focus on race and a plea for more comprehensive data.

ObjectivesTo quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality.MethodsWe gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009–14), Colorado (2010–19), Texas (2015–19), and California (2016–19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state.ResultsForty-five percent of these police shooting victims (N = 1,322) did not die. Black–white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed.ConclusionsRacial and age disparities in police shootings are likely more pronounced than previous estimates suggest.Policy implicationsOther states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings–which account for a large share of deadly force incidents–researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates.

595 Penetrating Pelvic Trauma from a Crossbow Bolt: An Unusual Choice of Weapon

Abstract Introduction The crossbow was a popular weapon in medieval times due to their relative ease of use and accuracy but was superseded by firearms around the 16th century. Today, it is legal for adults in the UK to own a crossbow without a licence. Case Report A young adult male victim was brought to a Major Trauma Centre with a single lower left quadrant penetrating wound caused a crossbow bolt that was self-removed immediately after the injury. A 2.5cm entry wound was present with no exit wound. The patient was haemodynamically unstable on arrival and was transferred to theatre without imaging within 16 minutes of arrival. The main operative findings were multiple small bowel serosal tears, a full thickness small bowel injury with no contamination and a left external iliac artery injury with active bleeding which were all repaired primarily. The post-operative recovery course included occlusive left cephalic and antecubital vein thrombi and an extensive non-occlusive left common femoral vein thrombus treated with anticoagulant therapy but was otherwise unremarkable. He was discharged 10 days later with no lasting sequelae at 6-week follow up. Discussion This case highlights a rare but important and likely underreported modality of penetrating injury. Crossbow bolts have low kinetic energy compared to bullets but high penetrative force, thus little energy is transferred to surrounding tissues. Hence the main injuries caused by crossbow bolts are due to direct damage to structures they come into contact with. Although rare, trauma surgeons should be aware of the pattern of injury caused by crossbows.

&lt;em&gt;The Serpent&lt;/em&gt; (2021)

&lt;em&gt;The Serpent&lt;/em&gt; (2021)

UNDERSTANDING CYBERCRIME AND YOUTH: A PERCEPTION BASED APPROACH

In recent years, the issue of cybercrime has overwhelmed everyone who is related to the internet in any capacity. Recent studies have shown that the incidents of cybercrime vastly involve youngsters, which has serious consequences for them as victims and as cyber offenders. The existing body of knowledge related to cybercrime focus upon various issues of internet in general and social media in particular. However, a thorough approach on the issues of cybercrime with relevance to youth is missing. Therefore, this study tries to fill this gap by offering youth and victim-based approach on the issues pertaining to cybercrime. For attaining this purpose, qualitative research approach was adopted in conducting this research project. Semi structured interviews were conducted with 40 young victims of cybercrime. The respondents were recruited through purposive sampling from district Peshawar of 18 to 25 years of age. Furthermore, the respondents were recruited from three clusters of district Peshawar namely Gul Bahar, Hayat Abad, and University town. Various dimensions of cybercrime and involvement of youth as victims and as criminals were explored. It can be concluded that the youth mostly experience cybercrime in the form of cyber bullying, blackmailing and hacking. Further, the findings suggest that many youngsters make their choices on social media and internet without being aware of cybercrimes and thus succumbed to cyber criminals. The participants also reiterated that lack of proper restrictions and policing have created a crime friendly zone for cyber criminals. Based on the findings and participant views, it is recommended that the government, relevant bodies, institutions, and all stake holders including youth should come forward and help in developing a research and technology driven policy backed by separate cybercrime policing system. Key Words: Cyber space, Cybercrime, Victimization, Cybercriminal, Youth

Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin: a forensic retrospective study in Shanghai, China

