Clinical analysis of 31 cases of fetal umbilical artery thrombosis / 中华妇产科杂志

Objective: To analyze the ultrasonic manifestations, clinical features, high risk factors and key points of pregnancy management in prenatal diagnosis of umbilical artery thrombosis (UAT). Methods: The data of 31 pregnant women of UAT diagnosed by prenatal ultrasonography and confirmed after birth from July 2017 to July 2022 at the Women's Hospital, Zhejiang University School of Medicine were retrospectively analyzed, including the maternal characteristics, pregnancy outcomes and fetal complications. In addition, the baseline data and pregnancy outcomes were compared in 21 patients who continued pregnancy after diagnosis of UAT. Of the 21 UAT cases that continued pregnancy, 10 cases were treated with low molecular weight heparin (LMWH; LMWH treatment group), while the other 11 patients had expectant treatment(expectant treatment group). Results: The age of the 31 pregnant women was (30.2±4.7) years, of which 5 cases (16%,5/31) were advanced age pregnant women. The gestational age at diagnosis was (32.9±4.0) weeks, and the gestational age at termination of pregnancy was (35.6±2.9) weeks. In 31 fetuses with UAT, 15 cases (48%) had fetal distress, 11 cases (35%) had fetal growth restriction, and 3 cases (10%) had intrauterine stillbirth. There were 28 cases of live births, including 26 cases by cesarean section and 2 cases by vaginal delivery. There were also 3 stillbirths, all delivered vaginally. Four neonates had mild asphyxia and two newborns had severe asphyxia. Among the 31 cases, 10 cases were terminated immediately after diagnosis, the gestational age at diagnosis was (35.9±2.9) weeks. Another 21 pregnancies continued, and their gestational age at diagnosis was (31.4±3.7) weeks. The median prolonged gestational age in LMWH treatment group was 7.9 weeks (4.6-9.4 weeks), and all were live births. The median prolonged gestational age in the expectant treatment group was 0.6 weeks (0.0-1.0 weeks), and 2 cases were stillbirths. There was a statistically significant difference in prolonged gestational age (P=0.002). Conclusions: Ultrasound is the preferred method for prenatal detection of UAT. Clinicians need to be vigilant for UAT when a newly identified single umbilical artery is detected by ultrasound in the second or third trimesters. The decision to continue or terminate the pregnancy depends on the gestational age and the condition of fetus. Attention should be paid to fetal movements as the pregnancy continues. The treatment of LMWH as soon as possible after diagnosis of UAT may improve the pregnancy outcome.

Research Progress on Molecular Changes in Pulmonary Hypoxia and Cause of Death Identification in Mechanical Asphyxia / 法医学杂志

Lung is the largest organ of the respiratory system. During hypoxia, pulmonary cells undergo rapid damage changes and activate the self-rescue pathways, thus leading to complex biomacromolecule modification. Death from mechanical asphyxia refers to death due to acute respiratory disorder caused by mechanical violence. Because of the absence of characteristic signs in corpse, the accurate identification of mechanical asphyxia has always been the difficulty in forensic pathology. This paper reviews the biomacromolecule changes under the pulmonary hypoxia condition and discusses the possibility of application of these changes to accurate identification of death from mechanical asphyxia, aiming to provide new ideas for related research.

Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana

Objective: This study examined factors identified during early neonatal death audits contributing to preventable newborn deaths at the Upper East Regional Hospital. Method: Data for this study was collected retrospectively from perinatal death audit forms using three data collectors. Data collection lasted two weeks, from 18th June to 2nd July 2021. The data collectors submitted 113 filled hard copy data collection forms. This was then entered into a designed Excel sheet and exported to STATA software version 15.0 for analysis. The analysis was descriptive statistics with cross-tabulation. The results were presented in charts and tables focusing on percentages. Results: Most of the 113 neonatal deaths were from birth asphyxia (63%). Forty-six (40.7%) of the deaths occurred within 24 hrs after birth. There were 38 factors reported 254 times in the audits as contributory to all the newborn deaths; 17 health personnel-related factors stated 141 (55.5%) times, four transportation and communication-related factors stated 43 (16.9%) times, seven health facility factors stated 31 (12.2%) times. Inappropriate care during transportation to the regional hospital was reported most - 21 times, followed by delay in referral - 18 times. Conclusion: The study identified many factors, such as medical personnel-related factors, transportation and communication factors, family-related factors, and health facility administration factors, contributing to early neonatal deaths. Effective implementation of neonatal death audit-based recommendations arising from these contributory factors is critical to preventing avoidable newborn deaths.

