scholarly journals Certification of Vehicular Hyperthermia Deaths in the Pediatric Population

2016 ◽  
Vol 6 (4) ◽  
pp. 657-662
Author(s):  
Reade A. Quinton
Keyword(s):  
Ambient Temperature ◽  
Cause Of Death ◽  
Pediatric Population ◽  
Clinical History ◽  
Infants And Children ◽  
Manner Of Death ◽  
Autopsy Findings ◽  
Scene Investigation ◽  
Medical Examiners ◽  
In Infants And Children

The investigation of vehicular hyperthermia deaths in infants and children requires coordination between the autopsy, clinical history, and scene investigation. Unfortunately, autopsy findings can be limited or nonspecific, clinical history may be unavailable, and details concerning ambient temperature and vehicular temperature may be vague. In cases where hyperthermia is established as the cause of death, the certification of manner of death can be challenging and inconsistent among medical examiners. This article provides an overview of vehicular hyperthermia deaths and the certification of cause and manner of death in these cases.

scholarly journals Medical Examiner Review of the Characteristics of Fire-Related Homicides

2020 ◽  
Vol 10 (2) ◽  
pp. 87-93
Author(s):  
Kyle S. Conway ◽  
Carl J. Schmidt ◽  
Theodore T. Brown
Keyword(s):  
Cause Of Death ◽  
Retrospective Studies ◽  
Medical Examiner ◽  
Manner Of Death ◽  
Wayne County ◽  
Autopsy Findings ◽  
Cohb Level ◽  
Scene Investigation ◽  
Medical Examiners ◽  
Ancillary Studies

While fire-related deaths are regularly encountered by medical examiners, fire-related homicides are relatively uncommon. Although some large retrospective studies of fire-related deaths have been performed, few large studies have specifically reviewed fire-related homicides. Autopsy, scene investigation, and ancillary studies were reviewed for 38 fire-related homicides evaluated at the Wayne County Medical Examiner’s Office in Detroit, Michigan. The largest proportion of cases were inhalation-related deaths in dwelling fires (n = 21, 55%), followed by deaths from thermal injury after immolation (n = 8, 21%) and traumatic death with contemporaneous or subsequent immolation (n = 8, 21%). There was one case of postmortem immolation. Although carboxyhemoglobin (COHb) levels played a significant role in evaluation of these cases, no single factor was diagnostic of a particular cause or manner of death. Fire-related homicides present unique diagnostic challenges because multiple insults frequently contribute to the cause death. Death at the scene and COHb level above 10% are the most useful factors in establishing smoke and soot inhalation as the cause of death. Some autopsy findings are helpful in establishing or ruling out smoke and soot inhalation as contributing to or sole cause of death, but an evaluation of the entire circumstances and autopsy findings is necessary.

Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group

2021 ◽  
pp. 109352662110072
Author(s):  
Oana Neagu ◽  
Amparo Fernández Rodríguez ◽  
Domitille Callon ◽  
Laurent Andréoletti ◽  
Marta C Cohen
Keyword(s):  
Sudden Death ◽  
Influenza A ◽  
Group A Streptococcus ◽  
Acute Myocarditis ◽  
Clinical History ◽  
Infants And Children ◽  
Group A ◽  
Clinical Awareness ◽  
Type 3 ◽  
In Infants And Children

Background Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths. Methods Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009–2019. Data retrieved included histological features, microbiology and clinical history. Results 23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected. Conclusion Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.

