Fatal α-PVP and amphetamine poisoning during a sauna and autoerotic practices

We describe the sudden death of a middle-aged man while having a sauna under the influence of alpha-pyrrolidinovalerophenone (alpha-PVP) (PM blood concentration: 0.8 mg/L), amphetamine (0.34 mg/L), and other drugs (buprenorphine, benzodiazepines), and engaging in solitary sexual activities. The drugs' effects on the cardio-circulatory system and on body thermoregulation combined with the high temperatures are likely to have been central mechanisms leading to death. The high levels of adrenaline triggered by sexual arousal and the respiratory depression caused by buprenorphine, in association with benzodiazepines, may have also contributed to his death. This previously unreported type of accidental autoerotic death illustrates the risk of using amphetamine-like sympathomimetic drugs (e.g. cathinone derivates) in hot environments such as a sauna, and during sexual activities therein.Non peer reviewe

Land-traffic crash leading to passenger vehicle submersion, drowning and other fatal injuries: A 44-year study based on records from the Finnish Crash Data Institute

Background: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable causeof injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passen-ger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015.Materials and methods: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal trafficaccidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered vari-ables on circumstances, vehicle, and fatality profiles.Results: During the study period, the FCDI investi-gated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passengercars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities sufferedsome–generally mild–injuries. The crashes frequently occurred during fall or summer (63.7%), in a riveror ditch (60.5%), and resulted in complete vehicle’s submersion (53.7 %). Half of the crashes occurred inadverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Amongdrivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%).Conclusion: Multidisciplinary investiga-tions of LMTCs have a much higher potential than do exclusive police and medico-legal investigations.The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generallythe fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physicalinjuries suggests that victims’ functional capacity is usually preserved during vehicle submersion.Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from generaltraffic-injury prevention to prevention of drowning, including development of safety features for sub-merged vehicles and simple self-rescue protocols to escape from a sinking vehicle.The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/).</p

Land motor vehicle-related fatal drowning in Finland: A nation-wide population-based survey

Objective: WHO mortality statistics overlook land motor-vehicle accident (LMVA)-related drowning. The aim of the study was to provide an overview of the prevalence and trends of fatal LMVA-related drowning in Finland, plus the main crash settings, victims' demographic characteristics, and contributing factors leading to such deaths.Methods: A descriptive, retrospective, population-based study of drowning deaths associated with LMVA among Finnish residents of all ages, 1971-2013. LMVA-related drownings and applicable variables were extracted from the Statistics Finland (SF) mortality database by cross-analysis of ICD injury- and external cause-of-death codes.Results: During the study period, 538 LMVAs leading to drowning occurred among Finnish residents (2.5/1 000 000/year; 4.9% of all unintentional drownings, 3.7% of all LMVA). Three main settings, ones responsible for over 95% of LMVA-related drownings, were recognized: traffic vehicle accidents involving a passenger car; non-traffic vehicle accident involving a snowmobile; and non-traffic accidents involving agricultural, industrial, or construction vehicles. Alcohol use was a contributing factor for death in > 40% of the victims, whereas severe injuries were reported in less than 6%.Conclusion: Because transport safety is crucial to prevent any vehicle entering the water, placing LMVA-related drowning in the category of transport accidents is warranted. Once the vehicle becomes submersed, however, prevention measures to avoid death by drowning remains decisive.</div

Unintentional drowning : Role of medicinal drugs and alcohol

Background: Alcohol is a well-known risk factor in unintentional drownings. Whereas psychotropic drugs, like alcohol, may cause psychomotor impairment and affect cognition, no detailed studies have focused on their association with drowning. Finland provides extensive post-mortem toxicological data for studies on drowning because of its high medico-legal autopsy rates. Methods: Drowning cases, 2000 through 2009, for which post-mortem toxicological analysis was performed, came from the database of the Toxicological Laboratory, Department of Forensic Medicine, University of Helsinki, using the ICD-10 nature-of-injury code T75.1. The data were narrowed to unintentional drowning, using the ICD-10 external-injury codes V90, V92, and W65-74. Each drowning case had its blood alcohol concentration (BAC) and concentrations of other drugs recorded. Evaluation of the contribution of psychotropic drugs to drowning was based on their blood concentration by means of a 6-grade scale. Results: Among victims >= 15 years old, unintentional drownings numbered 1697, of which, 303 (17.9%) were boating-related and 1394 (82.1%) non-boating-related. Among these, 65.0% of boating-related and 61.8% of non-boating-related victims were alcohol-positive (=BAC >= 50 mg/dL). The male-to-female ratio in alcohol-positive drownings was 7.3. At least one psychotropic drug appeared in 453 (26.7%) drowning cases, with some victims' bodies showing up to 7 different drugs. Overall 70 different psychotropic drugs were detectable, with 134 (7.9%) cases both alcohol-negative and psychotropic-drug-positive, of these, 59 (3.5%) were graded 4 to 6, indicating a possible to very probable contribution to drowning. Our findings suggest that psychotropic drugs may play a significant role in drowning, in up to 14.5% of cases, independently or in association with alcohol. Conclusions: Psychotropic drugs alone or in association with alcohol may be an overlooked risk factor in drowning, due to their effects on psychomotor function and cognition. Future studies should also address other mechanisms-for instance drug-induced long-QT syndrome-by which drugs may contribute to drowning.Peer reviewe

Quality of cause-of-death reporting using ICD-10 drowning codes: a descriptive study of 69 countries

Peer reviewe

Autopsy-Based Learning is Essential But Underutilized in Medical Education: A Questionnaire Study

To this day, autopsies and dissections have been essential in medical education, but declining autopsy numbers have endangered this long-standing tradition. Students' perceptions of these teaching methods should be constantly updated to help educators understand how to achieve their teaching goals. The purpose of this study was to explore the state of autopsy- and dissection-based teaching in two Finnish universities based on the experiences of the students, survey their perceptions of such teaching, and to compare the Finnish situation with students' perceptions in other countries as it emerges from medical literature. A questionnaire went to 859 second-, fourth-, and sixth-year medical students. The questions concerned dissection and autopsy classes these students had attended, the views of the students in regard to the number of classes, and the benefits of and attitudes towards autopsy teaching. An open question of how to improve autopsy teaching was included. The response rate was 19.4%. Most respondents requested more autopsy and dissection classes, especially practical education. They found autopsies most beneficial in learning anatomy and dealing with one's own emotions related to death. Their experiences proved least beneficial for interaction with the relatives of a deceased patient and for people skills. Integrational methods and focusing on the main learning outcomes were suggested as improvements. Overall, students found dissection and autopsy teaching important, but felt concerned about the diminishing autopsy numbers. Focusing on main learning objectives and better integration of autopsies in the teaching of different specialties could help to utilize autopsies to a greater extent

Fatal α-PVP and amphetamine poisoning during a sauna and autoerotic practices

We describe the sudden death of a middle-aged man while having a sauna under the influence of alpha-pyrrolidinovalerophenone (alpha-PVP) (PM blood concentration: 0.8 mg/L), amphetamine (0.34 mg/L), and other drugs (buprenorphine, benzodiazepines), and engaging in solitary sexual activities. The drugs' effects on the cardio-circulatory system and on body thermoregulation combined with the high temperatures are likely to have been central mechanisms leading to death. The high levels of adrenaline triggered by sexual arousal and the respiratory depression caused by buprenorphine, in association with benzodiazepines, may have also contributed to his death. This previously unreported type of accidental autoerotic death illustrates the risk of using amphetamine-like sympathomimetic drugs (e.g. cathinone derivates) in hot environments such as a sauna, and during sexual activities therein

Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care

Peer reviewe