Muerte súbita en epilepsia / Sudden death in epilepsy

The risk of sudden unexpected death in patients with epilepsy (SUDEP), is 20 to 25 times greater than in the general population. This increased risk is seen specially in refractory epilepsy, with an incidence of 9:1,000 patients-years. Risk factors have been established based on retrospective studies, finding that the frequency of seizures, specially generalized tonic clonic seizures, is the most important one. The physiopathological mechanism of SUDEP is not yet fully understood. Autonomic system abnormalities, as well as cardiac and respiratory changes have been found. The finding of new molecular biomarkers to identify patients with increased risk should be a priority. Treatment is based in the management of risk factors, although clear recommendations are hard to establish given the low level of evidence.

Situación del intervalo QTc en el período neonatal en un hospital del occidente de México, estudio piloto / QTc interval in the neonatal period in a Mexican population. A pilot study

Resumen Introducción: La prolongación del intervalo QT se asocia con arritmias ventriculares y muerte súbita. Objetivo: Determinar el valor del intervalo QTc en recién nacidos sanos y evaluar su comportamiento durante los primeros meses de vida. Métodos: Recién nacidos sanos a término de marzo-noviembre 2016 en el Hospital General de Occidente del Estado de Jalisco, México. Se les practicó un electrocardiograma de 12 derivaciones a una velocidad de 25 mm/s durante las primeras 48 h. Se midió el intervalo QT en DII y se calculó el QTc mediante la fórmula de Bazett. Los pacientes a los que se detectó prolongación del QTc en sus primeras 48 h se valoraron al mes con ECG y ecocardiograma. Si persistieron con QTc alargado se revaloraron a los 6 meses con ECG, Holter de 24 h y estudio electrocardiográfico a padres y hermanos. Los que persistieron con QTc alargado se revaloraron a los 9 meses con ECG. Resultados: Se incluyeron 548 pacientes. La media del intervalo QTc al nacimiento fue de 459 ms; durante este período 33 pacientes presentaron un QTc mayor de 470 ms, los cuales fueron evaluados al mes mediante un nuevo estudio electrocardiográfico, obteniendo una media del intervalo QTc de 446 ms. A los 6 meses se evaluaron 16 pacientes, con una media del intervalo QTc de 434 ms. A los 9 meses se evaluaron 6 pacientes, con una media del intervalo QTc de 438 ms, y solo 4 pacientes persistieron con QTc prolongado. Conclusiones: El intervalo QTc en nuestros pacientes es más prolongado en comparación con otras poblaciones y muestra una normalización paulatina.

Abstract Introduction: QT interval prolongation is associated with ventricular arrhythmias and sudden death syndrome. Objective: To determine the value of QTc interval in healthy newborns in a general hospital in Jalisco, Mexico, and their outcome during their first months of life. Methods: The study included healthy newborns from March to November 2016, in the Hospital General of Occidente in Jalisco, Mexico. A 12-lead electrocardiogram was performed at a speed of 25 mm/s during the first 48 h of life. The QT interval was measured in lead DII, and the QTc interval was calculated using the Bazett formula. Patients detected with QTc prolongation were assessed monthly with an ECG and echocardiogram. If they persisted with prolonged QTc interval, they were re-evaluated at 6 months with an ECG, 24 h Holter, and electrocardiography study on parents and siblings. Those who persisted with prolonged QTc interval were evaluated with an ECG at 9 months. Results: The study included 548 patients. The mean QTc interval at birth was 459 ms; during this period 33 patients has a QTc greated that 470 ms; which were evaluated monthly with a new electrocardiographic study, obtaining a mean QTc interal of 446 ms. At 6 months 16 patients were evaluated, with a mean QTc interval of 434 ms. At 9 months, 6 patients were found to have a mean QTc interval of 438 ms, and only 4 patients persisted with a prolonged QTc interval. Conclusions: The QTc interval in our population is prolonged compared to other populations and with a gradual return to normal.

