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American Journal of Hematology May 2022
Topics: Fresh Water; Hematologic Tests; Hemolysis; Humans; Near Drowning
PubMed: 35253933
DOI: 10.1002/ajh.26514 -
International Journal of Legal Medicine May 2023If a dead body is discovered in water, it nearly always raises the question about the cause of death, often associated with the persistent problem to differentiate...
If a dead body is discovered in water, it nearly always raises the question about the cause of death, often associated with the persistent problem to differentiate between a drowning incident and post-mortem immersion. In numerous cases, a reliable confirmation of death by drowning is often only possible by a combination of diagnoses obtained from autopsy and additional investigations. As to the latter, the use of diatoms has been suggested (and debated) since decades. Based on the consideration that diatoms are present in almost every natural waterbody and are unavoidably incorporated when water is inhaled, their presence in the lung and other tissues can provide evidence of drowning. However, the traditional diatom test methods are still subject of controversial discussion and suspected of erroneous outcome, predominantly through contamination. A promising alternative to minimize the risk of erroneous outcome seems to be disclosed by the recently suggested MD-VF-Auto SEM technique. Especially the establishment of a new diagnostic marker (L/D ratio), which represents the factorial proportion between the diatom concentration in lung tissue and the drowning medium, allows for clearer distinction of drowning and post-mortal immersion and is largely robust to contamination. However, this highly elaborated technique requires specific devices which are frequently unavailable. We therefore developed a modified method of SEM-based diatom testing to enable the use on more routinely available equipment. Process steps such as digestion, filtration, and image acquisition were thoroughly broken down, optimized, and ultimately validated in five confirmed drowning cases. Taking certain limitations into consideration, L/D ratio analysis provided promising results, even in cases of advanced decomposition. We conclude that our modified protocol indeed opens a way for a broader use of the method in forensic drowning investigation.
Topics: Humans; Diatoms; Drowning; Forensic Pathology; Lung; Water
PubMed: 36869250
DOI: 10.1007/s00414-023-02970-x -
AMA Journal of Ethics Jun 2021This graphic narrative explores struggles with underinsurance, compromised access to indicated care, and intergenerational health inequity.
This graphic narrative explores struggles with underinsurance, compromised access to indicated care, and intergenerational health inequity.
Topics: Drowning; Humans; Insurance Pools; Insurance, Health; Narration
PubMed: 34212852
DOI: 10.1001/amajethics.2021.499 -
Fa Yi Xue Za Zhi Feb 2022To explore the application values of diatom artificial intelligence (AI) search system in the diagnosis of drowning.
OBJECTIVES
To explore the application values of diatom artificial intelligence (AI) search system in the diagnosis of drowning.
METHODS
The liver and kidney tissues of 12 drowned corpses were taken and were performed with the diatom test, the view images were obtained by scanning electron microscopy (SEM). Diatom detection and forensic expert manual identification were carried out under the thresholds of 0.5, 0.7 and 0.9 of the diatom AI search system, respectively. Diatom recall rate, precision rate and image exclusion rate were used to detect and compare the efficiency of diatom AI search system.
RESULTS
There was no statistical difference between the number of diatoms detected in the target marked by the diatom AI search system and the number of diatoms identified manually (>0.05); the recall rates of the diatom AI search system were statistically different under different thresholds (<0.05); the precision rates of the diatom AI system were statistically different under different thresholds(<0.05), and the highest precision rate was 53.15%; the image exclusion rates of the diatom AI search system were statistically different under different thresholds (<0.05), and the highest image exclusion rate was 99.72%. For the same sample, the time taken by the diatom AI search system to identify diatoms was only 1/7 of that of manual identification.
CONCLUSIONS
Diatom AI search system has a good application prospect in drowning cases. Its automatic diatom search ability is equal to that of experienced forensic experts, and it can greatly reduce the workload of manual observation of images.
Topics: Artificial Intelligence; Diatoms; Drowning; Humans; Liver; Lung; Microscopy, Electron, Scanning
PubMed: 35725702
DOI: 10.12116/j.issn.1004-5619.2021.410719 -
Australian and New Zealand Journal of... Jun 2023This article aims to determine the impact of public holidays and long weekends on the risk of drowning and non-drowning deaths on the Australian coast.
OBJECTIVE
This article aims to determine the impact of public holidays and long weekends on the risk of drowning and non-drowning deaths on the Australian coast.
METHODS
A retrospective case-control study using relative risk ratios and Z-scores to compare all unintentional fatalities on the Australian coast between 2004 and 2021 to a longitudinal representative survey sample of the Australian public and their coastal usage.
RESULTS
Overall, the coastal mortality risk increased by 2.03 times for public holidays (95%CI = 1.77-2.33, p<0.0001) and 2.14 times by long weekends (95%CI = 1.85-2.48, p<0.0001). Children <16 years had the highest increased risk of death on public holidays (RR = 3.53, 95%CI = 1.98-6.31, p = 0.0005) and long weekends (RR = 2.90, 95%CI = 1.43-5.89, p = 0.011), while residents who were born overseas had a higher risk of death compared to those born in Australia. For public holidays, the greatest increase in risk was for swimming/wading and bystander rescues, while for long weekends, it was for scuba diving and snorkelling.