Carbon monoxide (CO) poisoning is a common cause of death, leading to morbidity and mortality worldwide. Features of the CO poisoning with low carboxyhemoglobin (COHb) levels remain to be characterized. This study collected a total of 307 CO poisoning cases from Shanghai Public Security Bureau, an official organization that handles the most complicated and life-threatening cases across Shanghai municipality in China, and regrouped these cases into three categories: group 1, 10% < COHb% < 30% (n = 58); group 2, 30% ≤ COHb% < 50% (n = 79); group 3, COHb% ≥ 50% (n = 170). Epidemiological, demographic, and forensic aspects of the CO poisoning cases, particularly those with low COHb levels, were analyzed. Our results showed that group 2 and 3 were mostly observed in younger victims (≤ 30 years), while group 1 equally distributed to all age groups (p = 0.03). All the CO poisoning from group 2 and 3 occurred in enclosed spaces, whereas cases from group 1 died additionally in outdoor spaces (p = 0.01). 81.03% of group 1 cases died in fire circumstances, while only 45.57% from group 2 and 30.59% from group 3 were fire-related (p = 0.00). Accordingly, group 1 was mostly related with fire burns, while group 2 or 3 were largely associated with gas leakage (p = 0.00). A combination with alcohol, but not other psychotropic drugs, associated with significant higher levels of blood COHb% in fire-unrelated (p = 0.021) but not fire-related cases (p = 0.23). Five extremely low COHb% (< 30%)-related poisoning deaths were negative of any cardiopulmonary pathology and psychoactive substances. In conclusion, CO poisoning with low COHb% significantly associates with fire circumstances and outdoor spaces and has no age preference. Further diagnostic markers mandates to be identified in order to avoid disputes in cases of extremely low COHb%-related poisoning.

Epidemiology of Eastern Massasauga (Sistrurus catenatus) Snakebites in the Great Lakes States, 1800-2015.

The eastern massasauga rattlesnake (Sistrurus catenatus) has the northernmost distribution of any venomous snake in the United States and presents a potential, but little-studied, risk to humans. We quantified the reported incidence of massasauga bites to humans in the Great Lakes states by searching historic and contemporary media reports between 1800 and 2015. We identified 848 reported massasauga bites across the region, most of which were concentrated along the border of Indiana and Michigan. The number of bites per decade increased into the late 1800s as human population increased; it then declined sharply in the 1900s, likely owing to declining massasauga population and habitat. The majority of bites were to adult males. There was no relationship between victim sex and age or activity when bitten. Most bites resulted from snakes the victims were unaware of, usually when individuals accidentally put their hands or feet near an unseen snake. Many bites, however, resulted from people intentionally interacting with a massasauga, such as attempting to capture or kill it. Fatality rates were lower among men than among women and were lower in adolescents than older or younger victims. No fatalities from massasaugas were reported after 1935. Fatality rates from massasauga bites reported herein should be interpreted with caution owing to the nature of the data we collected. In the modern era, massasauga bites are generally considered neither common nor life-threatening, although our findings suggest that historically they may have been both more frequent and potentially more dangerous.

PROTECTING THE CHILD VICTIM IN SEXUAL OFFENCES: IS THERE A NEED FOR SEPARATE LEGAL REPRESENTATION?

The number of children being sexually violated on a daily basis continues to escalate against a backdrop of a dearth in the conviction rate of their attackers. This is notwithstanding global efforts being made to protect children from the harrowing experience of being sexually violated. Creative measures such as the introduction of innovative child legislation have been largely neutralized by the inability of the criminal justice system to complement the child’s healing process. The gulf between policy and practice has given rise to a lack of protection in respect of the rights of children. In this paper, we seek to highlight the gaps in the South African criminaljustice system when it comes to safeguarding the interests of the minor complainant during the criminal process. We analyse key legislative instruments which purport to protect the minor victim. The analysis is aimed at determining whether or not the specified key provisions are in conflict with the Constitution. The introduction of separate legal representatives for child complainants is evaluated as an option in improving the plight of young child victims. The paper then concludes on an optimistic note by boldly opining that in line with legal developments in other international jurisdictions, the South African criminal justice system can accommodate the legal novelty of introducing separate legal representation for child victims.