Diretrizes brasileiras do angioedema hereditário 2022 ­ Parte 1: definição, classificação e diagnóstico / 2022 Brazilian guidelines for hereditary angioedema ­ Part 1: definition, classification, and diagnosis

O angioedema hereditário é uma doença autossômica dominante caracterizada por crises recorrentes de edema que acometem o tecido subcutâneo e o submucoso, com envolvimento de diversos órgãos. Os principais locais afetados são face, membros superiores e inferiores, as alças intestinais e as vias respiratórias superiores. Em decorrência da falta de conhecimento dessa condição por profissionais de saúde, ocorre atraso importante no seu diagnóstico, comprometendo a qualidade de vida dos indivíduos afetados. Além disso, o retardo no diagnóstico pode resultar em aumento da mortalidade por asfixia devido ao edema de laringe. A natureza errática das crises com variação do quadro clínico e gravidade dos sintomas entre diferentes pacientes, e no mesmo paciente ao longo da vida, se constitui em desafio no cuidado dos doentes que têm angioedema hereditário. O principal tipo de angioedema hereditário é resultante de mais de 700 variantes patogênicas do gene SERPING1 com deficiência funcional ou quantitativa da proteína inibidor de C1, porém nos últimos anos outras mutações foram descritas em seis outros genes. Ocorreram avanços importantes na fisiopatologia da doença e novas drogas para o tratamento do angioedema hereditário foram desenvolvidas. Nesse contexto, o Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH) em conjunto com a Associação Brasileira de Alergia e Imunologia (ASBAI) atualizou as diretrizes brasileiras do angioedema hereditário. O maior conhecimento dos diversos aspectos resultou na divisão das diretrizes em duas partes, sendo nessa primeira parte abordados a definição, a classificação e o diagnóstico.

Hereditary angioedema is an autosomal dominant disease characterized by recurrent attacks of edema that affect the subcutaneous tissue and the submucosa, involving several organs. The main affected sites are the face, upper and lower limbs, gastrointestinal tract, and upper airways. Because health professionals lack knowledge about this condition, there is a significant delay in diagnosis, compromising the quality of life of affected individuals. Furthermore, delayed diagnosis may result in increased mortality from asphyxia due to laryngeal edema. The erratic nature of the attacks with variations in clinical course and severity of symptoms among different patients and in one patient throughout life constitutes a challenge in the care of patients with hereditary angioedema. The main type of hereditary angioedema results from more than 700 pathogenic variants of the SERPING1 gene with functional or quantitative deficiency of the C1 inhibitor protein, but in recent years other mutations have been described in six other genes. Important advances have been made in the pathophysiology of the disease, and new drugs for the treatment of hereditary angioedema have been developed. In this context, the Brazilian Study Group on Hereditary Angioedema (GEBRAEH) in conjunction with the Brazilian Association of Allergy and Immunology (ASBAI) updated the Brazilian guidelines on hereditary angioedema. Greater knowledge of different aspects resulted in the division of the guidelines into two parts, with definition, classification, and diagnosis being addressed in this first part.

Forensic Research Progress on Postural Asphyxia / 法医学杂志

In recent years, the increase in the number of cases of postural asphyxia has gradually attracted the attention and discussion of forensic scientists domestically and internationally, but a systematic, comprehensive and recognized expert consensus and identification standard has not been established at home and abroad. This paper reviews the case characteristics, occurrence, mechanism of death, and identification criteria of postural asphyxia, to provide reference for future research.

