Sudden cardiac death in patients with coronary heart disease and antemortem alcohol intake: A STROBE – compliant retrospective study

The present study was aimed to assess the prevalence and possible causal relationship of alcohol intake prior to a sudden cardiac death event in patients with coronary artery disease. The retrospective research was performed at the Vilnius branch of The State Forensic Medicine Service. The autopsy protocols for five years were analyzed and the cases of sudden cardiac death were selected, when the determined cause of death was Coronary Heart Disease (CHD), a forensic autopsy and toxicological blood and urine test had been performed. Cases of the sudden death of non-cardiac origin, cases of cardiomyopathy of various origins, and cases of acute cardiac arrest of unspecified origin were excluded. The data collected was processed using R software. The study sample consisted of 2133 cases. 706 (33%) CHD cases were alcohol positive. Males and young age CHD victims were more likely to find alcohol than females (72% vs. 28%, respectively, P < .001). The mean blood alcohol concentration of the sample was 1.37 ‰± 1.01, urine‘s 1.73‰ ± 1.29. Alcohol was more commonly found during the winter months and the holidays. Deaths in alcohol-positive individuals were more common in the alcohol elimination phase with hemodynamically insignificant coronary artery stenosis (up to 50% of arterial lumen). Nearly every third CHD victim in Lithuania who experienced sudden death also had signs of antemortem alcohol consumption

Suicides in Lithuania: rates, methods and distribution by age, gender and settlement, 2012-2016

INTRODUCTION: According to the World Health Organisation regarding suicide rate, Lithuania was on the top in 2016 with 31.9 suicide events per 100 000 people of the population. This research was aimed at analysing the situation including methods of suicide and its distribution between different age, gender and settlement groups in Lithuania. METHODS: 4610 particular suicide cases were found and analysed from the given retrospectively collected data by the Hygiene Institute’s Register of Death Causes in Lithuania from 2012 till 2016. These cases have been categorised into age (10-19 years old, 20-69 years old and >70 years old), gender and settlement groups. Chi-squared and Fisher tests were used to analyse the associations between the suicide methods used, sex, as well as age. A significance level of p<0.05 was used. RESULTS: In total, 4610 suicide cases were registered in Lithuania in 2012-2016. People aged 20-69 years had the biggest proportion with 80%, followed by 16% for people older than 70 and 4% people aged 10-19. 82% of all cases were men. The most common method of suicides in all age groups was hanging, self-strangulation and self-suffocation; 92%. There is no statistical significant difference in methods used by the 10-19 years old group and above 20 years of age (20-70+). A difference was found between the groups under 70 years and above 70 years old. Moreover, the following difference was found between their genders (p=0.0002). In terms of using drugs and biological substances, women (54.24%) are more likely to commit suicide through these means than men in all age groups, while 100% of suicide methods by gas, steam or solvents were used by men. Though slightly more suicides were registered in cities, there was no statistically significant difference between people living in cities and in villages. CONCLUSIONS: Despite the fact that incidences of suicides are gradually decreasing every year, the situation is not yet satisfactory. The pattern almost has not changed for years – the most inclinable person to commit suicide is a 50-59 years old man living in a city and the most used method is still hanging

Epidemiology and risk factors of sudden death due to pulmonary thromboembolism: a retrospective study

Introduction. Pulmonary thromboembolism (PTE) is not an uncommon cause of sudden, unexpected death. Autopsy is the gold standard for cause of death determination in cases of suspected PTE. Mortality rates due to PTE are not estimated accurately. Objective. The aim of this study was to analyze distribution patterns and risk factors of sudden deaths due to PTE. Methods. Retrospective analysis of Lithuanian State Forensic Medicine Service autopsy data, period 2014-2018. A total of 4533 cases were reviewed; 80 cases met the criteria of immediate cause of death being PTE and were included in the study. PTE epidemiology, risk factors, clinical and pathoanatomical characteristics were described by reviewing scientific literature and statistical databases. Results. PTE as the cause of sudden death was diagnosed in 37(46.25%) men and 43(53.75%) women. Median age at the time of death was 62.8±17.2 years. Death occurred in hospital in 21(26.25%) cases. Trauma was the underlying cause of PTE in 11(13.75%) cases; 9(81.8%) patients were admitted to hospital after a traumatic event. Cardiac hypertrophy was observed in 70(87.5%) autopsies. Abdominal subcutaneous fat thickness was 4.08±2.64 cm in men and 5.35±2.69 cm in women. Deep vein thrombosis (DVT) was confirmed upon microscopic examination in all cases, being the underlying cause of death in 67(83.75%) cases. Conclusion. Sudden death due to PTE usually occurs at an older age and in absence of medical care. PTE is common after sustaining severe traumatic injuries which, when not immediately lethal, are managed in hospital. Cardiac hypertrophy and obesity may increase risk of death due to PTE. Undiagnosed and untreated DVT is often the underlying cause of sudden death due to PTE

The post-mortem evaluation of glucose concentration in blood and its diagnostical value