Parenteral Histamine2-Receptor Antagonists in the Pediatric Population

1994 ◽  
Vol 10 (2) ◽  
pp. 53-57
Author(s):  
Neeta Bahal O'Mara ◽  
Milap C. Nahata
Keyword(s):  
Product Information ◽  
Pediatric Population ◽  
Data Extraction ◽  
Infants And Children ◽  
Optimal Dosage ◽  
Receptor Antagonists ◽  
Study Selection ◽  
Stability Data ◽  
Administration Methods ◽  
In Infants And Children

Objective: To provide a review of the use of parenteral histamine2 (H2)-receptor antagonists cimetidine, ranitidine, and famotidine in the pediatric population. Data Sources: Information was identified by MEDLINE and a review of journals. References cited in published articles and manufacturers' product information also were used. Study Selection: Information was selected for review if it addressed the parenteral administration of H2-receptor antagonists in the pediatric population. Data Extraction: Data were extracted from references pertaining to the topic. Data Synthesis: Despite the lack of Food and Drug Administration pediatric labeling, the H2-receptor antagonists often are used for a variety of indications in infants and children. Although these agents differ somewhat in chemical structure, potency, and pharmacokinetics, the most important differences exist in their drug interactions and adverse effect profiles. Further, administration methods, compatibility, and stability data differ slightly among the agents. Conclusions: Parenteral H2-receptor antagonists are used for a variety of indications in infants and children. Despite their widespread use, additional studies are needed to define the optimal dosage regimens in this population.

Arousal pattern following central and obstructive breathing abnormalities in infants and children

1996 ◽  
Vol 81 (6) ◽  
pp. 2651-2657 ◽  
Author(s):  
Frances McNamara ◽  
Faiq G. Issa ◽  
Colin E. Sullivan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Pediatric Population ◽  
Infants And Children ◽  
Clinical Severity ◽  
Rapid Eye Movement Sleep ◽  
Active Sleep ◽  
Quiet Sleep ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
In Infants And Children

McNamara, Frances, Faiq G. Issa, and Colin E. Sullivan.Arousal pattern following central and obstructive breathing abnormalities in infants and children. J. Appl. Physiol. 81(6): 2651–2657, 1996.—We analyzed the polysomnographic records of 15 children and 20 infants with obstructive sleep apnea (OSA) to examine the interaction between central and obstructive breathing abnormalities and arousal from sleep. Each patient was matched for age with an infant or child who had no OSA. We found that the majority of respiratory events in infants and children was not terminated with arousal. In children, arousals terminated 39.3 ± 7.2% of respiratory events during quiet sleep and 37.8 ± 7.2% of events during active (rapid-eye-movement) sleep. In infants, arousals terminated 7.9 ± 1.0% of events during quiet sleep and 7.9 ± 1.2% of events during active sleep. In both infants and children, however, respiratory-related arousals occurred more frequently after obstructive apneas and hypopneas than after central events. Spontaneous arousals occurred in all patients with OSA during quiet and active sleep. The frequency of spontaneous arousals was not different between children with OSA and their matched controls. During active sleep, however, infants with OSA had significantly fewer spontaneous arousals than did control infants. We conclude that arousal is not an important mechanism in the termination of respiratory events in infants and children and that electroencephalographic criteria are not essential to determine the clinical severity of OSA in the pediatric population.

scholarly journals Developmental Pharmacokinetics in Pediatric Populations

2014 ◽  
Vol 19 (4) ◽  
pp. 262-276 ◽  
Author(s):  
Hong Lu ◽  
Sara Rosenbaum
Keyword(s):  
Drug Absorption ◽  
Pediatric Population ◽  
Drug Distribution ◽  
Drug Dose ◽  
Tubular Secretion ◽  
Infants And Children ◽  
Water Composition ◽  
Age Related ◽  
The Impact ◽  
In Infants And Children

Information on drug absorption and disposition in infants and children has increased considerably over the past 2 decades. However, the impact of specific age-related effects on pharmacokinetics, pharmacodynamics, and dose requirements remains poorly understood. Absorption can be affected by the differences in gastric pH and stomach emptying time that have been observed in the pediatric population. Low plasma protein concentrations and a higher body water composition can change drug distribution. Metabolic processes are often immature at birth, which can lead to a reduced clearance and a prolonged half-life for those drugs for which metabolism is a significant mechanism for elimination. Renal excretion is also reduced in neonates due to immature glomerular filtration, tubular secretion, and reabsorption. Limited data are available on the pharmacodynamic behavior of drugs in the pediatric population. Understanding these age effects provide a mechanistic way to identify initial doses for the pediatric population. The various factors that impact pharmacokinetics and pharmacodynamics mature towards adult values at different rates, thus requiring continual modification of drug dose regimens in neonates, infants, and children. In this paper, the age-related changes in drug absorption, distribution, metabolism, and elimination in infants and children are reviewed, and the age-related dosing regimens for this population are discussed.

