Physical activity and sudden cardiac death in elders - a Croatian study [Rekreacijska tjelovježba i nagla kardijalna smrt u osoba starije dobi u Hrvatskoj]

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs)

Kobna intoksikacija alkoholom i heroinom

Drug abuse with alcohol consumption have been on the rise in Split-Dalmatian County for a while now. This article reports two separate cases with three deaths due to fatal combinations of heroin and alcohol. The first case of poisoning is related to a young couple, a 30-year-old man and a 28-year-old woman, who were found dead in a car, surrounded by cans of a variety alcoholic drinks. Two needles were found beside the bodies as well. The victims were registered drug abusers who had been in withdrawal programs. The second case was a 29-year-old man who was found dead in a house. Three fresh injection marks were visible on his right arm, and two needles were near his body. He was not known as a drug addict, but he had tried to commit suicide recently. Carboxyhaemoglobin was found in blood samples of both victims from the first case. The concentration was 25 % and that could contribute to their death. In both described cases blood alcohol concentration was higher then 1.60 g kg-1. Toxicology tests were positive for heroin, meconin, acetaminophen, 6-acetylmorphine, codeine, noscapine and papaverine. Ethanol, being a respiratory depressant, combined with morphine drastically increases the risk of rapid death due to respiration failure.U posljednje vrijeme u Splitsko-dalmatinskoj županiji konzumiranje opojnih droga uz alkohol je u porastu. Ovim radom prikazali smo dva slučaja s tri smrtno stradale osobe koje su bile kobne žrtve kombinacije alkohola i heroina. U prvom slučaju, mladi par, u dobi od 30 i 28 godina, pronađen je u automobilu okružen limenkama raznih alkoholnih pića. Dvije šprice nađene su kraj tijela. Žrtve su bili registrirani ovisnici i na programima odvikavanja u organiziranim tretmanima. Drugi slučaj bio je 29-godišnji muškarac pronađen mrtav u napuštenoj kući. Na njegovoj desnoj ruci primijećene su tri svježe ubodne rane, a dvije šprice pronađene su kraj tijela. Nije bio poznat kao ovisnik o drogama, ali je nedavno pokušao samoubojstvo. Karboksihemoglobin nađen je u uzorcima krvi obiju žrtava iz prvog slučaja. Koncentracija je bila 25 %, što je moglo pridonijeti njihovoj smrti. U oba opisana slučaja maseni udjel alkohola u krvi bilo je veći od 1.60 g kg-1. Toksikološke analize bile su pozitivne na heroin, mekonin, acetaminofen, monoacetil morfin, kodein, noskapin i papaverin. Alkohol, i sam kao depresor respiracije, zajedno s heroinskom smjesom značajno povisuje rizik od nagle smrti kao posljedice zatajenja disanja

Samoubojstvo fentanilom

Fentanyl is a potent, short-acting narcotic analgesic widely used as surgical anaesthetic. This article presents a case in which fentanyl was self-injected by a 41-year old nurse, an employee at the hospital emergency department, who was found dead at home. She had no known history of drug and alcohol abuse. Two syringes, one empty and one filled with a clear liquid, were found near the body, while a needle was stuck into her hand. Toxicological analysis showed fentanyl poisoning. Fentanyl overdose was declared the cause of death and the manner of death was classified as suicide. To our knowledge, death due to the intravenous injection of fentanyl has not previously been reported in Croatia.Fentanil je snažan narkotik u velikoj mjeri upotrebljavan kao anestetik pri kirurškim zahvatima. U ovom radu prikazan je slučaj samoubojstva upotrebom fentanila. 41-godišnja medicinska sestra, zaposlena u hitnoj službi pronađena je mrtva u svom stanu. Nije bilo podataka o njezinu zaživotnom uživanju alkohola niti drugih sredstava ovisnosti. Dvije šprice, jedna prazna i druga ispunjena prozirnom tekućinom, pronađene su kraj njezina tijela, dok je igla bila ubodena u njezinu ruku. Toksikološka analiza dala je pozitivan rezultat na fentanil. Uzrok smrti bio je predoziranje fentanilom u svrhu samoubojstva. Prema našim saznanjima, ovo je prvi dokazani slučaj samoubojstva u Hrvatskoj koji je počinjen fentanilom

