Sickle cell lung disease and sudden death: a retrospective/prospective study of 21 autopsy cases and literature review

Sudden death in the setting of sickle cell lung disease (SCLD), is periodically seen in the practice of medical examiners. The goal of the present study was to identify the most common pathologic findings of SCLD associated with sudden or unexpected death. A retrospective/prospective review of 21 autopsy cases from sickle cell patients between 1990 and 2004 was performed. Review of medical records, autopsy reports, and H&E-stained slides of lung tissue was performed. Oil-Red-O and elastic staining of lung tissue were evaluated. All cases were screened for both acute and chronic forms of SCLD. Patients admitted for sickle cell pain crisis ranged in age from 8 months to 65 years. Fifteen out of 21 cases (71.4%) showed significant pulmonary pathology. The most frequent lung findings included pulmonary edema (47.6%), pulmonary thromboembolism (38.1%), fat emboli (33.3%), pulmonary hypertension, grades I-IV (33.3%), and microvascular occlusive thrombi (28.5%). Our study demonstrates higher-than-expected percentages of acute and chronic sickle cell-related lung injury such as fat embolism (33.3%) and pulmonary hypertension (33.3%), with right ventricular hypertrophy (33.3%). Therefore, we propose a simple and high-yield autopsy algorithm of ancillary procedures that should be applied on all known and suspected autopsy cases of sickle cell disease.     

Economic crisis and elections: The European periphery

This paper introduces the articles in the symposium which address the issue of democratic accountability and economic voting in polities on the European periphery. The economic crisis that hit the world economy in 2008 has severely challenged the capacity of governments to steer the national economy and has had a strong impact on their electoral support. The papers discuss whether economic voting and democratic accountability are increasing or, on the other hand, they could be depressed by globalisation and by shifts of ruling competence from the national to the supranational European arena.     

The integration hypothesis: How the European Union shapes economic voting

Whereas economic perceptions influence the national vote in Western European countries, globalization, or international openness, conditions the influence of economic perceptions on that national vote. But how do attitudes toward the EU itself influence the economic vote? After establishing the presence of a national economic vote in Southern Europe (Spain, Italy, Greece and Portugal) we test the hypothesis that heightened perception of European Union economic responsibility reduces the magnitude of the national economic vote coefficient. These tests are carried out on current (2009) survey data, via logistic regression analysis of fully specified voting behavior models, estimated country-by-country and in a data pool. Clearly, the national economic vote diminishes, to the extent the EU is held responsible for the economy.     

Fatalities temporally associated with the ingestion of ibogaine

Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5-76 h of taking ibogaine. The clinical and postmortem evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular, and/or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the uninformed use of ethnopharmacological forms of ibogaine.     

Palynological Investigation of Mummified Human Remains

Pollen analysis was applied to a mummified homicide victim in Nebraska, U.S.A., to determine the location of death. A control sample showed the normal ambient pollen in the garage crime scene. Ambient windborne types, common in the air of the region, dominated the control. Internal samples were analyzed from the sacrum, intestine, and diaphragm. Microfossils were recovered from the rehydrated intestine lumen. The intestinal sample was dominated by Brassica (broccoli). The sacrum sample was high in dietary types but with a showing of ambient types. The pollen from the diaphragm was dominated by ambient pollen similar to the control samples. The discovery of diverse pollen spectra from within a single mummy was unexpected. They show that ingested and inhaled pollen mixed in the corpse. The data linked the decedent to a specific crime scene in her Nebraska home in the southern tier of eastern counties on the border with Kansas.     

Suicide by cyanide: 17 deaths

We reviewed 17 intentional ingestions of cyanide that occurred in New York City over a ten-year interval. The toxicologic and postmortem findings were reviewed. Certain occupations and nationalities of the decedents predominated among this group of suicides. Scientists, jewelers. and metal workers were common occupations among the decedents. In addition, 8 of 17 fatalities were West Indian/Caribbean Island and South American decedents, including three decedents from Guyana. Fourteen of the 17 fatalities were male. Pink lividity, a "bitter-almond" smell. and a hemorrhagic gastric mucosa were not prevailing findings in these decedents. A color test was used for screening for cyanide with confirmation and quantitation using gas chromatography.     