Is pre-oxygenation with high-flow nasal oxygen safe? randomized control trial of 56 cases of elderly patients during induction of general anesthesia with endotracheal intubation / 南方医科大学学报

OBJECTIVE@#To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.@*METHODS@#Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (cSO2) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups.@*RESULTS@#The general data were comparable between the two groups. After 5 min of preoxygenation, PaO2 and cSO2 were significantly increased in both groups, and PaO2 was significantly higher in HF group than in M group (F=118.108 vs 9.511, P < 0.05). Both PaO2 and cSO2 decreased after intubation, but PaO2 decreased more slowly in HF group and still remained higher than that at T1; cSO2 decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (t=5.305, P < 0.05) with fewer times of mask ventilation (χ2= 6.720, P < 0.05). PaCO2 increased after intubation in both groups but was comparable between the two groups (F=3.138, P > 0.05).@*CONCLUSION@#High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.

Establishment of a nomogram model for predicting necrotizing enterocolitis in very preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for necrotizing enterocolitis (NEC) in very preterm infants and establish a nomogram model for predicting the risk of NEC.@*METHODS@#A total of 752 very preterm infants who were hospitalized from January 2015 to December 2021 were enrolled as subjects, among whom 654 were born in 2015-2020 (development set) and 98 were born in 2021 (validation set). According to the presence or absence of NEC, the development set was divided into two groups: NEC (n=77) and non-NEC (n=577). A multivariate logistic regression analysis was used to investigate the independent risk factors for NEC in very preterm infants. R software was used to plot the nomogram model. The nomogram model was then validated by the data of the validation set. The receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow goodness-of-fit test, and the calibration curve were used to evaluate the performance of the nomogram model, and the clinical decision curve was used to assess the clinical practicability of the model.@*RESULTS@#The multivariate logistic regression analysis showed that neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding were independent risk factors for NEC in very preterm infants (P<0.05). The ROC curve of the development set had an area under the curve (AUC) of 0.833 (95%CI: 0.715-0.952), and the ROC curve of the validation set had an AUC of 0.826 (95%CI: 0.797-0.862), suggesting that the nomogram model had a good discriminatory ability. The calibration curve analysis and the Hosmer-Lemeshow goodness-of-fit test showed good accuracy and consistency between the predicted value of the model and the actual value.@*CONCLUSIONS@#Neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding are independent risk factors for NEC in very preterm infant. The nomogram model based on the multivariate logistic regression analysis provides a quantitative, simple, and intuitive tool for early assessment of the development of NEC in very preterm infants in clinical practice.

Estimates of suicide mortality in women residents in northeast brazilian states from 1996 to 2018 / Estimativas de mortalidade por suicídio em mulheres residentes nos estados do nordeste brasileiro de 1996 a 2018

Abstract The objective of this study was to analyze the temporal trend of suicide mortality in women in the states of Northeastern Brazil. This is an ecological study of a time series stratified by states in Northeast Brazil from 1996 to 2018, with data extracted from the Mortality Information System (SIM). The temporal trend was evaluated by negative binomial regression (p values≤0.05). There was a higher proportion of deaths in black and brown women (73.9%), single (57.3%), with the place of death occurring in the home (53.4%). Hanging and strangulation stood out as the perpetration means (47.6%). Most states showed an upward temporal trend, except for Pernambuco, Rio Grande do Norte, Sergipe and Maranhão, which showed a steady trend (p>0.05). An upward temporal trend was identified in the analysis of deaths by suicide in women in five states in northeastern Brazil between 1996 and 2018. The information presented can support planning and decision-making for the prevention of suicide among women in northeastern Brazil.

Resumo O objetivo deste estudo foi analisar a tendência temporal da mortalidade por suicídio em mulheres nos estados do Nordeste do Brasil. Trata-se de um estudo ecológico de uma série temporal estratificada por estados do Nordeste do Brasil de 1996 a 2018, com dados extraídos do Sistema de Informações sobre Mortalidade (SIM). A tendência temporal foi avaliada por regressão binomial negativa (valores de p≤0,05). Houve uma proporção maior de mortes em mulheres negras e pardas (73,9%), solteiras (57,3%), com o local da morte ocorrendo em casa (53,4%). Suspensão e estrangulamento se destacaram como o meio de perpetração (47,5%). A maioria dos estados apresentou tendência temporal ascendente, com exceção de Pernambuco, Rio Grande do Norte, Sergipe e Maranhão, que apresentaram tendência estável (p>0,05). Uma tendência temporal ascendente foi identificada na análise dos óbitos por suicídio em mulheres em cinco estados do Nordeste brasileiro entre 1996 e 2018. Assim, as informações apresentados podem apoiar no planejamento e nas tomadas de decisões para prevenção do suicídio entre mulheres no Nordeste brasileiro.

