Causes of death

The iaterpretation of forensic toxicology (18) results is often challenging. Courts frequently ask if an amount of dmg detected ia a specimen could cause a specific type of behavior, ie, would someone be under the influence of a dmg at a specific concentration, would a particular dmg concentration cause diminished capacity, or was the dmg the cause of death In a random employee dmg testing case, a worker screened positive for opiates by EMIT and gc/ms analysis of the urine specimen showed low levels of morphine. Although one possibiUty was that the iadividual was a heroia user, a review of foods eaten ia the prior 24 hours suggested a more innocent cause a poppy-seed bagel. 

Rotavirus. Rotavims causes infant diarrhea, a disease which has major socio-economic impact. In developing countries it is the major cause of death in infants worldwide, causing up to 870,000 deaths per year. In the United States, diarrhea is stiU a primary cause of physician visits and hospitalization, although the mortaUty rate is relatively low. Studies have estimated a substantial cost benefit for a vaccination program in the United States (67—69). Two membrane proteins (VP4 and VP7) of the vims have been identified as protective epitopes and most vaccine development programs are based on these two proteins as antigens. Both Hve attenuated vaccines and subunit vaccines are being developed (68). 

Balantidiasis in humans is manifest by chronic episodes of intermittent diarrhea and constipation, symptoms similar to those of amebiasis. The patient may also have abdominal pain, tenderness over the colon, anorexia, nausea, severe weight loss, and weakness. The disease may be fatal and, before the avakabihty of a treatment, was the cause of death in approximately 30% of infected individuals. 

Cardiac arrhythmias are an important cause of morbidity and mortality approximately 400,000 people per year die from myocardial infarctions (MI) in the United States alone. Individuals with MI exhibit some form of dysrhythmia within 48 h. Post-mortem examinations of MI victims indicate that many die in spite of the fact that the mass of ventricular muscle deprived of its blood supply is often quite small. These data suggest that the cause of death is ventricular fibrillation and that the immediate availability of a safe and efficacious antiarrhythmic agent could have prolonged a number of Hves. The goals of antiarrhythmic therapy are to reduce the incidence of sudden death and to alleviate the symptoms of arrhythmias, such as palpitations and syncope. Several excellent reviews of the mechanisms of arrhythmias and the pharmacology of antiarrhythmic agents have been pubflshed (1,2). 

Mice are utilized for testing antiseptics for appHcation to cuts, wounds, and incisions (339). The test bacteria, type 1 pneumococcus and hemolytic streptococcus, ate appHed to the taHs of anaesthetized mice. The tip of the taH is then dipped into the antiseptic for 2 min, after which one-half inch of the taH is removed and inserted into the peritoneal cavity and the incision is closed. If after 10 days the animals survive, the product is considered satisfactory for use as a skin antiseptic. The blood of dead animals is sampled and streaked on blood agar for confirmation of infection from the test bacteria as the cause of death. Since lack of toxicity is another requirement of a product to be appHed to wounds, this test has been combined with a toxicity test (340). 

Nowadays the one of the leading cause of death in industrial country is Heart Failure (HF). Under the pathological conditions (e.g., Ischemic Heart Disease (IHD)) the changes in the enzymes activity and ultrastructure of tissue were obtained. The behavior of trace elements may reflect the activity of different types of enzymes. Pathological changes affects only small area of tissue, hence the amount of samples is strictly limited. Thereby, nondestructive multielemental method SRXRF allow to perfonu the analysis of mass samples in a few milligrams, to save the samples, to investigate the elemental distribution on the sample area. 

Reference, country Study subjects follow-up Occupation/exposure cause of death obs RR 9S% Cl... 

United Kingdom All causes of death cates) 1,2 P 0.05 matched on residence, year of death, age... 

In making an effort to miderstand the significance of risk analyses, it is helpful to place tlie estimated risks in tlie same perspective as otlier everyday risks tliat have been determined by a similar inctliodology. Table 18.7.1 lists a nmnber of risks for comparison. These have been derived from actual statistics and reasonable estimates." " People often overestimate tlie frequency and seriousness of dramatic, sensational, dreaded, well-publicized causes of death and miderestimate the risks from more familiar, accepted causes tliat claim lives one by one. Indeed, risk estimates by "experts and lay people (or "the public ) on many key enviromiieiital problems differ significantly. This problem and the reasons for it are extremely important because in our society the public generally does not trust experts to make important risk decisions alone. 

Thiamine, whose structure is shown in Figure 18.17, is known as vitamin Bj and is essential for the prevention of beriberi, a nervous system disease that has occurred in the Far East for centuries and has resulted in considerable sickness and death in these countries. (As recently as 1958, it was the fourth leading cause of death in the Philippine Islands.) It was shown in 1882 by the director-general of the medical department of the Japanese nayt that beriberi could be prevented by dietary modifications. Ten years later, Christiaan Eijkman, a Dutch medical scientist working in Java, began research that eventually showed that thiamine was the... 

Traumatic brain injury is the most common cause of death in subjects under the age of 40, and an important risk factor for AD. Loss of hippocampal cells and depletion of ACh and of muscarinic receptors can be attenuated in injured experimental animals, improve blood perfusion in ischemic areas and increase cholinergic transmission in cortex and hippocampus the same mechanism invoked for treatment of VD. 

