Vitreous humor is a fluid that is relatively well protected from postmortem degradation and contamination. Due to its postmortem stability, vitreous humor has high utility in forensic pathology. Vitreous humor biochemical constituents, especially potassium, have been widely used in the postmortem interval (PMI) estimations. The time dependant rise of vitreous potassium levels in the postmortem period has been considered to be helpful in PMI determinations. The relative stability of vitreous biochemistry is useful in assessing the antemortem metabolic status and in predicting the antemortem serum biochemistry of an individual. However, the validity of vitreous biochemistry in forensic applications has been questioned in light of the reported concentration differences of various biochemical constituents in the same pair of eyes at identical PMI. This study hypothesized that the concentration of vitreous biochemical constituents in the same pair of eyes change at the same rate and this change that occurs in a time dependent fashion may be utilized in accurately estimating the PMI. It was further hypothesized that postmortem vitreous humor biochemistry closely mimics antemortem serum biochemistry and may be a useful aid in establishing a postmortem diagnoses of hyperglycemia. To test these hypotheses, vitreous humor samples were collected from a total of 103 autopsies (Female, 35 and Male, 68; Mean Age ± SD, 60.6 ± 17.6) conducted at Royal University Hospital morgue between January 2003 to February 2005. In 61 of these subjects, the precise time of death was known. Right and left eye vitreous humor samples were collected separately through a scleral puncture at the lateral canthus. Most of the biochemical analyses were carried out immediately post-extraction. After centrifugation, the supernatant of the fluid were analyzed for sodium, potassium, chloride, calcium, magnesium, urea, creatinine, glucose and lactate on an LX-20 Analyzer (Beckman-Coulter). Osmolality was measured on an Osmometer model 3900 (Advanced Instruments Inc.). Vitreous humor hypoxanthine and xanthine were analyzed using a colorimetric method (Amplex® Red Xanthine/ Xanthine Oxidase Assay Kit, Molecular Probes Inc.). Vitreous humor lipid hydroperoxides were measured using the Ferrous Oxidation in Xylenol Orange assay version 2 (FOX 2). The data was statistically analyzed by paired t-test, linear regression analysis and Mann-Whitney test using Statistical Package for Social Sciences (SPSS) for Windows version 13.0. The results of this study indicated that there were no significant between-eye differences for all of the vitreous biochemical constituents that were studied. It was observed that there was a significant correlation between vitreous potassium (R, 0.731; P, <0.0001), hypoxanthine, (R, 0.450; P, <0.0001), xanthine (R, 0.590; P, <0.0001), lactate (R, 0.508; P, <0.0001), calcium (R, 0.33; P, <0.01) and PMI. The corresponding formulae derived from the linear regression equations to estimate PMI were for potassium (6.41 (K+) 46.25), hypoxanthine (0.32 (Hypoxanthine) 60.94), xanthine (0.14 (Xanthine) 50.08), lactate (5.21 (Lactate) 27.69) and calcium (200 (Ca2+) 380.4). On a comparison of the actual PMI and the estimated PMI calculated using the formulae derived from the linear regression correlationship, it was found that the lowest standard deviation and the highest correlationship was obtained for vitreous potassium. The mean paired actual and estimated PMI values were significantly correlated for potassium (P, <0.0001), hypoxanthine (P, <0.0001), xanthine (P, <0.0001), lactate (P, <0.0001) and calcium (P, <0.01). Only vitreous potassium along with lactate and xanthine were significantly correlated with PMI in the same linear regression model. It was found that there was a highly significant correlation between antemortem serum and postmortem vitreous urea (R, 0.967; P, < 0.0001) and antemortem serum and postmortem vitreous creatinine (R, 0.865; P, <0.0001) concentrations. There was a significant difference (P, <0.05) between the postmortem vitreous glucose levels in the diabetic subjects as compared to the non-diabetic subjects. Vitreous lactate and lipid hydroperoxide levels did not exhibit any significant differences in these two diagnostic subgroups. The results of the present study suggest that the previously reported between eye differences for various vitreous biochemical constituents in the same pair of eyes are insignificant so far as forensic applications are concerned. Vitreous potassium is a useful biochemical marker for PMI estimations. Vitreous hypoxanthine, xanthine, lactate and calcium are all significantly correlated with PMI and if used in conjunction with vitreous potassium may possibly enhance PMI estimations by narrowing the error margin. The knowledge of vitreous urea and creatinine levels are a useful index in predicting the antemortem metabolic and renal status of the deceased subject.