scholarly journals The Role of TLR4 Asp299Gly and TLR4 Thr399Ile Polymorphisms in the Pathogenesis of Urinary Tract Infections: First Evaluation in Infants and Children of Greek Origin

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Panagiota Karananou ◽  
Despoina Tramma ◽  
Socrates Katafigiotis ◽  
Anastasia Alataki ◽  
Alexandros Lambropoulos ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
Pediatric Population ◽  
Infants And Children ◽  
Healthy Children ◽  
Healthy Infants ◽  
Tract Infections ◽  
In Infants And Children

Urinary tract infections are one of the most common and serious bacterial infections in a pediatric population. So far, they have mainly been related to age, gender, ethnicity, socioeconomic level, and the presence of underlying anatomical or functional, congenital, or acquired abnormalities. Recently, both innate and adaptive immunities and their interaction in the pathogenesis and the development of UTIs have been studied. The aim of this study was to assess the role and the effect of the two most frequent polymorphisms of TLR4 Asp299Gly and Thr399Ile on the development of UTIs in infants and children of Greek origin. We studied 51 infants and children with at least one episode of acute urinary tract infection and 109 healthy infants and children. We found that 27.5% of patients and 8.26% of healthy children carried the heterozygote genotype for TLR4 Asp299Gly. TLR4 Thr399Ile polymorphism was found to be higher in healthy children and lower in the patient group. No homozygosity for both studied polymorphisms was detected in our patients. In the group of healthy children, a homozygote genotype for TLR4 Asp299Gly (G/G) as well as for TLR4 Thr399Ile (T/T) was showed (1.84% and 0.92 respectively). These results indicate the role of TLR4 polymorphism as a genetic risk for the development of UTIs in infants and children of Greek origin.

scholarly journals Bivalirudin as an Alternative to Heparin for Anticoagulation in Infants and Children

2015 ◽  
Vol 20 (6) ◽  
pp. 408-417 ◽  
Author(s):  
Marcia L. Buck
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Pediatric Population ◽  
Factor Xa ◽  
Infants And Children ◽  
Thrombin Inhibitor ◽  
Ventricular Assist ◽  
The Cost ◽  
In Infants And Children

Bivalirudin, a direct thrombin inhibitor, is a useful alternative to heparin for anticoagulation in infants and children. It has been found to be effective in patients requiring treatment of thrombosis, as well as those needing anticoagulation during cardiopulmonary bypass, extracorporeal life support, or with a ventricular assist device. While it has traditionally been used in patients who were unresponsive to heparin or who developed heparin-induced thrombocytopenia, it has recently been studied as a first-line agent. Bivalirudin, unlike heparin, does not require antithrombin to be effective, and as a result, has the potential to provide a more consistent anticoagulation. The case reports and clinical studies currently available suggest that bivalirudin is as effective as heparin at reaching target activated clotting times or activated partial thromboplastin times, with equivalent or the lower rates of bleeding or thromboembolic complications. It is more expensive than heparin, but the cost may be offset by reductions in the costs associated with heparin use, including anti-factor Xa testing and the need for administration of antithrombin. The most significant disadvantage of bivalirudin remains the lack of larger prospective studies demonstrating its efficacy and safety in the pediatric population.

scholarly journals Attitudes Towards Forensic Autopsy Standard B3.7 and the Use of Physician Extenders in Select Autopsy Cases