B-PO04-156 TEMPORAL TRENDS IN THE INCIDENCE AND CHARACTERISTICS OF SUDDEN CARDIAC DEATH AMONG YOUNG IN NORTHERN FINLAND DURING 1998-2017

Although the mean age of sudden cardiac death (SCD) victims has increased during recent decades, overall incidence has remained relatively stable. Small but very important proportion of SCDs occur in subjects under 40 years of age and temporal trends in the incidence and characteristics of SCD in young are not well known. We aimed to investigate temporal trends in the incidence and characteristics among young SCD victims. The Fingesture study has prospectively gathered data from 5,869 consecutive autopsy verified SCD victims in Northern Finland during 1998-2017. On the basis of Finnish law, all subjects who die unexpectedly undergo autopsy. Determination of the cause of death was based on medicolegal autopsy, clinical records and questionnaires sent to the next of kin. The reference population in the Northern Finland for every 5-year period was used for incidence calculations. Out of total 5,869 SCDs during the period, 160 occurred in subjects under 40 years of age (2.7%) indicating a total incidence of 1.4/100 000. Incidence decreased during the study period; 2.1/100 000 in 1998-2002, 1.9/100 000 in 2003-2007, 1.3/100 000 in 2008-2012 and 0.7/100 000 in 2013-2017. Coronary artery disease (CAD) was the cause of death in 29% of young SCD victims. Among non-ischemic causes, most common were obesity related hypertrophic myocardial disease (24%), primary myocardial fibrosis (19%), hypertensive myocardial disease (6.3%), myocarditis (5%) and hypertrophic cardiomyopathy (4%). Structurally normal heart was present in 5 subjects (3%). Proportion of CAD as the cause of SCD decreased as follows; 38% in 1998-2002, 33% in 2003-2007, 22% in 2008-2012 and 14% in 2013-2017 (p=0.09). Proportion of male gender (81%) and obesity as a comorbidity (BMI >30 kg/m2, 40%) remained relatively stable during the period (p=0.58 and p=0.79, respectively). The incidence of SCD in young has decreased in Northern Finland during 1998-2017. Most of the deaths are due to non-ischemic myocardial diseases and relative proportion of CAD has decreased.

Prevalence and potential genetic determinants of young sudden unexplained death victims with suspected arrhythmogenic mitral valve prolapse syndrome.

BackgroundMitral valve prolapse (MVP) is largely considered a benign condition. However, MVP is over-represented consistently in sudden unexplained death in the young (SUDY) cohorts.ObjectiveTo determine the prevalence and potential genetic underpinnings of suspected arrhythmogenic MVP in a referral cohort of SUDY cases.MethodsIn this retrospective study, medical records/autopsy reports and whole exome molecular autopsy (WEMA) results for 77 SUDY victims (27 female; average age at death 20.6 ± 8.9 years) were reviewed for evidence of myxomatous MVP and left ventricle (LV) fibrosis. Variants detected in the prespecified 147 WEMA gene panel with a minor allele frequency ≤ 0.001 in public exomes/genomes were classified using the 2015 American College of Medical Genetics (ACMG) guidelines.ResultsOverall, 6 of 77 (7.8%; 2 female; average age at death 20.7 ± 6.9 years) SUDY cases had MVP as the lone abnormal postmortem finding. The majority had bileaflet involvement (5/6; 83%) and microscopic LV fibrosis (5/6; 83%). In 2 SUDY cases (33%), subjects were diagnosed with MVP by echocardiography prior to death. Unexpectedly, an ACMG pathogenic/likely pathogenic (P/LP) was more likely to be detected in SUDY cases with MVP than those without (3/6 [50%] vs 9/71 [13%]; P < .05). Interestingly, the 3 variants identified in MVP-positive SUDY cases localized to genes associated previously with a cardiomyopathy/channelopathy predisposition (p.E1518fsX25-DMD, p.S285N-RYR2, and p.R109X-TTN).ConclusionThis WEMA series provides additional evidence that the combination of MVP and LV fibrosis underlies an unexpected number of SUDY cases. Whether P/LP variants in cardiomyopathy/channelopathy-susceptibility genes contribute to the pathogenesis of arrhythmogenic MVP requires further investigation.