Vitreous humor is a fluid that is relatively well protected from postmortem degradation and contamination. Due to its postmortem stability, vitreous humor has high utility in forensic pathology. Vitreous humor biochemical constituents, especially potassium, have been widely used in the postmortem interval (PMI) estimations. The time dependant rise of vitreous potassium levels in the postmortem period has been considered to be helpful in PMI determinations. The relative stability of vitreous biochemistry is useful in assessing the antemortem metabolic status and in predicting the antemortem serum biochemistry of an individual. However, the validity of vitreous biochemistry in forensic applications has been questioned in light of the reported concentration differences of various biochemical constituents in the same pair of eyes at identical PMI. This study hypothesized that the concentration of vitreous biochemical constituents in the same pair of eyes change at the same rate and this change that occurs in a time dependent fashion may be utilized in accurately estimating the PMI. It was further hypothesized that postmortem vitreous humor biochemistry closely mimics antemortem serum biochemistry and may be a useful aid in establishing a postmortem diagnoses of hyperglycemia. To test these hypotheses, vitreous humor samples were collected from a total of 103 autopsies (Female, 35 and Male, 68; Mean Age ± SD, 60.6 ± 17.6) conducted at Royal University Hospital morgue between January 2003 to February 2005. In 61 of these subjects, the precise time of death was known. Right and left eye vitreous humor samples were collected separately through a scleral puncture at the lateral canthus. Most of the biochemical analyses were carried out immediately post-extraction. After centrifugation, the supernatant of the fluid were analyzed for sodium, potassium, chloride, calcium, magnesium, urea, creatinine, glucose and lactate on an LX-20 Analyzer (Beckman-Coulter). Osmolality was measured on an Osmometer model 3900 (Advanced Instruments Inc.). Vitreous humor hypoxanthine and xanthine were analyzed using a colorimetric method (Amplex® Red Xanthine/ Xanthine Oxidase Assay Kit, Molecular Probes Inc.). Vitreous humor lipid hydroperoxides were measured using the Ferrous Oxidation in Xylenol Orange assay version 2 (FOX 2). The data was statistically analyzed by paired t-test, linear regression analysis and Mann-Whitney test using Statistical Package for Social Sciences (SPSS) for Windows version 13.0. The results of this study indicated that there were no significant between-eye differences for all of the vitreous biochemical constituents that were studied. It was observed that there was a significant correlation between vitreous potassium (R, 0.731; P, <0.0001), hypoxanthine, (R, 0.450; P, <0.0001), xanthine (R, 0.590; P, <0.0001), lactate (R, 0.508; P, <0.0001), calcium (R, 0.33; P, <0.01) and PMI. The corresponding formulae derived from the linear regression equations to estimate PMI were for potassium (6.41 (K+) 46.25), hypoxanthine (0.32 (Hypoxanthine) 60.94), xanthine (0.14 (Xanthine) 50.08), lactate (5.21 (Lactate) 27.69) and calcium (200 (Ca2+) 380.4). On a comparison of the actual PMI and the estimated PMI calculated using the formulae derived from the linear regression correlationship, it was found that the lowest standard deviation and the highest correlationship was obtained for vitreous potassium. The mean paired actual and estimated PMI values were significantly correlated for potassium (P, <0.0001), hypoxanthine (P, <0.0001), xanthine (P, <0.0001), lactate (P, <0.0001) and calcium (P, <0.01). Only vitreous potassium along with lactate and xanthine were significantly correlated with PMI in the same linear regression model. It was found that there was a highly significant correlation between antemortem serum and postmortem vitreous urea (R, 0.967; P, < 0.0001) and antemortem serum and postmortem vitreous creatinine (R, 0.865; P, <0.0001) concentrations. There was a significant difference (P, <0.05) between the postmortem vitreous glucose levels in the diabetic subjects as compared to the non-diabetic subjects. Vitreous lactate and lipid hydroperoxide levels did not exhibit any significant differences in these two diagnostic subgroups. The results of the present study suggest that the previously reported between eye differences for various vitreous biochemical constituents in the same pair of eyes are insignificant so far as forensic applications are concerned. Vitreous potassium is a useful biochemical marker for PMI estimations. Vitreous hypoxanthine, xanthine, lactate and calcium are all significantly correlated with PMI and if used in conjunction with vitreous potassium may possibly enhance PMI estimations by narrowing the error margin. The knowledge of vitreous urea and creatinine levels are a useful index in predicting the antemortem metabolic and renal status of the deceased subject.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