Application of Correspondence Analysis in the Analysis of Accidental Death of Chinese Residents / 法医学杂志

Objective To study the preference relation between residence, sex, age and causes of accidental death of Chinese residents. Methods In this study, 72 residence-sex-age groups and 8 causes of accidental death were qualitatively and quantitatively analyzed by correspondence analysis using the official statistical yearbook issued from 2014 to 2018, and the preference values were calculated. Results Among the 576 pairs of correspondences between the residence-sex-age groups and causes of accidental death, 352 pairs （61.11%） showed a preference relation （preference value>0）. In terms of residence and sex, accidental death preference among Chinese residents was higher in rural areas than in urban areas, and males were higher than females. In terms of the causes of accidental death, the overall risk of accidental mechanical asphyxia and motor vehicle accidents was the highest among all age groups of Chinese residents. In terms of age, with the increase of age, the preference value of accidental death of Chinese residents showed a trend of first increasing and then decreasing. The comparative analysis results of the preference values of various causes of accidental death in different age groups showed that motor vehicle traffic accidents, accidental poisoning, death by crush and electric shock were more likely to occur in the working age group between 20 and 59 years old, accidental fall and fire were more likely to occur in the elderly group over 80 years old, and drowning and accidental mechanical asphyxia were more likely to occur in the minor group between 1 and 19 years old. Conclusion There are different preference relations between residence-sex-age groups and causes of accidental death in China. Therefore, effective control strategies and measures should be formulated for Chinese residents with preference for accidental death.

Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China / 中国当代儿科杂志

OBJECTIVES@#To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia.@*METHODS@#A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis.@*RESULTS@#Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, @*CONCLUSIONS@#Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.

Baby led weaning: an integrative review of scientific evidence from 2011 to 2019 / Baby-led weaning: uma revisão integrativa das evidências científicas de 2011 a 2019

INTRODUCTION: Baby-led weaning (BLW) is an alternative approach to introducing food to infants that has become popular. OBJECTIVE: To investigate the scientific evidence regarding the BLW method and its modified version, Baby-Led Introduction to Solids (BLISS). METHODS: The research was carried out between June 2018 and June 2019, through the databases US National Library of Medicine National Institutes of Health (PubMed) using the following keywords: 'BLW', 'Baby-led weaning', 'BLISS', and 'Baby-Led Introduction to Solids'. All original articles from in English published between 2011 and 2019 have been included. RESULTS: Twenty-five studies were included in the analysis. Research on BLW/BLISS focused mainly on the themes: characteristics, behaviors and attitudes of mothers and children, knowledge of mothers and health professionals about feeding methods, weight and body mass index evaluation of children, evaluation of energetic and nutrient intake of children and evaluation of episodes of choking and gag reflex. CONCLUSION: Most research deals with BLW-related experiences and there is still little evidence on the method in terms of adequacy of energy and nutrient intake and growth in childhood. Positive points to child can be observed such as prolonged breastfeeding, greater independence when feeding and better response to satiety. The methods of food introduction do not differ in relation to the occurrence of episodes of choking.

INTRODUÇÃO: O Baby-led weaning (BLW) é uma abordagem alternativa para a introdução alimentar aos lactentes que tem se tornado popular. OBJETIVO: Investigar as evidências científicas a respeito do método BLW e sua versão modificada Baby-Led Introduction to Solids (BLISS). MÉTODOS: A pesquisa de artigos foi realizada entre junho de 2018 e junho de 2019, por meio da base de dados US National Library of Medicine National Institutes of Health (PubMed) utilizando as seguintes palavras-chaves: 'BLW', 'Baby-led weaning', 'BLISS', e 'Baby-Led Introduction to Solids'. Foram incluídos todos os artigos originais encontrados no idioma inglês, publicados entre 2011 e 2019. RESULTADO: Vinte e cinco estudos foram incluídos na análise. As pesquisas sobre BLW/BLISS focaram principalmente nos temas: características, comportamentos e atitudes de mães e crianças, conhecimento de mães e profissionais de saúde sobre os métodos de introdução alimentar, avaliação de peso e de índice de massa corporal, avaliação da ingestão energética e de nutrientes e avaliação de episódios de engasgo e reflexo de gag das crianças. CONCLUSÃO: A maioria das pesquisas aborda experiências relacionadas ao BLW/BLISS e ainda existem poucas evidências sobre o método em termos de adequação de ingestão de energia e nutrientes e de crescimento na infância. Pontos positivos para a criança podem ser observados como aleitamento materno prolongado, maior independência ao se alimentar e melhor resposta à saciedade. Os métodos de introdução alimentar não diferem entre si em relação à ocorrência de episódios de engasgos.

