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PubMed1976

A fatal case of strongyloidiasis with Strongyloides larvae in the meninges.

A case of fatal strongyloidiasis associated with pyogenic meningitis in an adult male African is reported. Strongyloides larvae were present in the purulent exudate in the the meninges, an observation not, to the authors knowledge, hitherto reported in man. Fatal strongyloidiasis due to autoinfection has been reported by several authors and De Paula (1962) reviewed the literature in 40 cases and added 10 others which he had studied. In Uganda fatal cases have been reported by Craven et al. (1971) and Poltera (1974). Although in some cases of fatal strongyloidiasis there was associated pyogenic meningitis (BROWN & PERNA, 1958; WILSON & THOMPSON, 1964; BASSAN-TREMINGER & EL-LANSHAR, 1968) we have not found in the literature any case in which Strongyloides stercoralis larvae or adult worms were found in the brain or meninges. We are, therefore, now reporting a case of fatal strongyloidiasis with pyogenic meningitis in which S. stercoralis larvae were present in the subarachnoid space.

Humans↗

PubMedDate not supplied

Fatality after report to a child abuse registry in Washington State, 1973-1986.

Between 1973 and 1986, 11,085 children born in Washington State were reported to the state child abuse registry. We analyzed the fatality rate subsequent to reported abuse for this cohort of children compared to a population of nonabused children matched on sex, county of birth, and year of birth. Children reported to the child abuse registry had an almost threefold greater risk of death than the comparison population. A report of physical abuse carried the greatest risk of subsequent death. However, the relative risks were also elevated for children who suffered neglect or sexual abuse. Children reported to the registry were almost 20 times more likely than the comparison population to die from homicide. Children less than 1 year of age at time of reported abuse had the highest fatality rate subsequent to abuse, but adolescents had the highest relative risk for fatality after abuse, compared to the population of nonabused children. Rates of fatality subsequent to abuse were equal for males and females. Although this study could not measure the extent to which any given intervention reduced the risk of subsequent fatality in abused children, registries can serve a valuable function in identifying subpopulations at risk and quantifying that risk relative to the general population.

Accidents↗

PubMed1992

Contributions of incidence and case fatality to mortality from bladder cancer in the south Thames Regions.

STUDY OBJECTIVE: The aim was to assess the individual contributions of incidence and case fatality to variations in bladder cancer mortality between districts in the South Thames Regions. DESIGN: The standardised mortality ratios for bladder cancer were calculated for the health districts in the South Thames Regions using data from the Thames Cancer Registry. The results were compared with the standardised registration ratios, used as a measurement of incidence, and survival hazard function, used as a measurement of case fatality. As one determinant of case fatality is the severity at presentation, mortality was also compared with the standardised proportion of cases with advanced disease at diagnosis. SETTING: The study took place in the 28 health districts in South East and South West Thames regional health authorities. SUBJECTS: Subjects were 3271 cases of bladder cancer aged 15-74 years resident in one of the two South Thames regional health authorities at diagnosis and registered between 1982 and 1985. MAIN RESULTS: The standardised mortality ratios for the different districts varied from 62 to 139. The standardised registration ratios, the survival hazard functions adjusted for age and stage of disease at diagnosis, and the proportion of cases with severe disease at diagnosis were all independently and significantly related to the standardised mortality ratios in each district. CONCLUSIONS: Mortality from bladder cancer was significantly related to measurements of incidence, case fatality, and severity at presentation. These relations have implications for the health services. The incidence of disease may be modified through preventative measures, the case fatality through improved quality of care, and severity at presentation possibly through prompt management of patients with haematuria. Further studies are needed to investigate why these factors have high values in some districts.

Adolescent↗

PubMed1992

The fatal paracetamol dosage--how low can you go?

Popular texts and forensic literature pertaining to paracetamol toxicology advocate an acceptable minimal dose or lower limit of the blood level 'normally' associated with a fatal single overdose. A case of fatal, acute paracetamol poisoning from a minimal single dose, within the recommended therapeutic daily total and associated with a zero blood paracetamol level, is reported. It also emphasizes the common knowledge that the toxicological tabulated reference data available on fatal levels of most drugs is merely a guide. The proper interpretation of the analytical results thus requires the full consideration of the circumstances surrounding the death in each case. The clinico-pathophysiology and toxicology of paracetamol poisoning is briefly reviewed in an attempt to establish how low a fatal paracetamol dosage can go. The phenomenon of fatal dose and blood level is in a paracetamol limbo.