The aim of this study was to determine the extent to which the cause of death in sudden natural death in adults could be ascertained without autopsy, based on information provided in the police report, and to evaluate any degree of error between that and the officially certified cause of death. Two methods were carried out: 1. A questionnaire-based retrospective survey of sudden natural deaths distributed to practitioners. The predicted cause of death was compared with the actual cause of death as determined after autopsy. The difference between the two causes of death was classified into 'no difference', minor and major difference according to the classification scheme developed for this study. 2. A prospective study of adult sudden natural deaths referred by the procurators fiscal in Lothian and Borders to the department during 2009 and 2010. The police reports were reviewed and a cause of death was ascribed by the author. This cause was compared with the actual cause of death in the final autopsy report and any difference assessed according to the classification scheme. In the view of the retrospective study results, it is possible to determine the cause of death which is with no or minor difference to that determined by autopsy if, in addition to provide sufficient information regarding deceased’s medical history and circumstances of death, the participants are given the option to select which cases should undergo external examination only. The prospective study results indicate that in certain circumstances the cause of death could be ascribed correctly based on the available information prior to autopsy. Causes of death such as ischaemic heart disease, hypertensive heart disease and alcohol related death are more frequently ascribed correctly. However, ischaemic and hypertensive heart disease were over-predicted. Results indicate that there are criteria to select which cases might be subject to a "view and grant" procedure with no significant loss of accuracy. The implications of the study for the development of medico-legal services are considered with specific reference to Kuwait.

There is a well-established connection between adult mortality and the conditions an individual is exposed to while in utero. There is a wealth of research that connects conditions such as asthma and allergies, mortality due to heart disease and diagnoses of schizophrenia to conditions during an individual?s early life and even their time in utero. The aim of this dissertation is to see if this same connection can be made to infant mortality, and further will there be any connection in contemporary cohorts? I use the Linked Birth/Infant Death dataset available from the Centers for Disease Control (CDC) for the years 2000 to 2004. This dissertation specifically uses the dependent variable "cause specific infant death" with various measures of the time the infant was born or was in utero. I undertake three multinomial logistic regression models with the dependent variable "cause specific infant death." I then proceed to a multilevel multinomial logistic regression model using state-level climate measures at the second level. I conclude with the construction of maps displaying the spatial relationship between infant mortality and climate. The first analysis uses the independent variable of interest "month of birth," the second analysis uses the independent variable of interest "months of first trimester," and the last level-one analysis uses the independent variable of interest "months of third trimester." After running all three models, I determined that the most effective independent variable of interest is "month of birth," which I use in a multilevel logistic regression model. The multilevel model uses the month of birth variable at level-one and incorporates state level measures of climate at the second level. I find that the humidity index and the temperature index are negatively associated with the month of birth variable and cause specific infant death variables, meaning that the higher these indices, the more the benefit to an infant's chances of survival. The wind index is consistently positive, meaning that the interaction of wind with cause specific infant death and month of birth is detrimental to an infant's survival. The last methods chapter shows the spatial relationship between infant mortality and climate. In this chapter I find that infant mortality in the United States is concentrated in the Southern U.S., which is also where there is a concentration of high temperature states. The connections between wind and humidity with the infant mortality rate are less consistent.

No description available.