Seizure Frequencies and Number of Anti-epileptic Drugs as Risk Factors for Sudden Unexpected Death in Epilepsy

The purpose of this study was to investigate the association between clinical variables and sudden unexpected death in epilepsy (SUDEP) and identify risk factors for SUDEP. SUDEP is one of the most frequent causes of death in patients with epilepsy. Previous studies have reported possible risk factors associated with SUDEP, but there need to be elucidated yet. The cases were 26 patients with SUDEP and three control patients were included for each case, matched for age, sex, and date of initial clinical visit. All demographic and clinical characteristics, including age, sex, disease duration, classification of epilepsy, age at seizure onset, kind and number of antiepileptic drugs, were compared between cases and controls. Seizure frequency was higher in SUDEP cases than in controls (P=0.035). Univariate analysis using conditional logistic regression showed that higher seizure frequency (odds ratio [OR]=3.1, P=0.021) and the number of antiepileptic drugs (AEDs) (OR=2.0, P=0.009) were significantly associated with SUDEP. Only the number of AEDs remained significant in multivariate analysis (OR=1.8, P=0.026). Frequent seizures and multi-drug therapy were associated with SUDEP. This may suggest that the severity of epilepsy is associated with SUDEP, regardless of the type of AED used.

Morte súbita no Brasil: soluções a vista? / Sudden death in Brazil: solutions at sight?

A morte súbita cardíaca (MSC) é um grave problema mundial, no entanto, não apenas no Brasil, mas em todo o mundo, estamos distantes de uma solução definitiva. Sua importância é determinada pelo impacto epidemiológico, potencial de ocorrência em população economicamente ativa e possibilidade de utilização de diferentes estratégias preventivas visando redução de sua incidência. Os caminhos para que o Sistema de Saúde Pública brasileiro solucione os problemas da MSC exigem: A - medidas assistenciais e educacionais, B - medidas burocráticas e de apoio à pesquisa. estratégias focando controle de fatores de risco, melhora da assistência aos cardiopatas, treinamento de profissionais da saúde e conscientização da população são necessárias para sua prevenção. A praticipação do Ministério da Sáude e das principais sociedades médicas brasileiras é essencial nestas intervenções. No Brasil, a melhora da gestão das ações e dos recursos financeiros, bem como a reestruturação de processos logísticos e recursos humanos para a melhora da assistência básica à saúde e de suporte à pesquisa devem ser aplicadas. Descrevemos, neste texto, as diferentes possibilidades de atuação na busca de soluções eficientes e factíveis para redução de sua incidência.

The sudden cardiac death (SCD) is a serious public health problem worldwide, however, not only in Brazil but worldwide we are far from a definitive solution. Its importance is determined by epidemiological impact, potential for occurence in the economically active population and the possibility of different preventive strategies. The paths to the Brazilian Public Health System to solve the MSC problem: A - care and educational measures, B - bureaucratic measures and research support. Strategies focusing on control of risk factors, improvement of assistance for heart disease patients, training of health professionals and public awareness are necessary for its prevention. The participation of the Ministry of Health and Brazilian medical societies is essential in these interventions. In Brazil, the improvement of management actions and financial resources, as well as the restructuring of logistics processes and human resources for improving basic health care and support for research should be applied. We describe in this paper the different possibilities to find feasible and efficient solutions to reduce its incidence.

Abordaje de la muerte súbita en niños y jóvenes desde la patología forense en Bizkaia y Sevilla (España) / A forensic pathology approach to sudden death in children and young adults in Biscay and Seville (Spain)

La muerte súbita (MS) en niños y jóvenes constituye un complejo problema multifactorial con implicaciones médico-legales y socio-familiares. En su investigación, la patología forense tiene una función importante ya que al tratarse de muertes inesperadas es necesaria una autopsia médico-legal para determinar la causa y el mecanismo de la muerte. La mayor parte de estas muertes tienen un origen cardiovascular y muchas de ellas tienen un componente hereditario. La autopsia puede ser la única posibilidad de que se efectúe un diagnóstico correcto de la enfermedad y que la familia reciba una orientación médica adecuada que permita la identificación de familiares asintomáticos y la prevención de futuras muertes. Para realizar un abordaje adecuado se requiere la colaboración de las distintas especialidades médicas implicadas (médicos forenses, patólogos, pediatras, cardiólogos, microbiólogos, genetistas), quienes deben trabajar de forma coordinada de acuerdo a protocolos internacionales. En este artículo se revisan las características epidemiológicas y clínico-patológicas de las principales enfermedades que se pueden manifestar como MS en niños y jóvenes y se presenta la casuística de las provincias de Sevilla y Bizkaia en los últimos años. Finalmente, se destaca la trascendencia de la patología forense en el abordaje y prevención de estos fallecimientos.

