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Epilepsia Open Apr 2024Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy...
OBJECTIVE
Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy and identify factors that may contribute to these deaths and may also include sudden unexpected death in epilepsy (SUDEP).
METHODS
We analyzed 5291 cases in which a postmortem imaging (PMI) study was performed using plane CT, because of an unexplained death. A rapid troponin T assay was performed using peripheral blood samples. Clinical information including the cause of death suspected by the attending physician, body position, place of death, medical history, and antiseizure medications was evaluated.
RESULTS
A total of 132 (2.6%) patients had an obvious history of epilepsy, while 5159 individuals had no history of epilepsy (97.4%). Cerebrovascular disease was the cause of death in 1.6% of patients in the group with epilepsy, and this was significantly lower than that in the non-epilepsy group. However, drowning was significantly higher (9.1% vs. 4.4%). Unspecified cause of death was significantly more frequent in the epilepsy group (78.0% vs. 57.8%). Furthermore, the proportion of patients who demonstrated elevation of troponin T levels without prior cardiac disease was significantly higher in the epilepsy group (37.9% vs. 31.1%). At discovery of death, prone position was dominant (30.3%), with deaths occurring most commonly in the bedroom (49.2%). No antiseizure medication had been prescribed in 12% of cases, while 29.5% of patients were taking multiple antiseizure medications.
SIGNIFICANCE
The prevalence of epilepsy in individuals experiencing unusual death was higher than in the general population. Despite PMI studies, no definitive cause of death was identified in a significant proportion of cases. The high troponin T levels may be explained by long intervals between death and examination or by higher incidence of myocardial damage at the time of death.
PLAIN LANGUAGE SUMMARY
This study investigated unusual deaths in epilepsy patients, analyzing 5291 postmortem imaging cases. The results showed that 132 cases (2.6%) had a clear history of epilepsy. In these cases, only 22% cases were explained after postmortem examination, which is less than in non-epilepsy group (42.2%). Cerebrovascular disease was less common in the epilepsy group, while drowning was more common. Elevated troponin T levels, which suggest possibility of myocardial damage or long intervals between death and examination, were also more frequent in the epilepsy group compared to non-epilepsy group.
Topics: Humans; Drowning; Postmortem Imaging; Troponin T; Epilepsy; Autopsy; Cerebrovascular Disorders
PubMed: 38173171
DOI: 10.1002/epi4.12891 -
Scientific Reports Jan 2024Airborne surface and underwater human pose recognition are crucial for various safety and surveillance applications, including the detection of individuals in distress...
Airborne surface and underwater human pose recognition are crucial for various safety and surveillance applications, including the detection of individuals in distress or drowning situations. However, airborne optical cameras struggle to achieve simultaneous imaging of the surface and underwater because of limitations imposed by visible-light wavelengths. To address this problem, this study proposes the use of light detection and ranging (LiDAR) to simultaneously detect humans on the surface and underwater, whereby human poses are recognized using a neural network designed for irregular data. First, a temporal point-cloud dataset was constructed for surface and underwater human pose recognition to enhance the recognition of comparable movements. Subsequently, radius outlier removal (ROR) and statistical outlier removal (SOR) were employed to alleviate the impact of noise and outliers in the constructed dataset. Finally, different combinations of secondary sampling methods and sample sizes were tested to improve recognition accuracy using PointNet++. The experimental results show that the highest recognition accuracy reached 97.5012%, demonstrating the effectiveness of the proposed human pose detection and recognition method.
Topics: Humans; Deep Learning; Drowning; Light; Movement; Neural Networks, Computer
PubMed: 38167475
DOI: 10.1038/s41598-023-50658-4 -
BMC Sports Science, Medicine &... Jan 2024The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more...
BACKGROUND
The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality.
METHODS
Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents' characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism.
RESULTS
A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death.
CONCLUSIONS
It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine.
TRIAL REGISTRATION
PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.
PubMed: 38167168
DOI: 10.1186/s13102-023-00799-w -
Preventive Medicine Feb 2024Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to...
OBJECTIVE
Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth).
METHODS
A case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012-2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls.
RESULTS
Mean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15-19.9 °C (Odds Ratio; OR: 1.75), 20-24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk.
CONCLUSIONS
Identifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.
Topics: Humans; Male; Female; Drowning; Cross-Over Studies; Temperature; Risk Factors; Water
PubMed: 38145877
DOI: 10.1016/j.ypmed.2023.107832 -
Australian and New Zealand Journal of... Dec 2023
Corrigendum to "Mortality trends and the impact of exposure on Australian coastal drowning deaths, 2004-2021" [Australian and New Zealand Journal of Public Health 47 (2023) 100034].
PubMed: 38142108
DOI: 10.1016/j.anzjph.2023.100125 -
Medicine Dec 2023In our search on PubMed, we found that reports of co-infections involving Aspergillus fumigatus and Nocardia cyriacigeorgica in the literature are notably scarce. Most... (Review)
Review
Rare occurrence of pulmonary coinfection involving Aspergillus fumigatus and Nocardia cyriacigeorgica in immunocompetent patients based on NGS: A case report and literature review.
RATIONALE
In our search on PubMed, we found that reports of co-infections involving Aspergillus fumigatus and Nocardia cyriacigeorgica in the literature are notably scarce. Most cases have been documented in patients with compromised immune systems or underlying pulmonary conditions. In contrast, our patient did not present with any of these risk factors. Furthermore, there have been no recent incidents such as near-drowning or other accidents in the patient history. To the best of our knowledge, this case represents a hitherto unreported clinical scenario. To enhance comprehension, we conducted a comprehensive literature review by compiling a total of 20 case reports (spanning from 1984 to 2023) on co-infections involving Aspergillus and Nocardia species, retrieved from PubMed.
