Discrepancies between clinical and autopsy diagnosis of cause of death among psychiatric patients who died due to natural causes. A retrospective autopsy study

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

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Causes of death in Serbia since the mid-20th century

Stanovnistvo ◽

10.2298/stnv1201089m ◽

2012 ◽

Vol 50 (1) ◽

pp. 89-106

Author(s):

Ivan Marinkovic

Keyword(s):

Cardiovascular Diseases ◽

Infectious Diseases ◽

20Th Century ◽

Cause Of Death ◽

21St Century ◽

Causes Of Death ◽

Total Population ◽

Total Mortality ◽

Population Mortality ◽

Circulatory Diseases

The structure of the leading causes of death in Serbia has considerably changed in the last half century. Diseases which presented the main threat to the population a few decades ago are now at the level of a statistical error. On the one side are causes which drastically changed their share in total mortality in this time interval, while others have shown stability and persistence among the basic causes of death. Acute infectious diseases "have been replaced" with chronic noninfectious diseases, due to the improvement of general and health conditions. One of the consequences of such changes is increased life expectancy and a larger share of older population which resulted in cardiovascular diseases and tumors to dominate more and more in total mortality. Convergent trends in the structure of the leading causes of death in Serbia from the middle of the 20th century are the reasons why there are considerably fewer diseases and causes with a significant rate in total population mortality at the beginning of the 21st century. During the 1950s, there were five groups of diseases and causes which participated individually with more than 10% of population mortality (infectious diseases, heart and circulatory diseases, respiratory diseases, some perinatal conditions and undefined states) while at the beginning of the new century there were only two such groups (cardiovascular diseases and tumors). Identical trends exist in all European countries, as well as in the rest of the developed world. The leading causes of death in Serbia are cardiovascular diseases. An average of somewhat over 57.000 people died annually in the period from 2007 - 2009, which represents 55.5% of total population mortality. Women are more numerous among the deceased and this difference is increasing due to population feminization. The most frequent cause of death in Serbia, after heart and circulatory diseases, are tumors, which caused 21,415 deaths in 2009. Neoplasms are responsible for one fifth of all deaths. Their number has doubled in three decades, from 9,107 in 1975 to about 20,000 at the beginning of the 21st century, whereby tumors have become the fastest growing cause of death. Least changes in absolute number of deaths in the last half century were marked among violent deaths. Observed by gender, men are in average three times more numerous among violent deaths than women. In the middle of the 20th century in Serbia, one third of the deaths caused by violence were younger than 25 and as many as one half were younger than 35 years old. Only one tenth (11%) of total number of violent deaths were from the age group of 65 or older. At the end of the first decade of the 21st century (2009), the share of population younger than 25 in the total number of violent deaths was decreased four times (and amounted to 8%). At the same time, the rate of those older than 65 or more quadrupled (amounted to 39%).

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miR-3113-5p, miR-223-3p, miR-133a-3p, and miR-499a-5p are Sensitive Biomarkers to Diagnose Sudden Cardiac Death

10.21203/rs.3.rs-147657/v1 ◽

2021 ◽

Author(s):

Fengping Yan ◽

Yuanyuan Chen ◽

Xing Ye ◽

Fu Zhang ◽

Shiquan Wang ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Cardiac Death ◽