Doble mecanismo de estrangulación. A propósito de un caso / Double mechanism of strangulation. Apropos of a case

RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

Suicidio por confinamiento con bolsa plástica y gas helio: presentación de dos casos / Suicide with plastic bag and helium gas: two case report

Resumen El confinamiento al igual que el sepultamiento son parte de las sofocaciones por carencia de aire respirable. Su etiología principal es la accidental, como ocurre con los mineros o los niños que juegan con bolsas de plástico o quedan atrapados dentro de lugares sin ventilación. En la actualidad se ha visto el aumento a nivel mundial sobre todo en países desarrollados, del uso de una bolsa plástica en conjunto con algún gas noble (principalmente helio) como método suicida "per se" o como proceso final de eutanasia. En el presente artículo se hará revisión de dos casos en Costa Rica, con sus hallazgos en la necropsia, la carencia de hallazgos toxicológicos y la importancia del escenario de muerte para poder emitir un criterio desde el punto de vista médico legal.

Abstract The confinement as well as the burial are part of the suffocations due to lack of breathable air. Its main etiology is accidental, as it happens with miners or the children who play with plastic bags or get trapped inside unventilated places. At present, the increase in the world has been seen especially in developed countries of the use of a plastic bag in conjunction with some noble gas (mainly helium) as a suicidal method or as a final process of euthanasia.

Mitochondrial Damage due to Hypoxia and Its Forensic Significance / 法医学杂志

Mitochondria are the special organelle in eukaryotic cells. Their main functions are to synthesize energy required for cell activity by oxidative phosphorylation. Most of the oxygen absorbed by the body is consumed in the mitochondria. The precise diagnosis of mechanical asphyxia is one of the difficulties in forensic pathology practice. Forensic pathologists have been trying to find a reliable and sensitive marker for the diagnosis of mechanical asphyxia. Mitochondria are very sensitive to hypoxic environments, and the markers of mitochondrion damage can be used as a basis for the diagnosis of mechanical asphyxia. The purpose of this paper is to review the research progress on mitochondrial damage in hypoxic environments and to explore the possibility of using markers of mitochondrion damage in forensic pathological practice.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Perfil das vítimas de suicídio necropsiadas no núcleo de medicina e odontologia legal de João Pessoa ­ PB ­ Brasil / Profile of necropsied victims in the nucleus of forensic medicine and dentistry of Joao Pessoa ­ PB ­ Brazil

Introdução: A incidência de suicídio vem crescendo no Brasil e no mundo, apresentando-se como problema de saúde pública. Objetivo: Traçar o perfil das vítimas de suicídio da cidade de João Pessoa/PB ­ Brasil. Material e Métodos: Estudo transversal, descritivo e de abordagem quantitativa por meio da avaliação de dados presentes nas Declarações de Óbito de vítimas de suicídio nos anos 2015 e 2016 emitidas pelo Núcleo de Medicina e Odontologia Legal da cidade de João Pessoa/PB ­ Brasil. Os dados foram fornecidos pela Vigilância Epidemiológica da Secretaria Municipal de João Pessoa. As variáveis estudadas foram sexo, idade, escolaridade, estado civil, ocupação, local do suicídio, se houve atendimento médico e causa básica da morte (de acordo com a Classificação Internacional de Doenças ­ CID-10). Procedeu-se a análise estatística descritiva e inferencial, adotando nível de significância de 5,0%. Resultados: 105 pessoas morreram vítimas de suicídio, com prevalência do sexo masculino (75,2%), entre 20 e 39 anos (41,9%), sendo a residência (73,3%) o local de eleição para a prática suicida. Quanto à forma, o enforcamento foi mais comum entre homens (57,1% e p=0,006) e a autointoxicação e o enforcamento (10,5% e p=0,006) entre mulheres. Não houve diferença estatisticamente significante quando o sexo foi relacionado ao estado civil (p=0,381), escolaridade (p=0,051) e ocupação (p=0,628). Conclusão: O perfil das vítimas de suicídio em João Pessoa nos anos de 2015 e 2016 foi de homens, adultos, solteiros, com baixa escolaridade, profissão relacionada à agricultura, ocorrendo, em sua maioria, na residência, por enforcamento (homens) e enforcamento e autointoxicação (mulheres)