PATIENT CONCERNS AND DIAGNOSIS
Chest CT revealed the presence of multiple nodules and clustered high-density shadows in both lungs. Bronchoscopy revealed mucosal congestion and edema in the apical segment of the right upper lobe of the lung, along with the presence of 2 spherical polypoid new organisms. The pathological analysis reported severe chronic inflammation with evidence of Aspergillus within the tissue. Next-Generation Sequencing of bronchoalveolar lavage fluid revealed the presence of reads corresponding to A fumigatus and N cyriacigeorgica. Positive cultures for A fumigatus and the Nocardia genus were yielded by prolonging the incubation of samples in the microbiology laboratory.
INTERVENTIONS
Treatment with voriconazole for A fumigatus and sulfamethoxazole-trimethoprim for N cyriacigeorgica infection was given.
OUTCOMES
The patient improved and was discharged. After 6 months of telephone follow-up, the patient reported no clinical symptoms, discontinued the medication on his own.
LESSONS
A fumigatus and N cyriacigeorgica can manifest as a co-infection in immunocompetent patients. Clinicians should prioritize the significant advantages and value of NGS in detecting rare and mixed pathogens associated with pulmonary infections.
Topics: Humans; Coinfection; Aspergillus fumigatus; Nocardia Infections; Nocardia; Lung
PubMed: 38134116
DOI: 10.1097/MD.0000000000036692 -
Occupational Therapy International 2023Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists...
Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists ( = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.
Topics: Humans; Occupational Therapists; Occupational Therapy; Qualitative Research; Learning; Hand Injuries
PubMed: 38130935
DOI: 10.1155/2023/5562025 -
GigaByte (Hong Kong, China) 2023Antimicrobial resistance (AMR) is a global public health threat. Environmental microbial communities act as reservoirs for AMR, containing genes associated with...
Antimicrobial resistance (AMR) is a global public health threat. Environmental microbial communities act as reservoirs for AMR, containing genes associated with resistance, their precursors, and the selective pressures promoting their persistence. Genomic surveillance could provide insights into how these reservoirs change and impact public health. Enriching for AMR genomic signatures in complex microbial communities would strengthen surveillance efforts and reduce time-to-answer. Here, we tested the ability of nanopore sequencing and adaptive sampling to enrich for AMR genes in a mock community of environmental origin. Our setup implemented the MinION mk1B, an NVIDIA Jetson Xavier GPU, and Flongle flow cells. Using adaptive sampling, we observed consistent enrichment by composition. On average, adaptive sampling resulted in a target composition 4× higher than without adaptive sampling. Despite a decrease in total sequencing output, adaptive sampling increased target yield in most replicates. We also demonstrate enrichment in a diverse community using an environmental sample. This method enables rapid and flexible genomic surveillance.
PubMed: 38111521
DOI: 10.46471/gigabyte.103 -
Royal Society Open Science Dec 2023Reconstruction of postglacial sea-level rise using reef cores recovered from Tahiti during IODP Expedition 310 showed that the first major acceleration, known as...
Reconstruction of postglacial sea-level rise using reef cores recovered from Tahiti during IODP Expedition 310 showed that the first major acceleration, known as Meltwater Pulse 1a (MWP-1a), was a 12-22 m rise in 340 years starting at 14.65 ka BP. Although it was reported that the pulse did not drown Tahitian reefs, the subsequent discovery of a fringing reef at the base of several cores implies that its timing, magnitude and impact require revision. Here, we report facies and paleodepth data from this reef, revise sea level, and revisit reef response. We find its reef crest is dominated by surf-adapted corals to a depth of 2.5 m and show that it retreated upslope over an approximately 1000-year interval from 16 ka. Reef development then apparently ceased at 15 ka at -106 m and remained absent for approximately 600 years, before resuming at 14.4 ka further upslope at -93 m. This absence is consistent with reef drowning and requires that MWP-1a had a smaller magnitude of 13.8 ± 1.3 m, and may have started 300 years earlier than previously reported. It confirms MWP-1a was a global event, drowning reefs on Tahiti as well as those in other oceans.
PubMed: 38094270
DOI: 10.1098/rsos.230918 -
Hawai'i Journal of Health & Social... Dec 2023Concussions are caused by physical trauma to the head, face, or neck and can be sustained while surfing, increasing the risk of drowning. The purpose of this pilot study...
Concussions are caused by physical trauma to the head, face, or neck and can be sustained while surfing, increasing the risk of drowning. The purpose of this pilot study was to establish a preliminary assessment of concussion knowledge in a group of adult recreational surfers. Using the standardized Concussion Knowledge Index, an anonymous survey was conducted with 55 surfers. The Concussion Knowledge Index and similar statistical measures were used in a previous study of adult soccer players in England. Data from these 2 groups were compared. The preliminary data suggests that the group of adult surfers demonstrate more concussion knowledge than the group of adult soccer players. Further study into surfers' knowledge of concussion with a larger sample size could increase the clinical utility and generalizability of this study.
Topics: Adult; Humans; Soccer; Athletic Injuries; Pilot Projects; Brain Concussion; Athletes
PubMed: 38093760
DOI: No ID Found