Quantitative Polymerase Chain Reaction ◽

Control Group ◽

Pathological Changes ◽

Diagnostic Challenge ◽

Roc Curve Analysis ◽

Injury Death ◽

Diagnostic Biomarkers ◽

Autopsy Findings

Abstract BackgroundSudden cardiac death (SCD) remains a great health threat and diagnostic challenge, especially those cases without positive autopsy findings. Molecular biomarkers have been urgently needed for the diagnosis of SCD displaying negative autopsy results. Due to their nature of stability, microRNAs (miRNAs) have emerged as promising diagnostic biomarkers for cardiovascular diseases. MethodsThis study investigated whether specific cardio-miRNAs (miR-3113-5p, miR-223-3p, miR-499a-5p, and miR-133a-3p) could serve as potential biomarkers for the diagnosis of SCD. Thirty-four SCD cases were selected, 18 categorized as acute myocardial infarction (AMI) without positive autopsy findings and 16 as atherosclerotic cardiovascular diseases (ASCVD) with gross myocardial scar. Carbon monoxide (CO) intoxication (n=14) and fatal injury death (n=14) that displayed no pathological changes of myocardium were selected as control group, respectively. Histological analyses were performed to reveal the pathological changes and real-time quantitative polymerase chain reaction (RT-qPCR) was used to determine the expression of those miRNAs. Resultsit showed that heart samples from the AMI group displayed no remarkable difference with regard to the expression of cleaved-caspase3, CD31, and CD68 and the extent of fibrotic tissue accumulation when compared with control samples. The four cardio-miRNAs were significantly up-regulated in the SCD samples as compared with control. When discriminating SCD from controls, ROC curve analysis revealed that the areas under the curve (AUC) of these 4 miRNAs were from 0.7839 to 0.9043 with sensitivity of 64.71-97.06% and specificity of 70-100%. Moreover, when discriminating the specific causes of SCD, the four miRNA expressions increased in the AMI heart as relative to ASCVD, and a combination of two miRNAs presented higher diagnostic value (AUC=0.7407-0.8667). ConclusionmiR-3113-5p, miR-223-3p, miR-499a-5p, and miR-133a-3p may serve as independent diagnostic biomarkers for SCD, and a combination of two of these miRNAs could further discriminate detailed causes of SCD.

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Clinical and autopsy findings of the homeless

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh161226094r ◽

2017 ◽

Vol 145 (9-10) ◽

pp. 508-512

Author(s):

Miodrag Radunovic ◽

Nemanja Radojevic ◽

Velimir Rakocevic ◽

Jelena Vucinic ◽

Ivana Curovic

Keyword(s):

Lung Diseases ◽

Causes Of Death ◽

Homeless People ◽

Homeless Persons ◽

Control Group ◽

Blood Alcohol ◽

Time Of Death ◽

Autopsy Findings ◽

The Past ◽

Homeless Men

Introduction/Objective. The population of homeless people has been growing rapidly over the past decades, and is a part of regular repertoire in daily autopsy practice. The paper aims to establish a contingent of autopsy findings specific for homeless persons using a cohort approach. Methods. The study group consisted of the bodies of 37 homeless men autopsied in the past 15 years. The control group consisted of 37 men and was created by a driven randomized selection following the same distribution of the causes of death. A standardized full autopsy was performed in every case, followed by microscopic examination and toxicology if indicated. Many external and internal features were compared. Results. Homeless people lived significantly shorter, and were more often unidentified at the time of autopsy (p < 0.05). As for external features, we found that homeless people were significantly shorter, with longer hair, beard, and nails, and worse dental status compared to the control group (p < 0.01); 70.3% of the homeless people were underweight; significantly more often suffered from infectious lung diseases, alcoholic liver disease and showed signs of old brain contusions (p < 0.01); they had higher blood alcohol concentrations at the time of death compared to the controls (p < 0.05), but a significantly lower atherosclerotic grade (p < 0.01), and were found to die significantly more often during the winter months (p < 0.01). Besides this, the homeless are more usually affected by specific and non-specific lung inflammations and alcohol liver diseases. Conclusion. Autopsy findings of homeless people define an almost particular presentation compared with controls.

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Clinically latent and autopsy-verified inflammatory disorders and malignant tumours in transplant patients

Journal of Clinical Pathology ◽

10.1136/jclinpath-2020-207080 ◽

2020 ◽

pp. jclinpath-2020-207080

Author(s):

Elias Mund ◽

Johannes Salem ◽

Hans H Kreipe ◽

Kais Hussein

Keyword(s):

Respiratory Failure ◽

Clinical Diagnosis ◽

Causes Of Death ◽

Diagnostic Techniques ◽

Class I ◽

Malignant Tumours ◽

Inflammatory Disorders ◽

Autopsy Findings ◽

Transplant Patients ◽

Postmortem Examinations

AimsThe number of clinical autopsies decreases while the rate of missed relevant diagnoses is known to be 2%–20%. In this study, we focused on postmortem examinations of patients after transplantation of solid organs.MethodsA total of 122 cases were assessed for this study. Transplant organs included liver (LiTx; n=42/122, 34%), heart (n=8/122, 7%), lungs (n=32/122, 26%), kidney (KTx; n=38/122, 31%) and KTx+LiTx (n=2/122, 2%).ResultsThe most frequent autopsy-verified causes of death were cardiac or respiratory failure (together n=85/122, 70%). The frequency of malignant tumours that were identified at autopsy was 5% (n=6/122). In 3% (n=4/122) of cases, Goldman class I discrepancies between clinical diagnosis and autopsy findings were identified.ConclusionsThe rate of missed relevant diagnoses might be relatively low, but these cases nevertheless refute the contention that modern diagnostic techniques negate the need for autopsies in patients who died after transplantation.