CONCLUSIONS
Public holidays and long weekends increase the risk of both drowning and non-drowning deaths on the Australian coast, which differed by demographics and activities.
IMPLICATIONS FOR PUBLIC HEALTH
These results highlight periods of risk when targeted coastal safety messaging to high-risk demographics (particularly children and overseas-born residents), and provision of surf lifesaving resources can be increased.
Topics: Child; Humans; Retrospective Studies; Holidays; Case-Control Studies; Australia; Risk Assessment; Drowning
PubMed: 37290984
DOI: 10.1016/j.anzjph.2023.100054 -
Critical Care (London, England) Oct 2021Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis...
BACKGROUND
Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis remains poorly explored in Intensive Care Units (ICUs) patients.
METHODS
We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model.
RESULTS
Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03-3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51-52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03-1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11-1.3], p < 0.0001).
CONCLUSIONS
In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis.
Topics: Critical Illness; Drowning; France; Fresh Water; Heart Arrest; Humans; Retrospective Studies; Risk Factors; Seawater
PubMed: 34689813
DOI: 10.1186/s13054-021-03792-2 -
Fa Yi Xue Za Zhi Feb 2022To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic...
OBJECTIVES
To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic pathological diagnosis of drowning.
METHODS
A total of 235 cases with clear cause of death through systematic autopsy were collected from January 2011 to June 2021 in Guangzhou. According to the location of body discovery, the cases were divided into the water body group (97 cases) and the nonwater body group (138 cases), and the water body group was further divided into the water drowning group (90 cases) and the water nondrowning group (7 cases). Non-water body group was further divided into the nonwater drowning group (1 case) and the nonwater nondrowning group (137 cases). Three senior forensic pathologists independently reviewed autopsy photos to determine whether there was hypostasis in the lungs. The detection rate of pulmonary hypostasis was calculated.
RESULTS
The detection rate of pulmonary hypostasis in the water drowning group (90 cases) was 0, and the negative rate was 100%. The detection rate of pulmonary hypostasis in the water nondrowning group (7 cases) was 100% and the negative rate was 0. The detection rate of pulmonary hypostasis in the water body group and in the nonwater body group (after excluding 2 cases, 136 cases were calculated) was 7.22% and 87.50%, respectively. There were statistically significant differences in the detection rate of pulmonary hypostasis between water body group and nonwater body group, and between water drowning group and water nondrowning group (<0.05).
CONCLUSIONS
The disappearance of pulmonary hypostasis can be used as a specific cadaveric sign to assist in the forensic pathological diagnosis of drowning.
Topics: Autopsy; Drowning; Forensic Pathology; Humans; Lung; Water
PubMed: 35725707
DOI: 10.12116/j.issn.1004-5619.2021.410920 -
Forensic Science, Medicine, and... Dec 2017
Topics: Drowning; Humans; Risk Factors; Rivers
PubMed: 28580497
DOI: 10.1007/s12024-017-9883-4 -
Environmental Health Perspectives Apr 2022Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the...
BACKGROUND
Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death.
OBJECTIVES
We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015.
METHODS
We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age.
RESULTS
A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure-response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure-response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03, 1.26) and 1.95 (95% CI: 1.70, 2.23) for heat and 1.13 (95% CI: 1.02, 1.26) and 2.33 (95% CI: 1.89, 2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes.
DISCUSSION
Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943.
Topics: Cause of Death; Cold Temperature; Drowning; Hot Temperature; Humans; Japan; Temperature
PubMed: 35394808
DOI: 10.1289/EHP9943 -
International Journal of Legal Medicine Sep 2023Drowning is the leading cause of death by accident of everyday life in people under 25 years of age. Xenobiotics are frequently involved in drowning cases but their...
Drowning is the leading cause of death by accident of everyday life in people under 25 years of age. Xenobiotics are frequently involved in drowning cases but their influence on the diagnosis of fatal drowning has not been studied so far. This preliminary study aimed to assess the influence of an alcohol and/or a drug intoxication on the autopsy signs of drowning, and on the results of diatom analyses in drowning deaths. Twenty-eight autopsy cases of drowning including 19 freshwater drownings, 6 seawater drownings, and 3 brackish water drownings were prospectively included. Toxicological and diatom tests were performed in each case. The influence of alcohol and other xenobiotics on drowning signs and diatom analyses was assessed separately then in combination through a global toxicological participation score (GTPS). Diatom analyses showed positive results in lung tissue in every case. No significant association was found between the degree of intoxication and the diatom concentration in the organs, even after considering freshwater drowning cases only. The vast majority of the traditional autopsy signs of drowning were not significantly affected by the individual toxicological status either, with the exception of lung weight which tended to raise in case of intoxication, probably due to the pulmonary edema and congestion increase. Further research on larger autopsy samples is needed to confirm the results of this exploratory study.
Topics: Humans; Drowning; Xenobiotics; Autopsy; Diatoms; Ethanol; Lung
PubMed: 37433906
DOI: 10.1007/s00414-023-03057-3