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Nilausen KF, Landt EM, Al-Shuweli S, Nordestgaard BG, Bødtger U, Dahl M. Venous thromboembolism associated with severe dyspnoea and asthma in 102 792 adults. ERJ Open Res 2023; 9:00631-2023. [PMID: 38020573 PMCID: PMC10658631 DOI: 10.1183/23120541.00631-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background The most recent guideline on acute pulmonary embolism (PE) indicates possible long-term sequelae such as dyspnoea and chronic thromboembolic pulmonary hypertension after a PE event. However, effects on lung function or asthma risk have not been evaluated in the general population. Methods We tested whether individuals with a venous thromboembolism (VTE) encompassing PE and deep vein thrombosis (DVT) have reduced lung function, or greater risks of dyspnoea and asthma using data from 102 792 adults from the Copenhagen General Population Study. Diagnoses of PE, DVT and asthma were collected from the national Danish Patient Registry. Factor V Leiden and prothrombin G20210A gene variants were determined using TaqMan assays. Results Prevalences of PE, DVT and VTE were 2.2%, 3.6% and 5.2%, respectively. Individuals with VTE had forced expiratory volume in 1 s of 92% predicted compared with 96% pred in individuals without VTE (p<0.001). Individuals with VTE versus those without had adjusted OR (95% CI) for light, moderate and severe dyspnoea of 1.4 (1.2-1.6), 1.6 (1.4-1.8) and 1.7 (1.5-1.9), respectively. Individuals with VTE versus those without had an adjusted OR for asthma of 1.6 (95% CI 1.4-1.8). Factor V Leiden and prothrombin G20210A genotype also associated with increased risk of asthma (p for trend=0.002). Population-attributable fractions of severe dyspnoea and asthma due to VTE were 3.5% and 3.0%, respectively, in the population. Conclusion Individuals with VTE have worse lung function and higher risks of severe dyspnoea and asthma, and may account for 3.5% and 3.0% of people with severe dyspnoea and asthma, respectively, in the general population.
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Affiliation(s)
| | - Eskild Morten Landt
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
| | - Suzan Al-Shuweli
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev–Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bødtger
- Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark
- Institute of Region Health Research, University of Southern Denmark, Odense, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bodwal J, Chauhan M, Behera C, Byard RW. Glass table tops: An unusual source of lethal domestic injury. MEDICINE, SCIENCE, AND THE LAW 2021; 61:305-308. [PMID: 33853458 DOI: 10.1177/00258024211005658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.
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Affiliation(s)
- Jatin Bodwal
- Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Hari Nagar, Delhi, India
| | - Mohit Chauhan
- Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, India
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Roger W Byard
- Forensic Science South Australia, Adelaide and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Falk J, Fischer V, Riepert T, Rothschild MA. Suicide by air embolism introduced by means of a bicycle pump. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00394-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractA 64-year-old man was found dead in bed in his flat. In his right hand he held a bicycle pump to which a small-gauge cannula was attached and two fresh puncture wounds were found on his left hand. During the autopsy an air embolism of ca. 50 ml air was detected in the right ventricle of the heart by means of an aspirometer. The air embolism could not be reliably detected in a thorax radiograph taken prior to autopsy. Blood in the right ventricle was foamy. Pathological changes to organs were not found. Aside from the puncture wounds, there were no signs of externally applied mechanical force. The results of the toxicological analyses were negative.
