Sudden cardiac death in a young woman: tumor of the atrioventricular (AV) node or citalopram intoxication?

Atrioventricular (AV) node tumor is a very rare lesion of the cardiac conduction system. Clinically, it is associated with complete AV block and sudden cardiac death, often in apparently healthy young people.We report a case of a 24-year-old woman who developed ventricular fibrillation during sexual intercourse and died before admittance to the hospital. The woman had a medical history of depression and was treated with citalopram.At first, no macroscopic or microscopic pathologic changes were found. Toxicologic analysis showed a toxic level of citalopram in the blood. Further microscopic examination of the cardiac conduction system disclosed a tumor of the AV node. Immunohistochemical staining confirmed endodermal origin in accordance with the latest hypothesis of the pathogenesis of this tumor.It was concluded that this young woman died of cardiac arrhythmia due to the AV tumor and not from citalopram intoxication, as first suspected. This case emphasizes the importance of a microscopic examination of the cardiac conduction system in cases of sudden unexpected death, even in cases with a plausible cause and manner of death at first glance.     

The Return of Prejudice in Europe's Regions: The Moderated Relationship between Group Threat and Economic Vulnerability

Using data from 16 countries and employing multilevel analysis that encompasses the national, regional, and individual levels, we find that both economic and social factors trigger anti-immigrant attitudes among Europeans. Regional per capita GDP is positively correlated with tolerant attitudes while the regional unemployment rate drives prejudice. We find a moderating relationship between immigrant population size and per capita GDP, which suggests that, as the size of the immigrant population increases, prejudice rises but only in poorer regions. In more affluent regions, an increase in the immigrant population corresponds to increased tolerance.     

Sudden infant death syndrome (SIDS)--standardised investigations and classification: recommendations

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.     

Death of a 10‐Month‐Old Boy After Exposure to Ethylmorphine

Abstract: Ethylmorphine, an opiate that is partially metabolized to morphine, is a common ingredient in antitussive preparations. We present a case where a 10‐month‐old boy was administered ethylmorphine in the evening and found dead in bed the following morning. Postmortem toxicological analyses of heart blood by gas chromatography‐mass spectrometry and liquid chromatography‐mass spectrometry revealed the presence of ethylmorphine and morphine at concentrations of 0.17 μM (0.054 mg/L) and 0.090 μM (0.026 mg/L), respectively. CYP2D6 genotyping showed that the deceased had an extensive metabolizer genotype, signifying a “normal” capacity for metabolizing ethylmorphine to morphine. The autopsy report concluded that death was caused by a combination of opiate‐induced sedation and weakening of respiratory drive, a respiratory infection, and a sleeping position that could have impeded breathing. This is the first case report where the death of an infant has been linked to ethylmorphine ingestion.     

Regional Innovation Systems: The Integration of Local ‘Sticky’ and Global ‘Ubiquitous’ Knowledge

The paper examines how firms in three regional clusters in Norway dominated by shipbuilding, mechanical engineering and electronics industry, respectively exploit both place-specific local resources as well as external, world-class knowledge to strengthen their competitiveness. From these case-studies we make four points: (1) Ideal-typical regional innovation systems, i.e., regional clusters surrounded by supporting local organisations, is rather uncommon in Norway. (2) External contacts, outside of the local industrial milieu, are crucial in innovation processes also in many SMEs. (3) Innovation processes may nevertheless be regarded as regional phenomena in regional clusters, as regional resources and collaborative networks often have decisive significance for firms' innovation activity. (4) Regional resources include in particular place-specific, contextual knowledge of both tacit and codified nature, that, in combination, is rather geographically immobile.