Sudden death (SD) in children and young adults is a complex multifactorial problem that entails medical forensic and socio-familial implications. Forensic pathology plays an important role in these cases due to the fact that they tend to occur unexpectedly, and therefore a postmortem examination is needed to determine cause and mechanism of death. Most of these deaths are of cardiovascular origin and many of them have a hereditary component. The autopsy may be the only way to establish the correct diagnosis of the underlying condition enabling the family to receive proper medical counseling, to identify asymptomatic relatives at risk, and to prevent subsequent deaths. A proper approach requires the collaboration of various medical specialties (coroners, pathologists, pediatricians, cardiologists, microbiologists, geneticians), who must work in coordination in accordance to international protocols. In this article, the epidemiologic and clinical-pathological features of the main conditions that may lead to SD in children and young adults are reviewed and a case series from Seville and Biscay provinces is presented. Finally, the importance of forensic pathology in the management and prevention of these cases is underlined.

Características epidemiológica, clínica y patológica de la muerte súbita en el servicio de patología del instituto de medicina legal durante el periodo del 2007 -2009 / Features epidemiological, clinical and pathological sudden death in the service of pathology forensic institute during the period 2007 -2009

Estudio descriptivo, corte transversal. Se encontró que el riesgo de Muerte Súbita es significativamente superior en varones que en mujeres, la incidencia es más alta en mayores de 50 años que los adultos jóvenes. La enfermedad ateroesclerosis coronaria fue la principal patología de muerte súbita cardiaca la cual está en relación directa con la edad, y la hora de fallecimietno que fue en horas de la mañana. La hemorragia subaracnoidea fue la principal causa de muerte súbita extracardiaca. Se recomienda la importancia de la realización de una autopsia completa en todos los casos de muerte súbita para obtener datos fiables respecto a las causas reales de muerte. Elaborar un sistema de base computarizado que permita la introducción de los datos registrados en los protocolos de autopsia realizadas desde año 2000 y hasta las actuales. Al Ministerio de Salud que elabore campañas de sensibilización y educación sanitaria sobre medidas de resucitación cardiopulmonar, así como la necesidad de ambulancias móviles con personla calificado

Mortality in children with severe epilepsy: 10 years of follow-up / Mortalidade em crianças com epilepsia severa: 10 anos de seguimento

Epilepsy is the main neurological condition in children and adolescents. Unfortunately patients with medical refractory epilepsy are more susceptible for clinical complications and death. We report a prospectively evaluated cohort of children followed for approximately 10 years. Fifty-three of 1012 patients died. Forty-two patients died due to epilepsy or its clinical complications and the main causes of death were pneumonia (in 16 cases), sepses (in 9 patients), status epilepticus (in 8 patients). In 11 patients cause of death was sudden unexpected death in epilepsy (SUDEP). Mental retardation was significantly more frequent in patients who did not die from SUDEP. SUDEP may be a significant condition associated with mortality in children and adolescents with epilepsy.

Epilepsia é uma das condições neurológicas mais comuns em crianças e adolescentes. Infelizmente, pacientes com epilepsias refratárias ao tratamento medicamentoso estão mais susceptíveis a complicações clínicas e óbito. Neste trabalho reportamos, em uma análise prospectiva, um cohort de crianças acompanhadas por aproximadamente dez anos. Cinquenta e três de 1012 pacientes foram a óbito. Quarenta e dois pacientes morreram em decorrência da epilepsia ou de suas complicações clínicas; as principais causas foram pneumonia (16 casos), sepse (9 casos) e estado de mal epiléptico (8 casos). Em 11 pacientes a causa da morte foi SUDEP. A presença de retardo mental foi significantemente associada a mortalidade em crianças e adolescentes com epilepsia.

Morte súbita em atletas: há como prevenir? / Sudden death in athletes: is how to prevent?

A morte súbita em atletas é um evento dramático de grande impacto social. Sua melhor forma de prevenção até o momento é a detecção precoce das cardiopatias relacionadas a ela. Entretanto há ainda muita discussão de qual o melhor método para o rastreamento de cardiopatias em uma grande população assintomática para, dessa forma, criar protocolos reprodutíveis e de fácil acesso aos mais variados sistemas de saúde.

Sudden, unexpected and natural death in young adults of age between 18 and 35 years: A clinicopathological study.