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Clinical Diagnoses and Autopsy Findings: A Retrospective Analysis of 252 Cases in Greece

Archives of Pathology & Laboratory Medicine ◽

10.5858/2005-129-210-cdaafa ◽

2005 ◽

Vol 129 (2) ◽

pp. 210-214

Author(s):

Chaido Spiliopoulou ◽

Stavroula Papadodima ◽

Nikolaos Kotakidis ◽

Antonios Koutselinis

Keyword(s):

Retrospective Analysis ◽

Clinical Diagnosis ◽

Cause Of Death ◽

Diagnostic Errors ◽

Postmortem Diagnosis ◽

Autopsy Findings ◽

Quality Of Patient Care ◽

Clinical Diagnoses ◽

Unexpected Findings

Abstract Context.—Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science. Objective.—To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies. Design.—Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999–2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient. Results.—In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 105 cases (42%), the autopsy requests did not include any suggestion about the cause of the patient's death. In 7 cases (3%), several diagnoses were suggested by the clinicians, and in 16 cases (6%), the comparison between clinical and postmortem diagnosis was not possible. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism. Conclusions.—It is concluded from this study that autopsies may reveal unexpected findings that are of critical importance and that a continued emphasis on autopsy evaluation is necessary to improve the quality of patient care.

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Death rates and causes of death in cohorts of serum hepatitis patients followed up for more than 20 years

Epidemiology and Infection ◽

10.1017/s0950268801005064 ◽

2001 ◽

Vol 126 (1) ◽

pp. 89-96 ◽

Cited By ~ 5

Author(s):

S. GJERULDSEN ◽

M. ABDELNOOR ◽

S. OPJORDSMOEN ◽

B. MYRVANG

Keyword(s):

Risk Factors ◽

Cause Of Death ◽

Causes Of Death ◽

Early Death ◽

Drug Addict ◽

Drug Addicts ◽

Serum Hepatitis ◽

Death Rates ◽

Risk Of Death ◽

Somatic Diseases

A cohort of 214 drug addicts with serum hepatitis and a cohort of 193 hepatitis patients without drug addiction were examined in respect of death rates, causes of death and a number of risk factors for reduced survival. The death rate was significantly higher among the drug addicts than among non-addicts. The annual mortality rate was 1·5% in the drug addict group and 0·7% in the non-addict group. The highest relative risk of death was 860 for female drug addicts in age group 15–24 compared to females of the same age in the general population. The most prevalent cause of death in the drug addict group was drug overdose (53%), whereas in the other group 66% died from various somatic diseases. Hepatitis or complications of viral hepatitis played no role as cause of death among the drug addicts, and infections as a whole were also responsible for very few deaths. For male drug addicts, imprisonment before admission and leaving hospital without the doctors' permission were risk factors for early death.

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The Evolution of Mortality and Death Causes in Type 2 Diabetes Patients from Timisoara Diabetes Centre Between 1970 And 1999

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0006 ◽

2013 ◽

Vol 20 (1) ◽

pp. 45-53

Author(s):

Corina Marcela Hogea ◽

Bogdan Timar ◽

Alin Albai ◽

Romulus Timar ◽

Viorel Şerban

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Diseases ◽

Cause Of Death ◽

Causes Of Death ◽

Metabolic Diseases ◽

Study Group ◽

Newly Diagnosed ◽

All Cause Mortality ◽

Death Causes

Abstract Background and Aims: Cardiovascular disease represents the principal cause of death in type 2 diabetes (T2DM) patients. The aim of our study was to evaluate the all cause mortality and the main causes of death in T2DM patients and their trend of evolution between 1970 and 1999. Material and methods: 3719 T2DM patients newly diagnosed between 1970-1979 in the Timisoara Diabetes, Nutrition and Metabolic Diseases Centre were followed until 1999. The study group included 2084 women (56.0%) and 1635 men (44%), with a mean age at diagnosis of 58.2±11.5 years. Results: Throughout the analyzed period we noticed a tendency of decrease for all cause mortality, the main causes of death being cardiovascular diseases. Conclusions: The results of the study confirm the tendency of reduced mortality in T2DM patients and maintenance of cardiovascular diseases as the main cause of death in T2DM patients.

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Nutritional Intervention May Improve Body Mass Index of Malnourished Hospitalized Psychiatric Patients – A Preliminary Observation

Current Topics in Nutraceutical Research ◽

10.37290/ctnr2641-452x.18:256-259 ◽

2019 ◽

Vol 18 (3) ◽

pp. 256-259

Author(s):

Hou Y.C. ◽

Hsieh Y.L. ◽

Tzeng I.S. ◽

Kuo C.Y.