Introduction: Suicide has been increasing in Brazil and worldwide, presenting itself as a public health problem. Objective: Outline the suicide victims profile in the city of João Pessoa/PB, Brazil. Material and Methods: Cross-sectional, descriptive and quantitative-approach study, through the evaluation of data presented in the Death Certificates of suicide victims in the years 2015 and 2016 issued by Nucleus of Forensic Medicine and Dentistry of João Pessoa city/PB ­ Brazil. The data were provided by the Epidemiological Surveillance of the Municipal Secretariat of João Pessoa. The variables studied were sex, age, schooling, marital status, occupation, place of suicide, if there was medical attention and basic cause of death, according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistical analysis were used, with a significance level of 5.0%. Results: 105 people died of suicide, showing prevalence of males (75.2%), between 20 and 39 years (41.9%), and residence as being the place of choice for suicidal practice (73.3%). Regarding the method, hanging was more common among men (57.1% and p = 0.006) and autointoxication and hanging (10.5% and p = 0.006) among women. There was no statistically significant difference when genre was related to marital status (p = 0.381), schooling (p = 0.051) and occupation (p = 0.628). Conclusion: The suicide victims profile in the city of Joao Pessoa in the years 2015 and 2016 was man, adult, single, with low schooling, agriculture-related profession, mostly occurring in the residence, by hanging (men) and hanging and autointoxication (women)

Ahorcamiento con soga. Presentación de un caso atípico / Hanging with rope. Presentation of an atypical case

RESUMEN Las asfixias mecánicas son aquellas que resultan de un impedimento mecánico a la penetración del aire en las vías respiratorias. Suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina, y a su modo de actuar. El ahorcamiento no es más que la constricción del cuello, ejercida por un lazo sujeto a un punto fijo, sobre el cual ejerce tracción el propio peso del cuerpo. La muerte, según las circunstancias del caso, puede ocurrir por un mecanismo asfíctico, circulatorio, inhibitorio o por lesión medular (caso raro de presentación). El presente trabajo constituyó un caso atípico de ahorcamiento. El ciudadano que resultó fallecido, al dejarse caer bruscamente del balcón de su vivienda, con el dogal en el cuello (soga) y quedar pendiendo el cuerpo, ocasionó un traumatismo raquimedular severo; lo que trajo como consecuencia que se produjera una fractura de la 3ra vértebra cervical, y una contusión medular que lo llevó a la muerte de forma instantánea por el shock medular ocasionado. Para la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, y el examen del cadáver externa e internamente.

ABSTRACT Mechanical asphyxias are those resulting from a mechanical interruption of air penetration to the respiratory tract. They are usually classified according to the nature of the mechanical mean originating them and the way they perform. Hanging is no more that the neck constriction, executed by a lace attached to a fixed point, on which the proper weight of the body applies traction. Death, according to the circumstances of the case, may occur by an asphyxiating, circulatory, inhibitory mechanism or by medullar lesion (a rare case of presentation). The current work reports a case of atypical hanging. The person who died, when abruptly jumped down the balcony of his house with the rope around the neck and the body was left pending, suffered a severe spinomedullar trauma, causing a fracture of the 3rd cervical vertebra, and a medullar contusion causing an instantaneous death due to the medullar shock. To discuss the case, the authors took into account elements of the location where it took place, and the external and internal examination of the body.