Acetaminophen↗

PubMed1992

Factors potentially associated with reductions in alcohol-related traffic fatalities--United States, 1990 and 1991.

Traffic crashes are the single greatest cause of death among persons aged 5-32 years in the United States (1); almost half of all traffic fatalities are alcohol-related (1,2). An estimated 40% of persons in the United States may be involved in an alcohol-related traffic crash sometime during their lives (1). In 1991, the number of alcohol-related traffic fatalities (ARTFs) declined almost 10% when compared with 1990 (3), and the total number of deaths during 1991 (19,900) is the lowest since more complete alcohol-related fatal crash data became available in 1982. This report summarizes data from the National Highway Traffic Safety Administration's (NHTSA) Fatal Accident Reporting System on trends in ARTFs in the United States from 1982 through 1991 and presents information regarding several factors potentially related to the decline in fatalities during 1991.

Accidents, Traffic↗

PubMedDate not supplied

[Etiological study of the fatal cases in the period of the influenza A epidemic of 1977-1978].

The etiology of the disease, the age structure of fatalities, the time of death were studied in 34 fatal cases in the period of influenza A (H1N1) epidemic in December 1977-February 1978 and in 33 fatal cases during influenza A/Victoria/3/75 (H3N2) epidemic in January-March, 1975 (data from some autopsy offices of Kiev). The results of the investigation of the etiology by immunofluorescence and the histological methods were mostly similar. The polyetiological structure of the diseases in the influenza epidemic of 1975 and rather monoetiological one in the influenza epidemic of 1977-1978 were observed. In 1975, fatal cases were found mostly in 2 age groups: infants under 1 year and adults over 20, in 1977-1978 in 4 age groups: infants under 1, children of 1-3, over 9, and adults. In both epidemics the maximum number of fatal cases coincided with the beginning of a decline in the epidemic wave and subsequently they were registered evenly for over one month. A high infection rate with a new influenza A virus variant (H1N1) was found among normal subjects in all age groups.

Adolescent↗

PubMed1978

Fatal Rocky Mountain spotted fever.

Forty-four fatal cases of Rocky Mountain spotted fever (RMSF) occurring in 1974 were compared with 50 nonfatal cases of similar age, sex, date of onset, and place of occurrence. Diagnosis and initiation of treatment in fatal cases were substantially delayed compared with nonfatal cases. Several reasons for this delay were identified: (1) the rash appeared later in the course of illness in the fatal cases, often not until the patient was terminal, (2) a history of tick bite was less often obtained during life or obtained late in the clinical course in fatal cases, and (3) initial nonspecific symptoms or unexpected symptoms led to an initial diagnosis of more common diseases. Only two fatal cases were treated with either tetracycline or chloramphenicol before the sixth day of illness. Presumptive diagnosis of RMSF and initiation of tetracycline therapy before onset of rash may be necessary to reduce mortality.

Adolescent↗

PubMed1992

Risk factors for fatal colon cancer in a large prospective study.

BACKGROUND: Diet, physical activity, obesity, aspirin use, and family history may all modify the risk of colon cancer, but few epidemiologic studies are large enough to examine these factors simultaneously. PURPOSE: We prospectively assessed the relationship of diet and other factors to risk of fatal colon cancer. METHODS: Using data from Cancer Prevention Study II--an ongoing prospective mortality study--we studied 764,343 adults who, in 1982, completed a questionnaire on diet and other risk factors and did not report cancer or other major illness. We assessed mortality through August 1988 and identified 1150 deaths from colon cancer (611 men and 539 women). Multivariate analyses were used to compare these case patients with 5746 matched control subjects drawn from the cohort. RESULTS: Risk of fatal colon cancer decreased with more frequent consumption of vegetables and high-fiber grains (P for trend = .031 in men and .0012 in women). The relative risk (RR) for the highest versus lowest quintile of vegetable intake was 0.76 in men (95% confidence interval [CI] = 0.57-1.02) and 0.62 in women (95% CI = 0.45-0.86). Dietary consumption of vegetables and grains and regular use of aspirin were the only factors having an independent and statistically significant association with fatal colon cancer. Participants who consumed the least vegetables and grains and no aspirin had a higher risk compared with those who consumed the most vegetables and used aspirin 16 or more times per month. For men in the former category, the RR was 2.4 (95% CI = 1.1-5.3); for women, it was 2.9 (95% CI = 1.3-6.7). Weaker associations were seen for physical inactivity, obesity, total dietary fat, and family history. No associations were seen with consumption of red meat or total or saturated fat in either sex, but this finding must be interpreted cautiously. CONCLUSIONS: These findings support recommendations that increased consumption of vegetables and grains may reduce the risk of fatal colon cancer. Regular use of low doses of aspirin may prove to be an important supplemental measure.