Keyword(s):

Body Weight ◽

Psychiatric Patients ◽

Psychiatric Hospitals ◽

Nutritional Intervention ◽

Nutrition Intervention ◽

Calorie Intake ◽

Psychiatric Ward ◽

Increased Risk ◽

Total Calorie ◽

Total Calorie Intake

Malnutrition is an important issue in hospitalized patients. Poor nutrition may lead to increased risk of morbidity and death, impaired mental and physical conditions, apathy, depression, self-neglect, increased risk of medical complications, increased risk of pressure ulcers, reduced immune response, delayed wound healing, longer hospital stays, and reduced quality of life. However, few studies have investigated malnutrition in psychiatric patients. Psychiatric patients are known to have an increased risk of malnutrition, but psychiatric hospitals rarely conduct physical examinations and nutritional assessments. In this preliminary study, patients from a psychiatric ward of the Taipei Tzu Chi Hospital were chosen using the Malnutrition Universal Screening Tool. We used the before-and-after analysis to test the effect of a nutrition intervention on the selected parameters. We found that patients who had an impaired nutritional status showed significant increases in body weight (mean: 43.6 ± 7.5 vs. 46.5 ± 8.2 kg; P < 0.001), BMI (mean: 16.8 ± 2.0 vs. 17.9 ± 2.1 kg/m2; P < 0.001), and total calorie intake (mean: 1128 ± 230 vs. 1378 ± 320 Kcal; P < 0.001). Nutritional intervention significantly improved body weight, BMI, and total calorie intake. Nutritional intervention may help prevent malnutrition and improve the management of psychiatric patients.

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The Effect of Cognitive Remediation Therapy on Social Skills in Institutionalized Elderly Patients with Schizophrenia

Reviews on Recent Clinical Trials ◽

10.2174/1574887112666170522142315 ◽

2017 ◽

Vol 12 (3) ◽

pp. 182-186 ◽

Cited By ~ 1

Author(s):

Fatemeh Mohammadi ◽

Yadollah Abolfathi Momtaz ◽

Seyedeh Ameneh Motalebi ◽

Shahnaz Boosepasi

Keyword(s):

Social Skills ◽

Elderly Patients ◽

Behavioral Problems ◽

Psychiatric Patients ◽

Intervention Group ◽

Cognitive Remediation ◽

Control Group ◽

Cognitive Remediation Therapy ◽

Chi Square ◽

Institutionalized Elderly

Background: There are limited scientific investigations on cognitive remediation in elderly patients with schizophrenia. The present study was aimed to examine the efficacy of cognitive remediation therapy on social skills in institutionalized elderly patients with schizophrenia. Methods: The study employed a randomized clinical trial. A total of 60 institutionalized elderly patients with schizophrenia from Razi Psychiatric Hospital, Tehran were selected and randomly allocated into two equal groups (control and intervention). The intervention group attended to cognitive remediation therapy for 8 weeks. The Evaluation of Living Skills Scale for psychiatric patients was used for data collection. The Chi Square, independent and paired t-tests using SPSS, version 22, were employed to analyze the data. Results: The mean age of 60 elderly patients participated in the study was 65.25 ± 4.19 years. No significant differences were found between two groups at baseline. However, independent t-tests showed significant differences between the intervention and the control group in social skills after implementation of intervention. Additionally, the results of paired t-tests revealed significant improvements in intervention group on communication skills (t=5.50, p<0.001), behavioral problems with others (t=5.44, p<0.001), and self-care (t=4.70, p<0.001). No significant differences were observed from pretest to post test in control group. Conclusion: The results of the present study may support the efficacy of cognitive remediation therapy on social skills of elderly patients with schizophrenia.

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Wearable Triboelectric Nanogenerators for Heart Rate Monitoring

Chemical Communications ◽

10.1039/d1cc02091a ◽

2021 ◽

Author(s):

Sophia Shen ◽

Xiao Xiao ◽

Jun Chen

Keyword(s):

Heart Rate ◽

Cardiovascular Diseases ◽

Causes Of Death ◽

Heart Rate Monitoring ◽

Triboelectric Nanogenerators ◽

Physiological Indicator

Cardiovascular diseases are currently the leading causes of death globally and are projected to remain the leading cause in 2040, making heart rate an important physiological indicator to regularly monitor....

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