Context: To identify various causes, risk factors, age and sex distribution associated with sudden and unexpected natural deaths (SUNDs) in young adults of age between 18 and 35 years. Materials and Methods: Retrospective analysis of autopsy reports and medical records of all SUNDs that occurred instantaneously or within 24 hours of onset of symptoms in young adults, between 2001 and 2009. Result: Of the total 6453 deaths autopsied during 2001-2009, 64 (0.99%) were SUNDs in young adults, chiefly in males between 30 and 35 years of age. Non-cardiac causes significantly predominated (73.4%) over cardiac causes (7.8%). Most of the SUND cases were due to preventable causes, including infections (54.6% cases), cerebrovascular accidents (9.37%) and ischemic cardiac causes (6.25%). Sudden adult death syndrome (SADS) accounted for 18.75% deaths. Conclusion: SUND in young adults is preventable. A meticulous post-mortem examination with special attention to the conduction system of heart and detailed toxicological analysis can pinpoint the cause of death in SADS.

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization / Incidência de SUDEP numa coorte de pacientes com epilepsia refratária: papel da cirurgia e da localização da lesão

OBJECTIVE: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. METHOD: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. RESULTS: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2 percent of the 166 patients of the non operated group and in 3.7 percent of the 384 patients who were operated (OR=3.02, 95 percent CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). CONCLUSION: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP.

OBJETIVO: O objetivo deste estudo é avaliar a incidência e características de morte súbita em pacientes com epilepsia refratária (SUDEP) e sua relação com cirurgia prévia e localização da lesão. MÉTODO: Estudo de Coorte realizado com 550 pacientes com epilepsia refratária seguidos no Programa de Epilepsia do Hospital Universitário da PUCRS, Porto Alegre, Brasil, entre Janeiro, 1992 e Julho, 2002. Os pacientes foram distribuídos em dois grupos (operados e não operados). Tipo de epilepsia, distribuição das descargas interictais e achados em RNM foram correlacionados com SUDEP. RESULTADOS: A incidência estimada de SUDEP foi 29:1000 indivíduos. A incidência de provável SUDEP nos 166 pacientes do grupo de não operados foi 1,2 por cento e nos 384 pacientes no grupo operado 3,7 por cento (OR=3,02, 95 por cento IC 0,69-13,16) (p=0,11). Comparando os pacientes que morreram com os sobreviventes do grupo operado houve diferença significativa nas seguintes variáveis: pacientes com SUDEP apresentam uma predominância de crises epilépticas generalizadas (p=0,002), lesões extratemporais na RNM (p<0,001) e atividade epileptiforme na região extratemporal (p=0,001). CONCLUSÃO: A localização da lesão e as descargas extratemporais em pacientes tratados cirurgicamente com epilepsia refratária correlacionaram-se significativamente com SUDEP. Então, é possível que nestes pacientes uma doença sobrejacente possa estar envolvida na patogênese da SUDEP.

Does sudden unexpected death in children with epilepsy occur more frequently in those with high seizure frequency? / Morte súbita em crianças com epilepsia ocorre naquelas que apresentam maior frequência de crises?

People with epilepsy are more likely to die prematurely and the most common epilepsy-related category of death is sudden unexpected death in epilepsy (SUDEP). Several studies have reported a moderate or high seizure frequency among SUDEP cases and SUDEP is considered rare in patients in remission. METHOD: We reviewed the occurrence of SUDEP in our epilepsy unit over an 8-year period to identify a potential association between seizure frequency and SUDEP occurrence in children with epilepsy. RESULTS: From 835 patients evaluated, 12 had suffered SUDEP and nearly all of the SUDEP cases in our children are related to chronic uncontrolled epilepsy (daily - 50.0 percent, two to four/week - 41.7 percent, monthly - 8.3 percent). CONCLUSION: SUDEP is not a rare event in children and increased mortality was recorded in those individuals who had not responded to pharmacologic treatment. Improved seizure control seems to be one of the most important measures to prevent SUDEP.