Introduction: Hyperglycemia is a consequence of uncontrolled diabetes and over a long period of time can lead to serious violations of the various systems of the body. In daily clinical practice, glucose level in blood and glycated hemoglobin are major and frequently used worldwide laboratory findings for the diagnosis of glucose metabolism disorders. In forensic medicine, the diagnostic value of post-mortem blood glucose levels is questionable because of its significant and rapid variation after death. Our research was aimed to analyse glucose concentration in blood after death and to estimate its diagnostic value. Methods: Data analysis of the State Forensic Medicine Service (SFMS) of Vilnius region of sudden death cases was performed. 238 autopsy findings were analysed. A retrospective analysis was performed using the R commander program. Results: The analysis included 238 individuals, 161 (67.6%) were men and 77 (32.4%) women. Mean age was 52.28 ± 15.45 yeras. Mean alcohol level in blood was 2.257 ± 1.482 g/L. Mean post-mortem glucose concentration in blood was 6.716 ± 5.800 mmol/l. The lowest glucose concentration was 0.600 mmol/l and the highest - 33.300 mmol/l. There were no significant glycemia level difference between men and women (p = 0.279). In 6 cases, glucose concentrations were compared before and after death. The difference in blood glucose was insignificant (p = 0.90). There was no strong correlation between ethyl alcohol and glucose concentration (r = 0.037, p = 0.667). There was a weak correlation between age and blood glucose concentration (r = 0.03, p = 0.639). Conclusions: According to SFMS autopsy data, post-mortem glucose levels remain within the normal values. Evaluation of glucose after death remains a valuable diagnostic criterion for sudden death due to hyperglycaemia, when the hyperglycaemic episode is first and fatal to the subject

Traumatic spleen rupture diagnosed during postmortem dissection A STROBE-compliant retrospective study

Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. The aim of this study was to perform a retrospective assessment of the cases of acute and subacute isolated traumatic spleen ruptures. A retrospective study performed on 50 patients, whose cause of death was isolated spleen rupture and bleeding into the abdominal cavity. An acute spleen rupture was diagnosed in 47 cases, whereas the rest 3 cases demonstrated a subacute rupture. In cases of acute spleen rupture, the mean weight of spleen was 309.6 g, whereas in 3 cases of subacute rupture the mean weight of the organ achieved 710 g. The mean weight of spleen in the control group with no spleen rupture was 144.7 g. Recording of the cases of isolated acute and subacute traumatic spleen ruptures and morphological assessment of them are important in forensic pathology science and in clinical practice as well

Deontological examination as a criterion for the assessment of personal healthcare professional quality A Strobe compliant retrospective study

Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance. A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol. The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient’s death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved. The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare qualit

Deontological examination: Clinical and forensic medical diagnoses discrepancies

Background: Globally, the frequency of discrepancies between clinical and forensic medical diagnoses is about 30%. The most common errors made during determination are the main disease pathogenesis and tanatogenesis. Aims: To identify the causes of incorrect diagnosis determination and suggest the rules for the precise diagnosis formulation. Materials and methods: A retrospective analysis of the forensic medical deontological examinations from the case histories data of the State Forensic Medicine Service has been done from 1984 to 2014. There were 1192 forensic medical deontological examinations. A descriptive method was used. The foreign literature data was analysed in order to compare the results for a comprehensive study. Results: 1192 deontological expertises were analysed during 1984–2014. This study revealed that 37% of clinical and forensic medical diagnosis did not match completely, 24% – matched partially, 37% – matched. Majority of the discrepancies between diagnoses were identified of surgeons – 13.42%, obstetricians-gynecologists – 8.10%, neurosurgeons – 7.34%, and 23% of all cases when a person was treated at the intensive care unit. Conclusions: More common discrepancies between diagnoses were identified of surgeons, obstetricians-gynecologists, neurosurgeons and when a person was treated at the intensive care unit. Frequency of discrepancies between clinical and forensic medical diagnoses is growing. The correct formulation of the clinical diagnosis is the first step towards a proper treatment. The final diagnosis should consist of three sections: main disease/injury, pathology followed by the complications and the accompanying conditions of the patient

Importance of effusion of blood under the dura mater in forensic medicine: A STROBE – compliant retrospective study

Subdural hemorrhage is commonly associated with mechanical brain injury and has a correspondingly high mortality rate. Subdural hematomas may immediately provoke symptoms or may be initially asymptomatic, with further symptoms evolving rapidly and fatally. The data regarding forensic autopsy of victims were obtained from The State Forensic Medicine Service of Lithuania between the years 2013 and 2016. A retrospective study was performed including 110 patients, whose cause of death was subdural hemorrhage. 95% confidence intervals were calculated. It was calculated, that in cases of sudden death, after subdural hemorrhage was diagnosed, a higher concentration of ethyl alcohol in blood (mean 2.22±1.3%) demanded a smaller amount of blood under the dura matter (mean 81.6±60.5 g) in order for the patient to die. It was also noted that hospitalized patients with subdural hemorrhage had a smaller concentration of blood ethyl alcohol (mean 1.33±1%) and a larger amount of blood under the dura (mean 135.6±82.9 g). Due to the toxic effect of ethyl alcohol, even a small amount (81.6±60.5 g) of blood under the dura matter can determine a sudden death

Human deaths from drug overdoses with carfentanyl involvement - new rising problem in forensic medicine: A STROBE - compliant retrospective study

Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl. Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography–time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection. Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl. The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert’s attention to new substances in drug trade