Suicide and Emo Youth Subculture – A Case Analysis

Depression and suicide present a serious health problem especially for teenagers as they are increasingly diagnosed with mood disorders of different severity, possibly leading to suicidal activity. Reported here is a misfortunate young girl who committed suicide by jumping from high altitude. She left a suicide note which, together with her behavior in the death-preceding period, pointed to her apparently belonging to an Emo subculture. Although few and scarce, most existing articles and reports on Emo subculture found that its members like to focus on negative things, dark premonitions and deprivation of enjoyment, like self harm and suicide but no scientific information are available about the characteristics, trends and possible suicidal tendencies of children and adolescents who belong to this subgroup. It is for the future researches to answer whether this type of behavior and music preference are causal factors for increased suicidal vulnerability, or personal characteristics and anamnesis, upbringing and mental health status are actual sources of the problem

Toplotni udar radnika na autocesti

Toplotni udar je stanje koje nastaje zbog prekomjernog izlaganja suncu i velike vlažnosti zraka, uz neadekvatnu zaštitu tijela te nedovoljnu konzumaciju tekućine. Takvog stanja nisu pošteđeni ni radnici koji svoje radno vrijeme provode u navedenim uvjetima. U ovom se radu opisuje slučaj tridesetsedmogodišnjeg radnika na Dalmatini (autocesti) kojem je za vrijeme posla pozlilo te je odveden na Hitnu pomoć KBC-a Split gdje je, usprkos odgovarajućoj liječničkoj intervenciji, nakon nekog vremena preminuo. Simptomi s kojima je doveden podudaraju se sa simptomatologijom toplotnog udara: vrtoglavicom, općim lošim stanjem, nesvjesticom koja progredira do kome, povišenom temperaturom i ukočenim vratom. Obdukcijski nalazi su, u ovakvim slučajevima, nespecifirani i izolirani i ne omogućavaju postavljanje dijagnoze uzroka smrti od toplotnog udara. Zbog toga je od neobične važnosti dobro i potpuno poznavanje okolnosti slučaja. Direktno izlaganje suncu treba izbjegavati u određenim vremenskim razdobljima. Ukoliko se izlaganje ovakvim uvjetima ne može izbjeći, potrebno je primijeniti odgovarajuću zaštitu

Drug Related Deaths in the Split-Dalmatia County 1997–2007

Drug overdoses are a major cause of mortality for drug users and, in many countries, are the leading cause of death in this group. The aim of the present study is to explore the frequency of all drug related deaths in the Split-Dalmatia County in the period between 1997 and 2007 and to analyze some of the characteristics of these deaths to help target preventive policies. The data on drug related deaths were collected using records from the Department of Forensic Medicine, Clinical Hospital Centre Split, University of Split, School of Medicine. There were 190 drug related deaths in the observed period of 11 years. Statistically significant difference (p=0.004, c2-test for trend) was found in the number of deaths in 1997 in comparison with the number of deaths in 2007. The majority of 105 (55%) the decedents were 25–34 years old, and 92.1% (175) of them were male. There was a 94% higher probability of mortality in the 25–34 years group (c2=5.55, p=0.064). Average age of all dead people was 31.01±7.59 years (median 31.0 years; range 18–49). Almost three quarters of the decedents were single and more than three fifths hadn’t been employed. The most common location of death was at home. Approximately, 80% were autopsied followed by full histological and toxicological analyses. Out of all examined cases, the majority of drug related deaths (93 or 60.8%) were attributed to heroin. Heroin was the sole cause of death in 35 (22.9%) cases. Methadone was cause of death in 24 (15.7%) cases. 3.4-methylenedioxy-methamphetamine (MDMA) deaths were rare (3.3%). Cocaine deaths were also rare (1.3%). Three fifths (55.6%) of the cases involved includes multi-substance use. During the investigation there was an evident trend towards multi-substance abuse patterns. These data suggest that interventions to prevent drug related mortality should address the use of drugs such as heroin and alcohol in combination

Analiza droga u nekrofilnim muhama i ljudskim tkivima

Necrophagous insects may provide useful information about the time, place and cause of death. In addition, they can serve as reliable alternative specimens for toxicological analysis in cases where human tissue and fluids, normally taken during autopsies, are not available, due to decomposition of the corpse. This paper reports the results of drug analysis of the larvae of two fly families, Calliphoridae and Sarcophagidae, collected from the body of a middle-aged man who had committed suicide approximately three weeks before his corpse was found. Multiple samples of decomposed human tissue, of the blowfly, and of the larval flesh were analysed using gas chromatography/mass spectrometry (GC/MS), and amphetamine was detected in all samples. While the screening results were beyond doubt, the quantitative analysis was less clear, and further research is needed in this area.Insekti strvinari mogu pružiti korisne informacije o vremenu, mjestu i uzroku smrti. Dodatno, oni mogu poslužiti kao pouzdani zamjenski uzorci za toksikološke analize u slučajevima kada ljudska tkiva i tekućine, koji se uobičajeno uzimaju tijekom obdukcije, ne postoje zbog raspadanja trupla. Ovaj rad prikazuje rezultate analize droga u uzorcima ličinki dviju porodica muha (Diptera: Calliphoridae i Sarcophagidae), prikupljenima s tijela muškarca srednje životne dobi koji je počinio samoubojstvo otprilike 3 tjedna prije pronalaska njegova mrtvog tijela. Višestruki uzorci raspadajućeg ljudskog tkiva i ličinki muha analizirani su uporabom plinske kromatografije uz detekciju spektrometrijom masa (GC/MS) i u svima su otkriveni amfetamini. Dok su rezultati preliminarne kvalitativne analize bili izvan svake sumnje, kvantitativni su rezultati bili manje jasni te se preporučuje daljnje istraživanje u ovom području