Pessoas com epilepsia têm maior chance de morrer prematuramente e a principal causa de morte relacionada à epilepsia é a morte súbita em epilepsia (SUDEP). Vários estudos têm relatado uma freqüência de crises moderada ou elevada em pacientes com SUDEP e SUDEP é considerada rara em pacientes em remissão. MÉTODO: Revisamos a ocorrência de SUDEP em nossa unidade de epilepsia por um período de oito anos com o objetivo de identificar uma possível associação entre freqüência de crises e a ocorrência de SUDEP em crianças com epilepsia. RESULTADOS: De 835 pacientes avaliados, 12 evoluíram com SUDEP e a maioria das crianças apresentava epilepsia crônica não controlada (50 por cento com crises diárias; 41,7 por cento com duas a quatro crises/semana; 8,3 por cento com crises mensais). CONCLUSÃO: SUDEP não é um evento raro em crianças e maior mortalidade foi observada em indivíduos que não responderam ao tratamento medicamentoso. Melhor controle de crises parece ser uma das principais medidas na prevenção de SUDEP.

Muerte súbita de origen neuropatológico: I parte / Sudden death origin neuropathological

Se presenta una serie de dos artículos en este número de la revista Medicina Legal de Costa Rica sobre muerte súbita de origen neuropatológico. En esta primera parte se analiza a profundidad el concepto de muerte súbita, se propone una definición lo más completa posible y se identifican sus principales causas. Asimismo se habla de la neuropatología forense no traumática, es decir, aquellas patologías originadas en el sistema nervioso central capaces de originar una muerte no violenta. Se revisa sus principales características y perfil epidemiológico con base en literatura médica actualizada.

Avaliação dos óbitos ocorridos no Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC) / Evaluation of deaths occurred at the University Hospital (HU/UFSC)

OBJETIVO: Avaliar os óbitos ocorridos no HU/UFSC. Comparar o perfil dos pacientes que morreram nas enfermarias com o daqueles que morreram na UTI. Verificar se os óbitos foram considerados esperados (E) e não evitáveis (NE). Constatar se houve recusa/suspensão de terapêutica (RST) precedendo a morte. MÉTODOS: Obtivemos dados por meio de ficha elaborada pela Comissão de Óbito Hospitalar (COH), na qual constavam os aspectos demográficos, clínicos e terapêuticos dos pacientes e a avaliação da COH sobre a expectativa/evitabilidade dos óbitos. RESULTADOS: Analisamos os dados dos 326 pacientes com mais de 14 anos, que morreram entre julho/2004 e dezembro/2005. Desses, 128 morreram na UTI (G1) e 198 nas enfermarias (G2). A RST precedeu 38,2 por cento dos óbitos no G1 e 2 por cento no G2 (p<0,001). As principais terapêuticas recusadas/suspensas foram drogas vasoativas e antibióticos. No G1 cerca de 20 por cento das mortes foi classificada como E/NE. No G2 considerou-se 5 por cento das mortes evitáveis e 6,5 por cento não esperadas (p<0,001). Os pacientes do G1 eram mais jovens e do sexo masculino (p<0,005). A ordem de não reanimar constava em 48,4 por cento dos prontuários do G2 e em 6,3 por cento do G1(p<0,001). Manobras de reanimação cardiorrespiratória (RCR) ocorreram em 23,4 por cento no G1 e em 5,5 por cento no G2(p<0,001). CONCLUSÃO: Na UTI, os pacientes que morreram eram mais jovens, receberam mais DVA e os óbitos foram mais freqüentemente precedidos da RST. Houve reanimação cardiorrespiratória em 5 por cento das PCR nas enfermarias onde se constatou ordem de não reanimar em 48 por cento dos prontuários. Poucos óbitos foram considerados E/NE. Não houve indícios de erro profissional ou institucional nesses óbitos.

OBJECTIVE: To evaluate the deaths which occurred at the HU/UFSC. To compare the profile of patients who died in the wards with that of patients who died in the ICU. To classify deaths which were expected or not, and avoidable or not. To verify how often withholding or withdrawing (WW) therapy preceded death. METHODS: Archives of the Hospital Death Commission (HDC) were analyzed. The clinical and demographic records were retrieved from the HDC data bank. Deaths were classified by the HDC as expected or not and avoidable or not. RESULTS: Data from 326 dead persons over 14 years of age were analyzed. One hundred and twenty eight deaths occurred in the ICU (G1) and 198 in the wards (G2). WW therapy preceded 38.2 percent of deaths in G1 and 2 percent in G2 (p<0.001). The main WW therapies were vasoactive drugs and antibiotics. Almost 20 percent of deaths were unexpected/avoidable in G1. In G2 6.5 percent were considered unexpected and 5 percent avoidable (p<0.005). Patients in G1 were younger and mostly male (p<0.005). Do-not-resuscitate orders were registered in 48.4 percent of patients' medical charts in G2 and 6.3 percent in G1 (p<0.001). Cardiopulmonary resuscitation was performed in 23.4 percent of patients in G1 and in 5.5 percent in G2 (p<0.001). CONCLUSION: In G1, patients were younger and deaths were more frequently preceded by WW. In G2, half of the patients had do-not-resuscitate order registered in their medical charts. In only a few patients were deaths considered unexpected or avoidable. No evident professional or institutional error was identified.