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Kamei T, Kanaji N, Nakamura H, Arakawa Y, Miyawaki H, Kishimoto N, Suzaki N, Yamamoto A, Nanki N, Yamazaki Y, Ishii T, Kohi F, Hirao T, Fujita J, Bandoh S, Hoshikawa Y. Asthma mortality based on death certificates: A demographic survey in Kagawa, Japan. Respir Investig 2019; 57:268-273. [PMID: 30833156 DOI: 10.1016/j.resinv.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/10/2018] [Accepted: 01/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to determine the reasons for the high rate of asthma mortality in Kagawa Prefecture, Japan, by analyzing death certificates. METHODS We analyzed the death certificates between 2009 and 2011 in a demographic survey. Of 1187 patients with documented disease names suggesting bronchial asthma, analysis was performed on 103 patients in whom the cause of death was classified as asthma based on ICD-10 Codes. The patients were then classified into the following 4 groups: asthma death, asthma-related death, non-asthma death, and indistinguishable death. Based on this classification, consistency between ICD-10-based asthma death and asthma/asthma-related deaths was examined for each age group as well as for the site of death. RESULTS Of 103 asthma deaths based on the ICD-10 classification, 30 (29%) were classified as asthma death, 44 (43%) as asthma-related death, 16 (16%) as non-asthma death, and 13 (13%) as indistinguishable death. Asthma death based on our classification correlated with that of ICD-10-based classification as a cause of death in patients younger than the median age (87 years), but correlation was not observed in patients aged older than 87 years. Deaths occurred outside the hospital in 45% of patients, and many ICD-10-based deaths reported at nursing homes and geriatric health care facilities were classified as non-asthma deaths in this survey. CONCLUSION Re-examination of the death certificate revealed that asthma deaths were reported incorrectly on the death certificates of elderly patients who died outside the hospital.
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Affiliation(s)
- Tadashi Kamei
- Kamei Internal Medicine and Respiratory Clinic, 3007-4 Ohta-shimomachi, Takamatsu, Kagawa, Japan.
| | - Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyuki Nakamura
- Department of Internal Medicine, Sakaide City Hospital, Kagawa, Japan
| | - Yukako Arakawa
- Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations Takamatsu Hospital, Kagawa, Japan
| | - Hiroshi Miyawaki
- Department of Respiratory Medicine, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Nobuhito Kishimoto
- Department of Pulmonary Medicine, Takamatsu Municipal Hospital, Kagawa, Japan
| | - Noriyuki Suzaki
- Department of Internal Medicine, Kagawa Rosai Hospital, Kagawa, Japan
| | - Akiyoshi Yamamoto
- Department of Respiratory Medicine, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Nobuki Nanki
- Department of Respiratory Medicine, Sanuki Municipal Hospital, Kagawa, Japan
| | | | - Tomoya Ishii
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Fumikazu Kohi
- Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations Takamatsu Hospital, Kagawa, Japan
| | - Tomohiro Hirao
- Department of Public Health, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shuji Bandoh
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoichi Hoshikawa
- Department of Health and Welfare, Kagawa Prefectural Government, Kagawa, Japan
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Abstract
In the clinical setting, the role of systemic inflammation in patients with asthma has attracted increased attention, and some authors showed that increased IL-6 and high-sensitivity C-reactive protein characterized a group of asthmatic patients. In the realm of forensic pathology, a postmortem diagnosis of asthmatic death can be extremely challenging. The aim of this study was to determine the postmortem serum levels of C-reactive protein, IL-6, and tumor necrosis factor α in a series of severe acute bronchial asthma deaths that underwent medicolegal investigations. A total of 35 autopsy cases were retrospectively selected and included deaths in asthmatic subjects (related and unrelated to severe acute bronchial asthma, in situations characterized or not by systemic inflammation) as well as deaths in nonasthmatic individuals (in situations characterized or not by systemic inflammation). Our findings suggest that IL-6 is selectively increased in the systemic circulation of individuals with asthma, irrespective of whether the cause of death depends on a fatal asthma attack, compared with other biomarkers. Accordingly, postmortem serum IL-6 values in cases of death during severe acute bronchial asthma can be measured and considered of diagnostic relevance to estimate the magnitude of the systemic inflammation responses characterizing the disease.