Physical Activity and Sudden Cardiac Death in Elders – A Croatian Study

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15–25 mm. In Croatia, about 7 per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p=0.05730), in the total male population aged 15–40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p=0.00387), in young athletes: 0.15/100 000 (p=0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year. Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs)

Nove psihoaktivne tvari u uzorcima urina prikupljenima tijekom Ultra Europe festivala u Splitu

We believe that analysing pooled urine samples for recreational drugs used at mass events can provide useful information about trends in drug use. An opportunity arose with the Ultra Europe music festival, which is attended by more than 150,000 people from over 150 countries every year. We analysed 30 pooled urine samples collected from portable chemical toilets located at or close to the Ultra Europe music festival venue in Split, Croatia in 2016–2018 to detect the presence of classic and new psychoactive substances (NPS). Four urine samples collected in 2016 were from a toilet without added chemicals (otherwise used to kill the smell) while the remaining samples were collected from toilets with added chemicals. Samples were qualitatively analysed with gas chromatography-mass spectrometry (GC/MS) using the fullscan mode. Data were compared with the Wiley mass spectral library of designer drugs and our in-house library containing about 1000 compounds and metabolites. We identified forty-six different substances and metabolites, 26 of which were classic substances/metabolites, mostly from the stimulants group, while 20 were NPS. In the NPS group, most of them were phenethylamines and cathinones. The variety of substances was the highest on the first day of the festival regardless of the year, but 2018 showed a significant drop compared to the previous two years. The results of our study revealed a stable trend of classic drug consumption, while NPS trend changed from one year to another.Analiza uzoraka urina prikupljenih iz prijenosnih kemijskih zahoda korisna je u otkrivanju droga za rekreaciju koje su se koristile tijekom Ultra Europe glazbenoga festivala. Zbog prisutnosti više od 150 000 ljudi iz više od 150 svjetskih zemalja, moguće je dobiti više informacija o svjetskom trendu NPS-a. Analiza uzoraka urina koji su se prikupljali od 2016. do 2018. tijekom glazbenoga festivala Ultra Europe u Splitu provedena je radi otkrivanja prisutnosti novih psihoaktivnih tvari (NPS). Analizirano je trideset uzoraka urina prikupljenih iz prijenosnih kemijskih zahoda smještenih na mjestu festivala ili blizu njega. U 2016. godini prikupljeno je osam uzoraka urina iz dvaju zahoda koji su bili smješteni na dvama različitim mjestima, i to jedan s dodanim kemikalijama, a drugi bez njih. U 2017. godini prikupljeno je deset uzoraka urina iz triju zahoda na trima mjestima, svi iz zahoda s dodanim kemikalijama. U 2018. godini prikupljeno je dvanaest uzoraka urina iz devet prijenosnih kemijskih zahoda na četirima mjestima, svi s dodatkom kemikalija. Uzorci su kvalitativno analizirani tehnikom plinske kromatografije-spektrometrije masa (GC/MS) korištenjem načina ukupnog skeniranja. Podatci su uspoređeni s bazom spektara masa Wiley (DD2015), kao i s vlastitom bibliotekom koja sadržava oko 1000 spojeva i metabolita. U analiziranim uzorcima pronađeno je 46 različitih tvari i metabolita, od kojih 26 klasičnih tvari/metabolita, uglavnom iz skupine stimulansa, te 20 tvari iz skupine novih psihoaktivnih tvari (NPS). U skupini NPS-a najviše ih je bilo iz skupina fenetilamina i katinona. U svakoj promatranoj godini, prvoga festivalskog dana otkriveno je više tvari nego u ostalim danima. Suprotno 2016. i 2017. godini, u 2018. godini broj otkrivenih tvari bio je znatno manji. Rezultati našeg istraživanja pokazali su stabilnost konzumacije klasičnih droga, ali su se trendovi NPS-a mijenjali