Comportamiento clínico epidemiológico de la cardiopatía isquémica en la unidad de cuidados intensivos polivalente / Clinical and epidemiological behavior of ischemic heart disease at the polyvalent intensive care unit

OBJETIVO: Dentro de las enfermedades cardiovasculares las que afectan las arterias coronarias, son las más frecuentes y engloban procesos que van desde la angina de pecho, Infarto Agudo del Miocardio, hasta la muerte súbita. El objetivo de este trabajo fue describir las características clínicas y epidemiológicas de estos pacientes. MÉTODOS: se realizó un estudio descriptivo, prospectivo, transversal de los 71 pacientes atendidos, con diagnóstico de Cardiopatía Isquémica en la Unidad de Cuidados Intensivos Polivalente del hospital Ciro Redondo García, en el período comprendido de Agosto 2006- Enero 2007. RESULTADOS: A partir de la revisión de historias clínicas se obtuvieron datos que fueron procesados estadísticamente. Los factores de riesgo mayormente encontrados fueron la HTA, el hábito de fumar y la Diabetes Mellitus. El mayor número de los pacientes tuvo una estadía de 5 días o menos y las complicaciones presentadas fueron arritmia, angina post infarto, fallo VI, schok cardiogénico y muerte, la mortalidad de 2,8 % representó un caso de schok cardiogénico y uno de trombo embolismopulmonar. CONCLUSIONES: esperamos que este trabajo sirva para trazar estrategias con el fin de mejorar el pronóstico y calidad de vida de los pacientes(AU)

OBJECTIVE: Within the cardiovascular diseases, those affecting the coronary arteries are the most frequent and they include processes that go from angina pectoris and acute myocardial infarction to sudden death. The objective of this paper was to describe the clinical and epidemiological characteristics of these patients. METHODS: A descriptive, prospective and cross-sectional study of the 71 patients with diagnosis of ischemic heart disease that received attention at the Polyvalent Intensive Care Unit of "Ciro Redondo" Hospital from August 2006 to January 2007, was undertaken. RESULTS: The data obtained from the medical histories were statistically processed. The commonest risk factors were arterial hypertension, smoking habit and diabetes mellitus. Most of the patients had a hospital stay of 5 or less days. The complications observed were arrhythmia, postinfarction angina, failure VI, cardiogenic shock and death. A case of cardiogenic shock and one of pulmonary thromboembolism accounted for 2.8 % of mortality. CONCLUSIONS: We hope this paper serves to lay down strategies aimed at improving the prognosis and quality of life of the patients(AU)

Sudden natural death in Khartoum Mortuary

The sudden natural death is defined as: Death occurs within 24 hours from the onset of symptoms. The disclosing of the causes of sudden natural death is important for prevention and improving outcome. The objectives of this study were to determine the causes of sudden natural death in Khartoum Mortuary Descriptive, cross- sectional study of natural sudden death in Khartoum Mortuary, which was located in Khartoum Teaching Hospital and offers services to the state. The autopsy records of 2007, which were 150, were considered. Data were collected by a structured check list, and analysis was done by the SPSS soft ware. The most important systems involved in sudden natural deaths were respiratory [49.3%], cardiovascular [24%], gastro intestinal [15.3%] and cerebral [4%], while the leading causes of sudden natural death were pneumonia [20%], myocardial infarction [17.3%] and tuberculosis [14%]. Sudden natural death occurred in slightly higher ratio in the age group 40 years and below [50.1%], males were dominating [83%]. The commonest causes of sudden natural death, which were pneumonia, myocardial infarction and tuberculosis, were different from the literature in which the commonest causes were myocardial infarction followed by pulmonary embolism. The study highlighted the importance of respiratory diseases besides myocardial infarction as leading causes of sudden natural death, and the need for further researches in this issue

The temporal variations of presumptive sudden death of Thai people in Singapore and Taiwan.