Adult↗

PubMed1977

Work-energy level, personal characteristics, and fatal heart attack: a birth-cohort effect.

In a 22-year followup of 3686 San Francisco longshoremen, a cohort analysis assessed job activity and six personal characteristics in relation to 395 fatal heart attacks. Four cohorts aged 35-44, 45-54, 55-64, and 65-74 in 1951 were studied annually for job shifts affecting energy output and for sudden or delayed death from heart attack by age 75. All subjects underwent multiphasic screening for heavy cigarette smoking, higher blood pressure, history of prior heart disease, obesity, abnormal glucose metabolism, and higher blood cholesterol. The first three of these characteristics added risk of fatal heart attack. The amount of risk varied in the four cohorts. Higher energy output on the job reduced risk of fatal heart attack, especially sudden death, in the two younger cohorts, where less active workers were at threefold increased risk. Lack of this effect in the two older cohorts could imply real differences in their work habits, such as being less energetic in heavy jobs or more energetic in light jobs than the younger cohorts. Or, before the study began, early deaths may have winnowed susceptibles from the two older cohorts. Combined low-energy output, heavy smoking, and higher blood pressure increased risk by as much as 20-fold. By elimination of these adverse influences, this population might have had an 88% reduction in its rate of fatal heart attack during the 22 years.

Adult↗

PubMed2025

Morning-to-evening change in home blood pressure as a predictor of fatal and nonfatal cardiovascular events.

OBJECTIVE: We investigated the morning-to-evening changes in home blood pressure (BP) in relation to the risk of fatal and nonfatal cardiovascular events. METHOD: The study participants (≥18 years of age) were outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry. Home BP was measured at baseline for 7 consecutive days in the morning and evening five times consecutively, of which the first three readings were averaged for analysis. The morning-to-evening changes in home BP were calculated by subtracting the BP values in the morning from that in the evening. RESULT: During a mean (±SD) follow-up of 4.9 (±2.6) years, 184 cardiovascular events occurred among the 5057 study participants. The mean morning-to-evening change in home SBP/DBP was -2.2 ± 8.1/-2.5 ± 4.5 mmHg. The age and sex-standardized incident rate was highest in quartile 1 of the changes in both SBP and DBP for fatal and nonfatal cardiovascular events, stroke (log-rank test, P  < 0.001). After adjustment for confounding factors, including the mean of morning and evening BP, the hazard ratios for patients in quartile 1 of the morning-to-evening change relative to the overall study participants reached statistical significance for SBP [1.39, 95% confidence interval (95% CI) 1.03-1.88] and DBP (1.59, 95% CI: 1.17-2.15) in relation to fatal and nonfatal stroke, and for diastolic BP in relation to fatal and nonfatal cardiovascular events (1.42, 95% CI: 1.13-1.77). CONCLUSION: In outpatients, a mild to moderate BP drop from morning to evening was associated with a significantly higher risk of all cardiovascular events, especially stroke.

Humans↗

PubMed1992

Work-related electrical fatalities in Australia, 1982-1984.

Work-related electrical fatalities were studied as part of a larger investigation into all work-related fatalities in Australia in the period 1982-1984. The 95 electrical fatalities (all men) represented an incidence of 0.49 per 100,000 persons (0.79/100,000 men) in the employed civilian labor force during the study period. Electricity was the fifth highest cause of work-related fatalities in Australia and resulted in 10% of all workplace deaths. Ninety-four percent of the workers were performing their usual tasks at the time of their death, and 38% of them were doing work of an electrical nature at the time. The greatest number of deaths occurred on farms and nonconstruction industrial sites, with overhead powerlines as the main source of current. Better placement of overhead powerlines, improved worker awareness of electrical hazards, and the use of residual current devices would probably have prevented most of the deaths.

Accidents, Occupational↗

PubMed1992

[Fatal traffic accidents among the elderly in the county of Ringkøbing].