Chronic obstructive pulmonary disease (COPD) affects over 5% of the adult population, is the fourth leading cause of death worldwide and is the only major cause of mortality that is increasing worldwide. It is an inflammatory disorder of the lungs, caused mainly, but not exclusively, by cigarette smoking. 15-20% of smokers develop COPD. 

It has been proposed that the development of the complications of diabetes mellitus may be linked to oxidative stress and therefore might be attenuated by antioxidants such as vitamin E. Furthermore, it is discussed that glucose-induced vascular dysfunction in diabetes can be reduced by vitamin E treatment due to the inactivation of PKC. Cardiovascular complications are among the leading causes of death in diabetics. In addition, a postulated protective effect of vitamin E (antioxidants) on fasting plasma glucose in type 2 diabetic patients is also mentioned but could not be confirmed in a recently published triple-blind, placebo-controlled clinical trial [3]. To our knowledge, up to now no clinical intervention trials have tested directly whether vitamin E can ameliorate the complication of diabetes. 

Tuberculosis is a major health problem throughout the world, infecting more than 8 million individuals each year. It is die world s leading cause of death from infectious disease Individuals living in crowded conditions, those widi compromised immune systems, and individuals widi debilitative conditions are especially susceptible to tuberculosis. 

Major gastrointestinal effects include decreased gut motility and changes in secretion of gastric and intestinal fluids. Morphine and most p receptor agonists cause pupillary constriction. Some tolerance to this effect may develop, but addicts with high opioid levels will still have miosis. Respiratory depression is the usual cause of death from opioid overdose. 

The management of comorbid medical and psychiatric conditions has become an essential component of effective opioid addiction treatment. Hepatitis C has now surpassed AIDS as the most common cause of death in... 

Potenza MN, Gold SJ, Roby-Shcmkowitz A, et al Effects of regulators of G protein-signaling proteins on the functional response of the mu-opioid receptor in a mel-anophore-based assay. J Pharmacol Exp Ther 291 482 91, 1999 Quaglio G, Talamini G, Lechi A, et al Study of 2708 heroin-related deaths in northeastern Italy 1985—98 to establish the main causes of death. Addiction 96 1127— 1137, 2001... 

Necropsy—The gross examination of the organs and tissues of a dead body to determine the cause of death or pathological conditions. 

Hanvelt et al. (1994) estimated the nationwide indirect costs of mortality due to HIV/AIDS in Canada. A descriptive, population-based economic evaluation study was conducted. Data from Statistics Canada were used, which contained information about aU men aged 25-64 years for whom HIV/AIDS or another selected disease was listed as the underlying cause of death from 1987 to 1991. Based on the human capital approach, the present value of future earnings lost for men was calculated. The estimated total loss from 1987 to 1991 was US 2.11 billion, with an average cost of US 558,000 per death associated with HIV/AIDS. Future production loss due to HIV/AIDS was more than double during the period 1987 to 1991, from US 0.27 to US 0.60 billion. A more comprehensive update of this smdy was presented by Hanvelt et al. (1996). The same database and the same data section but for the calendar years 1987-1993 was used. The indirect cost of future production due to HIV/AIDS in Canada based on the human capital approach for that period was estimated to be US 3.28 billion. The authors also calculated the willingness-to-pay to prevent premature death due to HIV/AIDS, which was estimated based on... 

The effects of protein deficiency on endosulfan toxicity were studied in Wistar rats (Boyd and Dobos 1969 Boyd et al. 1970). Rats fed a diet totally deficient in protein for 28 days prior to administration of a single oral dose of endosulfan had an LDjq of 5.1 mg/kg of endosulfan. Rats fed a low-protein diet (3.5% protein) for 28 days had an LDjq of 24 mg/kg of endosulfan. Rats fed standard laboratory chow (26% protein) had an LDjq of 102-121 mg/kg. The immediate cause of death in all animals was respiratory failure following tonic-clonic convulsions. This study demonstrated that, while a protein-deficient diet does not affect the nature of the toxic reaction, it may affect the sensitivity of rats to the lethal effects of endosulfan. 

Although the specific cause of death was not discussed in the Hack et al. (1995) study, it does not appear that neurological effects played any role. Mice generally appear to be more sensitive to the lethal effects of endosulfan than rats (Gupta 1976 Gupta et al. 1981). Female rats are more sensitive to the lethal effects of endosulfan than male rats (Gupta 1976 Hoechst 1990). 

Renal Effects. Hemorrhage of the medullary layer of the kidneys was observed in an early report of three fatal cases of acute oral poisoning with endosulfan (Terziev et al. 1974). More recent studies have reported acute renal failure after ingestion of endosulfan as a major contributing cause of death in two individuals in both cases, postmortem examination showed extensive tubular necrosis (Blanco-Coronado et al. 1992 Lo et al. 1995). Neither case discussed the possible mechanism of endosulfan-induced acute renal failure, but in one case, the authors of the report indicate that the renal lesions may relate to sepsis and shock (Blanco-Coronado et al. 1992). Ingested doses were not determined in any of these cases, and it is not totally clear that the effects observed at autopsy were a direct result of endosulfan exposure, although based on results from acute animal studies, it seems likely. 

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