Background. Hepatocellular carcinoma results in most cases from underlying chronic liver disease. The most common causes are the Hepatitis B virus and the Hepatitis C virus in-fections, the alcoholism and the aflatoxin. Mortality statistics of liver cell carcinoma in Peru is limited. Objectives. Update statistics on hepatocellular carcinoma mortality in Peru between the years 2005 and 2016. Methods. Observation-al, descriptive studyand secondary analysis of the Ministry of Health database. Records with the basic cause of death ICD 10: C22, the liver cell carcinoma were reviewed. Mortality was calculated according to the age, the sex and the department in which death was recorded; Also, standardized mortality by age was calculated. Results. 2,170 people were registered as deceased due to hepatocellular carcinoma. The 50.1% were male and the 67.5% older than 60 years. The standardized mortality rate in Peru decreased from 1.1 to 0.7 per 100,000 population from 2005 to 2016. The raw cup of mortality per 100,000 population shows that when comparing the first period (2005-2010) with the second (2011-2016), the tendency in Peru has decreased. The only region that presented a decrease in mortality was the Mountains (% change =-40.1). Conclusions. Standardized mortality by age had a slight decrease from 2005 to 2016; however, this difference does not show considerable variations. Mortality from this neoplasm seems to remain high and stable since the period from 1995 to 2000. / Revisión por pares

Numa amostra de 997 óbitos de pacientes portadores de transtornos mentais procedeu-se a análise critica das estatísticas de mortalidade segundo causas básicas e associadas de morte por meio da comparação das causas mencionadas nos atestados de óbito originais com as causas de novo atestado refeito após consulta a todas informações disponíveis sobre os falecidos, informações estas existentes nos prontuários clínicos, resultados de exames de laboratório, relatórios de exames radiológicos, de biópsia, de autópsia e outros. O número médio de diagnósticos por atestado, após consulta às informações adicionais, aumentou de 2,08 para 4,11, número este que não variou sensivelmente com o sexo e a idade dos falecidos, observando-se entretanto variação da média de diagnósticos por atestado segundo a especialidade do médico atestante. As causas básicas dos atestados refeitos diferiram em 43,13 por cento dos casos das causas básicas selecionadas nos atestados originais. A tabulação de todas as causas, básicas e associadas, permitiu evidenciar a importância, no processo da morte, de muitas causas menos frequentes causa básica. como As principais causas de morte, básicas e associadas, de pacientes cujos transtornos mentais incluíram-se nos grupos Psicose, Transtornos da Personalidade e Outros Transtornos Mentais Não-Psicóticos e Deficiência Mental foram analisadas a partir dos diagnósticos do atestado refeito, comparando estas causas com aquelas dos atestados originais, constatando-se que, nestes atestados, os transtornos mentais são subestimados como causa de morte. Tal subestima se deve em parte a influência das disposições da Classificação Internacional de Doenças para a seleção da causa básica de morte. Foram também estudadas as principais associações de doenças naqueles casos em que as causas básicas pertenceram a grupos de causas relacionadas aos transtornos mentais. / In a sample of 997 deceased patients bearing mental disorders, a cri tical statistical analysis of the mortal i ty due to underlying and associated causes of death was undertaken by comparing the causes mentioned in the original death certificates and those registered in the renewed ones which were made up after full review of all available information on these patients by going through such sources as medica! and hospital records besides laboratory examinations, radiological, biopsy, autopsy and other results. The average number of diagnoees per certificate after the aditional information gained by the investigation went up from 2.08 to 4.11; the latter did not vary due do sex or age of the deceased but did according to the speciality of the certifying doctor. The underlying causes of death of the renewed death certificates differed from those of the original ones in 43.13 per cent of the patients. Crosstabulation of all causes of death, both the underlying and associated ones, uncovered the importance of many less frequent causes as underlying in the process of death. The main causes of death, both underlying and associated, of patients whose mental disorders were included in the groups i of Psychosis, Personality Disorders and Other Non-Psychotic Mental Disorders as well as Mental Deficiency were analysed through data obtanined from the renewed death certificates and later compared with those· registered in the original ones. An underestimation of mental disorders as causes of death in the latter was discovered. Such underestimation is partly due to the influence of arrangements in the Internacional Classification of Diseases for the selection of the underlying cause of death. The main associations of diseases were also studied in those cases where the underlying causes of death belonged to groups of causes related to mental disorders.