Adherencia a la estrategia minuto de oro en sala de partos de una institución de segundo nivel, de cali (colombia), junio-agosto de 2017: estudio de corte transversal / Adherence to the helping babies breathe strategy at delivery room of an institution level ii of cali (colombia), year 2017: cross sectional study

RESUMEN Objetivo: determinar la adherencia global y por componentes a la estrategia minuto de oro en médicos que atienden recién nacidos en una entidad de mediano nivel de complejidad. Materiales y métodos: estudio de corte transversal; se incluyeron recién nacidos vivos de partos vaginales espontáneos atendidos por médicos pediatras, ginecólogos o internos en sala de partos de un hospital universitario de la ciudad de Cali, Colombia, en el 2017. Se excluyeron fetos con mal- formaciones congénitas mayores, gemelares y con menos de 34 semanas de edad gestacional. Muestreo sistemático. Tamaño muestral: 150 recién nacidos. Se evaluaron las características basales de los recién nacidos y sus madres, y la adherencia a la estrategia minuto de oro y sus componentes. Se hizo análisis descriptivo. Resultados: la adherencia al minuto de oro en médicos pediatras fue del 65,6 % (IC 95 %: 53,8-78,4), en ginecobstetras, de 33,33 % (IC 95 %: 4,3-77,7), y en médicos internos, de 75,3 % (IC 95 %: 64,8- 85,1). La menor frecuencia se dio en la colocación del gorro al recién nacido, 64,90 % (IC 95 %: 56,7- 72,4), y poner al bebé piel a piel sobre la madre, 65 % (IC 95 %: 55,9-74,4); la mayor frecuencia se presentó en cubrir al recién nacido con paños calientes, 98,6 % (IC 95 %: 95,3-99,8), y la ventilación con presión positiva en los casos en los que no había respuesta a la estimulación inicial, 100 % (IC 95 %: 30-100). Conclusiones: los resultados obtenidos sobre el grado de adherencia de los profesionales sugieren la necesidad de realizar procesos continuos de educación y evaluación sobre la aplicación de esta estrategia de reconocida efectividad en las institu- ciones que ofrecen el servicio de atención de partos.

ABSTRACT Objective: To determine adherence, overall and by components, to the Helping Babies Breathe strategy by physicians caring for neonates in an intermediate complexity institution. Materials and Methods: Cross-sectional study that included live neonates born by spontaneous vaginal delivery and who received care from pediatricians, gynecologists or interns in the delivery room of a university hospital in the city of Cali, Colombia, in 2017. Fetuses with major congenital malformations, twins, and neonates with less than 34 weeks of gestational age were excluded. Sampling was systematic and the sample size was of 150 neonates. Baseline neonatal and maternal characteristics were assessed, as well as adherence to the Helping Babies Breathe strategy and its components. A descriptive analysis was performed. Results: Adherence to the Helping Babies Breathe was 65.6% (95% CI 53.8-78.4) for pediatricians, 33.33% (95% CI: 4,3-77,7) for obstetricians and gynecologists, and 75.3% (95% CI: 64,8-85,1) for interns. The lowest frequency was found for cap placement on the neonate's head, 64.90% (95% CI: 56.7-72.4), and placement of the baby in contact with the mother's skin, 65% (95% CI: 55.9-74.4); the highest frequency was found for covering the baby with warm blankets, 98,6% (95% CI: 95.3-99.8), and positive pressure ventilation in those cases of absent response to initial stimulation, 100% (95% CI 30-100). Conclusions: Results pertaining to the degree of adherence on the part of the practitioners suggest the need to implement continuous education and evaluation processes focused on the application of this strategy which has been shown to be effective in institutions offering childbirth care.

Hematoma sofocante, su fisiopatología / Suffocating hematoma, its pathophysiology

Se revisan la fisiopatología y los mecanismos que producen la sofocación en el hematoma cervical y se determina que el único tratamiento con posibilidades de éxito vital es el inmediato drenaje del hematoma.

In this article are reviewed the physiopathology and the mechanisms that causes suffocation in the cervical hematoma. It is determined that the only treatment with possibilities of vital success is the immediate drainage of the hematoma.