BACKGROUND: Sudden Unexplained Death Syndrome (SUDS) is the major cause ofsudden death in Thai adults, especially Thai migrant workers in Singapore and Taiwan. Temporal variations of sudden death of Thai people abroad are not well known. OBJECTIVE: To study the month, day and time of death of presumptive sudden death (PSD) in Singapore, Taiwan. MATERIAL AND METHOD: The authors reviewed the death certificates of Thai people who died in Singapore and Taiwan and previously SUDS reported cases form Singapore. The time, day and month ofPSD and Non-PSD deaths in Singapore and Taiwan were compared. RESULTS: From January 1994 to January 1995, 46 SUDS died in Singapore (gr A), from May 2000 to August 2002, 39 PSD died in Singapore (gr B), from January 1999 to May 2002, 100 presumptive or probable sudden unexplained death syndrome (PSUDS) died in Taiwan (gr C) and 254 Non-PSD death aboard (gr D) as controls. The annual SUDS/PSD death rates (per 100,000) in Singapore were 91.1 in 1994, 30.7 in 2001 and 33.5 in Taiwan in 2000. All but two SUDS/PSD cases were male. The mean age in gr A + B and C were 34.9 + 7.5 and 33.1 +/- 6.0 years old respectively. In gr. A, B and C, compared with gr D, Tuesday was the weekday of lowest SUDS/PSD death rate and Saturday was the highest. (p < 0.05). Time of death in gr B and C were peak during midnight to 8 a.m. and there was some trend of seasonal variation in occurrence of SUDS/PSD with the peak death rate in April and trough death rate in September; which is significantly different from gr D (1.49% vs 10.89% of all deaths, p < 0.01). CONCLUSION: The presented data demonstrate some temporal variations in SUDS/PSD death aboard. The sudden death of Thai people in Singapore and Taiwan may be more prevalent in the "work-to-rest" than "rest-to-work" periods.

Causes of Sudden Death Related to Sexual Activity: Results of a Medicolegal Postmortem Study from 2001 to 2005

Sexual activity (SA), combined with organic heart disease, may cause sudden death (SD). However, the causes of SD related to SA are not known well. The aim of this study was to assess the causes of SD related to SA. From August 2001 to November 2005, all autopsies (n=1,379) performed at Kyungpook National University were prospectively searched for SD cases related to SA. Fourteen cases (46+/-11 yr old, 9 males) of SD related to SA were found. All were heterosexual. The toxicologic study was negative in all. Ten cases were witnessed; during SA in 4 cases, just after SA in another 4 cases, 2 and 5 hr after in 1 each case. In 4 unwitnessed cases the victims were found dead less than 12 hr from the end of their SA. The partners were steady extramarital partners (n=8), prostitutes (n=2), marital partner (n=1) and unknown (n=3). The causes of the SD were as follows; coronary artery disease in 6, subarachnoid hemorrhage with ruptured berry aneurysm in 4, fibromuscular dysplasia of the atrioventricular nodal artery in 2, and unknown in 2. Coronary artery disease and subarachnoid hemorrhage with ruptured berry aneurysm were important as causes of SD related to SA.

Causes of Sudden Death Related to Sexual Activity: Results of a Medicolegal Postmortem Study from 2001 to 2005

Sexual activity (SA), combined with organic heart disease, may cause sudden death (SD). However, the causes of SD related to SA are not known well. The aim of this study was to assess the causes of SD related to SA. From August 2001 to November 2005, all autopsies (n=1,379) performed at Kyungpook National University were prospectively searched for SD cases related to SA. Fourteen cases (46+/-11 yr old, 9 males) of SD related to SA were found. All were heterosexual. The toxicologic study was negative in all. Ten cases were witnessed; during SA in 4 cases, just after SA in another 4 cases, 2 and 5 hr after in 1 each case. In 4 unwitnessed cases the victims were found dead less than 12 hr from the end of their SA. The partners were steady extramarital partners (n=8), prostitutes (n=2), marital partner (n=1) and unknown (n=3). The causes of the SD were as follows; coronary artery disease in 6, subarachnoid hemorrhage with ruptured berry aneurysm in 4, fibromuscular dysplasia of the atrioventricular nodal artery in 2, and unknown in 2. Coronary artery disease and subarachnoid hemorrhage with ruptured berry aneurysm were important as causes of SD related to SA.