Suicidal behavior by burns among adolescents in Kurdistan, Iran: a social tragedy

The aim of this study was to identify the epidemiologic features and current etiological factors of suicidal behavior by burns among adolescents in Kurdistan, Iran. A prospective population-based study was carried out on patients with suicidal behaviors by burns requiring hospitalization among adolescents during 2000-2001 in Kurdistan, Iran. Sociodemographic and etiological factors were obtained through interviews with each patient or with family, relatives, or friends of the patient. Of 54 hospitalized burn patients aged 13-19 years, 40 (74.1%) patients were hospitalized because of suicidal behaviors by burns (6 males and 34 females). The incidence rate of these behaviors was 18.1 per 100,000 person-years (P-Y) and varied by gender (the incidence rates for females and males were 31.6 and 5.3 per 100,000 P-Y, respectively, p(2) = .000004). Most of the patients (60%) were single, 70% were homemakers, and 60% were either illiterate or had a low level of education. The most common precipitating factors for suicidal behaviors by burns were a quarrel with a family member or relative (47.5%) and marital conflict (17.5%). Most of the patients who were able to communicate regretted their suicidal behaviors (85.7%). Adolescents in Kurdistan are at higher risk of suicidal behaviors by burns compared to adolescents in other areas of Iran. Factors likely to be associated with suicidal behaviors by burns include lower socioeconomic status and family problems. These factors should be investigated further to better elucidate the etiology of these events. It also is necessary to implement prevention programs and strategies known to be effective to reduce the incidence of suicide in this region.     

Ecstasy (MDMA) deaths in New York City: a case series and review of the literature

MDMA ("ecstasy") has gained renewed popularity as a drug of abuse. To access the epidemiology and causes of death of MDMA-positive fatalities, all deaths investigated by the OCME that tested positive for MDMA (22 deaths) between January 1997 and June 2000 were reviewed. There were three deaths in each 1997 and 1998, eleven in 1999, and five in the first part of 2000. Of these 22 deaths, 13 were due to acute drug intoxications, 7 due to mechanical injury (blunt trauma, gunshot wounds), and 2 due to a combination of natural disease and acute drug intoxication. Evidence of recent opiate and/or cocaine use was found in 7 of the acute intoxication deaths and in none of the traumatic or combination natural/intoxication deaths. The race of all decedents was White between the ages of 17-41 years, and 18 of 22 were men.     

The happy land homicides: 87 deaths due to smoke inhalation

We reviewed all 87 deaths from the Happy Land Social Club fire. All deaths were due to smoke inhalation. The carboxyhemoglobin (COHb) concentrations ranged from 37 to 93% with a mean of 76.5%. The vast majority (97%) of the decedents had a COHb concentration over 50%. Cyanide blood concentrations ranged from 0 to 5.5 mg/L with a mean of 2.2 mg/L. Nine decedents had no cyanide detected, and seven had cyanide concentrations of less than 1 mg/L. Fewer than one third of the decedents had thermal injuries, and most were partial thickness burns involving less than 20% body surface area. Ethanol was detected in 72% of decedents with a range of 0.01 to 0.29 g% and a mean blood concentration of 0.11 g%. Cocaine or cannabinoid use was identified in 9% of the decedents. All decedents were visually identified, and all had soot in the airway extending to the major bronchi. Carboxyhemoglobin concentrations corresponded well with deaths from smoke inhalation. Cyanide concentrations did not correspond with the extent of smoke inhalation, and the role of cyanide in contributing to these deaths is doubtful. Hydrogen chloride inhalation, as evidenced by comparison of the pH of tracheal mucosa to controls, was not a factor.     

Charitable giving and the future of NGOs in Russia: what can we learn from individual data?

This study seeks to discuss the survivability of charitable nongovernmental organizations (NGOs) in Russia without foreign funding. We use cross-sectional data from a quantitative household survey conducted in April 2016 to investigate common giving patterns of Russians. We find that Russians prefer to give directly to people in need rather than to NGOs; the donations are small, spontaneous, and irregular; they are mainly targeted to supporting the poor and the sick. Involvement in religious activities and higher self-assessed income are two factors that contribute most to the probability of donating. Educated and younger donors are more likely to donate to NGOs compared to donating to particular people/families. The study suggests that private donations to NGOs will decline if no changes in public policy are made. NGOs supporting education, environment, culture, or civil organizations seem to be worst hit.