2019 ◽  
Vol 9 (3-4) ◽  
pp. 181-190
Author(s):  
Cassie B. MacRae ◽  
Seth H. Weinberg ◽  
Mitchell L. Weinberg
Keyword(s):  
Gold Standard ◽  
National Association ◽  
Forensic Autopsy ◽  
Forensic Pathologist ◽  
Manner Of Death ◽  
Autopsy Findings ◽  
Physician Extenders ◽  
Medical Examiners ◽  
Administrative Responsibilities ◽  
Overdose Deaths

Studies have demonstrated that autopsy is the gold standard for determining cause and manner of death. Indeed, the current National Association of Medical Examiners standard B3.7 states that a forensic pathologist (FP) shall perform a forensic autopsy when the death is by apparent intoxication by alcohol, drugs, or poison. Unfortunately, the recent increase in drug-related deaths has led to some question about the feasibility of maintaining compliance with standard B3.7. We constructed a voluntary survey to address consensus on standard B3.7 and the use of supervised accredited pathologists’ assistants (PAs) in performing select medicolegal autopsies. Additional questions were included to help characterize variables related to FP’s workload and experience. Each of these variables was predicted to influence FP’s attitudes toward B3.7 and the use of PAs. Our respondent pool (n = 107) consisted primarily of actively practicing FPs with administrative responsibilities (42%) and actively practicing FPs without administrative responsibilities (41%). Sixty-five percent agreed that standard B3.7 is appropriate. Opinion on the use of PAs was split between those who agreed (45%) and those who did not (44%). Tendency to agree with either B3.7 or the use of PAs was not a function of FP’s individual or office workload; however, respondents were more likely to agree with B3.7 if they previously experienced a case where internal autopsy findings radically altered diagnosis in an otherwise suggestive overdose case (P < 0.001). In certain offices and under certain conditions, the use of PAs may be one solution to ensuring all potential overdose deaths receive an autopsy.

Primary Hyperparathyroidism Diagnosed at Autopsy a Study of Eight Cases

1983 ◽  
Vol 28 (4) ◽  
pp. 360-363 ◽  
Author(s):  
J. N. Webb ◽  
V. Crucioli ◽  
A. Gordon
Keyword(s):  
Primary Hyperparathyroidism ◽  
Hospital Admission ◽  
General Hospital ◽  
Cause Of Death ◽  
Clinical History ◽  
Pathological Findings ◽  
Autopsy Findings ◽  
Psychiatric Disturbances ◽  
Western General Hospital

This paper describes the clinical and pathological findings of eight cases of primary hyperparathyroidism first diagnosed at autopsy. The eight cases were obtained from the autopsy files of the Western General Hospital, Edinburgh over a decade (1971–80). The duration of the final hospital admission was very short in the majority of cases but analysis of the clinical history, in which gastro-intestinal and neuro-psychiatric disturbances figured prominently, showed that symptoms of the disease may have been present for very much longer—perhaps years in some instances. Details of the main autopsy findings and cause of death are also presented.

scholarly journals Death Certification Errors and the Effect on Mortality Statistics

2017 ◽  
Vol 132 (6) ◽  
pp. 669-675 ◽  
Author(s):  
Lauri McGivern ◽  
Leanne Shulman ◽  
Jan K. Carney ◽  
Steven Shapiro ◽  
Elizabeth Bundock
Keyword(s):  
Cause Of Death ◽  
Primary Objective ◽  
Error Rates ◽  
Death Certificates ◽  
Mortality Statistics ◽  
Manner Of Death ◽  
Registration System ◽  
National Mortality ◽  
Icd 10 ◽  
Medical Examiners

Objective: Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non–Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics. Methods: We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates. Results: Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death ( P < .001). Certificates for deaths occurring in hospitals were more likely to have major errors than certificates for deaths occurring at a private residence (59% vs 39%, P < .001). A total of 580 (93%) death certificates had a change in ICD-10 codes between the original and mock certificates, of which 348 (60%) had a change in the underlying cause-of-death code. Conclusions: Error rates on death certificates in Vermont are high and extend to ICD-10 coding, thereby affecting national mortality statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics.

Sign in / Sign up

Export Citation Format

Share Document