The cases of all persons aged 70 years or more who were killed in traffic accidents in the County of Ringkøbing during the period 1.1.1983-31.12.1990 were reviewed on the basis of the death certificates and the police reports. A total of 58 deaths were involved and this was significantly greater than in the age group 0-69 years (p < 0.01). Twenty-eight of the accidents (48.3%) were car accidents. The commonest cause of these car accidents was that "give way" signs had not been respected and there were thus no solo accidents. The next most frequent type of accident consisted of knocking down of pedestrians (25.9%), followed by bicycle accidents (15.5%) and moped accidents (8.6%). Out of the total of fatal accidents, only one of the fatally injured persons was under the influence of alcohol (1.7%). If passengers in motor vehicles were excluded, a total of 39 of the fatally injured persons (88.6%) were themselves the cause of the accident concerned. It is concluded that fatal traffic accidents among elderly persons in the County of Ringkøbing constitute a great problem and that the driving abilities of elderly persons should be investigated further.

Accidents, Traffic↗

PubMed1979

Fatal reactions to drugs. A 10-year material from the Swedish Adverse Drug Reaction Committee.

Drug-induced deaths (n = 274) in Sweden during a 10-year period have been analyzed. The incidence has been remarkably constant, with 25--30 reported cases per year. There is a marked increase with age in the incidence of fatal reactions, more so than for all drug reactions. Women consume more drugs than men and get more reactions, but not more fatal reactions. Anti-inflammatory drugs (antibiotics and sulfonamides) are responsible for 21% of the fatal reactions, followed by oral antidiabetics (9%), oral contraceptives (9%) and antiphlogistic drugs (8%). The blood and the bone marrow are the most susceptible organs, responsible for 40% of the fatal reactions, followed by thromboembolism (10%) and hepatocellular damage (9%). It is important to note that rapid changes have occurred with regard to responsible drugs as well as to the types of adverse reactions encountered.

Adolescent↗

PubMed1979

Reduction in road fatalities and injuries after legislation for compulsory wearing of seat belts: experience in Victoria and the rest of Australia.

In 1970 the Government of the State of Victoria became the first in the 'western' world to introduce legislation for compulsory wearing of seat belts. Within 14 months the other Australian states followed. Seat belt wearing rates increased to attain 90 per cent in 1977. This paper presents an evaluation of changes during the period 1955--77 in the incidence of road crash fatalities and injuries for vehicle occupants in Victoria and the rest of Australia. The introduction of the legislation in Victoria and subsequently in the other Australian states coincided with significant and marked decreases in driver and passenger fatality and injury rates (numbers per 10 000 registered vehicles). The decreases were enough to reduce the total numbers of vehicle occupant fatalities and injuries for all post-legislation years in Victoria. The improvements have been maintained throughout the entire post-legislation period. The legislation did not apply to child passengers of less than 8 years of age and the frequency of seat belt or harness wearing among them remained low. These children did not share in the overall improvement for passengers. The Australian experience supports the view that legislation for compulsory wearing of seat belts is the single most effective method available for the protection of vehicle occupants in road crashes.

Accidents, Traffic↗

PubMed1992

Fatal poisonings in Jutland (Denmark) during the 1980s.

During the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.

Accidents↗

PubMedDate not supplied

Rapidly fatal Q-fever pneumonia in a patient with chronic granulomatous disease.

Acute Q-fever is a systemic illness which rarely has a fatal outcome. Fatal cases do occur with the chronic form of the disease and associated with endocarditis. This report presents the case of a fatal, acute Q-fever pneumonia in an 11-year-old patient with chronic granulomatous disease. Complement fixation antibody titer rose to 1:1,024 with positive IgM in immunofluorescence. Giemsa stained lung sections and indirect immunofluorescence demonstrated the microorganisms in the tissues. The Coxiella burnetii infection was probably contracted during a holiday trip to rural France. Despite the fact that the patient received a variety of antimicrobial agents with broad spectrum activity against bacteria and fungi, coverage for Q-fever, i.e. chloramphenicol or tetracyclines, was not included.

Anti-Bacterial Agents↗

PubMed1975

Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis.

A 58 year old Chinese male, one week after arriving in Canada from Hong Kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by Escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of Strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.

Colon↗

PubMed1992

Firearm fatalities.

One hundred and twenty eight cases of shooting fatalities were investigated during an 11-year period. Of these 57% were homicidal shootings with 34% suicidal in nature. Only two suicidal fatalities were female. Analysis of the sites of entrance wounds confirmed the 'sites of election' in suicidal shootings, whilst homicidal wounds showed a much wider distribution. Multiple entrance wounds were seen in 42% of homicidal shootings. Injuries to hands were seen in 7 homicidal fatalities.

Adolescent↗