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Scarpelli MP, Keller S, Tran L, Palmiere C. Postmortem serum levels of IgE and mast cell tryptase in fatal asthma. Forensic Sci Int 2016; 269:113-118. [PMID: 27888720 DOI: 10.1016/j.forsciint.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022]
Abstract
The aim of this study was to characterize the concentrations of total and specific IgE as well as mast cell-derived tryptase in postmortem serum from femoral blood and evaluate the usefulness of their determination for diagnostic purposes in cases of fatal asthma attacks. 36 autopsy cases were retrospectively selected including cases of witnessed death in asthmatic subjects, deaths in asthmatics and atopic subjects with causes of death unrelated to asthma or allergic anaphylaxis as well as deaths in non-atopic, non-allergic individuals with causes of death unrelated to asthma or allergic anaphylaxis. Initial results indicated increased postmortem serum total IgE in atopic and asthmatic individuals, irrespective of the cause of death. Conversely, increased mast cell tryptase levels were noted exclusively in fatal asthma attacks. This suggests that mast cell tryptase measurement in cases of death potentially caused by severe acute bronchial asthma may be useful for diagnostic purposes.
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Affiliation(s)
- Maria Pia Scarpelli
- Dipartimento di Sanità Pubblica e Medicina di Comunità, Università degli Studi di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Sanjiv Keller
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Lara Tran
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland
| | - Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, Lausanne 25, Switzerland.
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Thompson M, Wills S, Byard RW. Forensic Features of Lethal Late-Presenting Diaphragmatic Hernias. J Forensic Sci 2016; 61:1261-5. [PMID: 27329694 DOI: 10.1111/1556-4029.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/17/2015] [Accepted: 01/02/2016] [Indexed: 01/11/2023]
Abstract
Diaphragmatic defects are a relatively common and benign finding in adults which may be congenital or secondarily acquired. The case files at Forensic Sciences South Australia were reviewed over a 10-year period from July 2005 to June 2015 for all adult (>17 years) cases in which diaphragmatic hernias were identified at postmortem examination that had either caused or contributed to death. Five cases were found: age range 49-90 years (average 67.2 years); male:female ratio 2:3. Herniated organs included the stomach (N = 3), small (N = 3) and large intestines (N = 2). Mechanisms of death involved lung compression with respiratory failure and/or mediastinal shift, and vascular compromise with gastric or intestinal infarction and/or perforation. Diaphragmatic hernias may not be identified until the time of autopsy and may be quite complex entities to evaluate due to a lack of clinical history and to difficulties in determining their origin and possible contributions to mechanisms of death.
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Affiliation(s)
- Melissa Thompson
- Anatomical Pathology, SA Pathology, Frome Rd, Adelaide, SA 5000, Australia.,Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia
| | - Stephen Wills
- Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia
| | - Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia. .,School of Medicine, The University of Adelaide, Frome Rd, Adelaide, SA 5005, Australia.
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Abstract
Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner's Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests.
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9
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Abstract
Asthma is a common disease in the population and fatal asthma cases are not rare. Patients with fatal asthma not infrequently die outside of hospitals and become forensic cases. The pathologic features of asthma are very variable, but fatal asthma is always characterized by extensive mucous plugs in the airways and lungs that tend to remain inflated when the chest is opened. Other microscopic features that may be seen in asthma include increased amounts of airway smooth muscle, marked thickening of airway basement membranes, goblet cell hyperplasia, and various patterns of airway inflammation including eosinophils, neutrophils, and lymphocytes. Absent a history, a presumptive diagnosis of fatal asthma can be made in a patient whose lungs are hyperinflated and demonstrate numerous mucous plugs in the large airways, and this is usually accompanied by a markedly thickened basement membrane in the large airways on microscopic examination, but the possibility that the fatal asthma attack was precipitated by exogeneous factors such as drugs, fumes, or irritants should be borne in mind.
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Affiliation(s)
- Joanne L. Wright
- University of British Columbia, St. Paul's Hospital in Vancouver, BC
- Department of Pathology, University of British Columbia, Vancouver, BC (AC)
| | - Andrew M. Churg
- Department of Pathology, University of British Columbia, Vancouver, BC (AC)
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