The prevalence and selected characteristics of non-fatal opioid overdoses attended by ambulance in Australia

Key Points
1. Ambulance attendance at non-fatal opioid overdose is a common event in mainland Australia (among heroin users in particular).
2. The monthly rate of non-fatal opioid overdose attended by ambulance was generally highest in Victoria (Melbourne) followed by NSW with the rates substantially lower in the remaining mainland states over the period Jan  1999 - Feb 2001.
3. Non-fatal opioid overdose victims were most likely to be male in all states with the proportion of males highest in Victoria (77%).
4. Non-fatal opioid overdose victims were aged around 28 years with ages lowest in WA (26) and highest in NSW (30).
5. The rates of transportation varied according to ambulance service practice across the states with around 94% of cases transported in WA and around 19% and 30% of cases transported in Melbourne and NSW respectively.

Fatal women in renaissance tragedy, 1550-1650

Drawing upon the femme fatale of film noir, this thesis examines the presence of a fatal woman on the Renaissance stage. The thesis analyses the representation of emotionally and sexually independent women as fatally attractive to, yet ultimately destructive of, the men they entrap and seduce.

As origens históricas do Zaratustra nietzcheano: o espelho de Zaratustra, a correção do mais fatal dos erros e a superação da morte de Deus

Through a careful examination of the relationship between Zoroastrianism and the Western tradition, and a detailed and critical reading of the writings of Nietzsche, this work aims at showing to what extent the character Zarathustra , his discourses and poetical-philosophical thoughts, and related passages from many distinct Nietzschean works, directly or undirectly reflect a philosophy that harvests contributions from the Zoroastrian tradition or its headways (in the Judeo-Greco-Christian tradition, and furthermore in the whole Western philosophical tradition). Supplied with this provisions, and with the interpretation cast upon them, Nietzschean philosophy questions the entire Western tradition of thought, and proposes its replacement by a new attitude towards life. This work also intends to show the way the Nietzschean Zarathustra was built up, in the writings of the German philosopher, together with the idea of making, out of the namesake character of the ancient Iranian prophet (Zarathushtra or Zoroaster, the founder of Zoroastrianism), the herald of that important text that intended to bring the German language to its highest perfection , clumping together, and leading to a prophetic-poetic climax consonant with the meaning of the Earth , Nietzsche s key ideas about the rectification of the most fatal of errors and about the death of God . An elaborate investigation has been pursued after the reasons and manners of the building up of Nietzsche s Zarathustra mirroring its Iranian namesake (sections 1.1 to 1.6), and a survey of the works of Nietzsche has suggested unquestionable relations with the Zoroastrian tradition, mostly through the Jewish, Greek or Christian repercussions of this tradition. These relations have been put in context, in many framings (sections 2.1 to 2.3.2), in the ambit of the most fatal of errors - the - creation of morals in the very occasion of its transposition to metaphysics (Ecce Homo, Why I am a destiny , 3). Through an evaluation of the possible circumstances and repercussions of the death of God , the relations between Nietzsche s writings and Zoroastrian tradition have been investigated (sections 3.1 to 3.7), allowing the understanding of this event as an essential component, and tragic outcome, of the rectification of the most fatal of errors

Fatal outcome in bronchus-associated lymphoid tissue lymphoma

Linfomas primários do pulmão são raros. O tipo histológico mais freqüente é o linfoma do tecido linfóide associado ao brônquio. Este tipo de linfoma tem curso indolente e excelente resposta à terapia. Um terço dos casos é descoberto incidentalmente. Devido à raridade desta doença, no entanto, pouco se conhece sobre sua história natural em termos de disseminação e evolução. Neste relato, descrevemos o caso incomum de um homem de 61 anos que recusou o tratamento após diagnóstico de linfoma do tecido linfóide associado ao brônquio e, 2 anos após o diagnóstico, morreu por infiltração pulmonar maciça sem disseminação para outros órgãos.

Envenenamento fatal por baiacu (Tetrodontidae): relato de um caso em criança

É descrito um envenenamento pela ingestão de vísceras de um baiacu-pintado (Sphoeroides testudineus) por uma criança de dois anos, que apresentou sudorese fria, fraqueza muscular progressiva, parada cardiorrespiratória e morte. São discutidos os riscos do consumo da carne e vísceras de baiacus, fato comum em certas regiões do Brasil.

A fatal attack caused by a lowland tapir (Tapirus terrestris) in Southeastern Brazil

A 55-year-old man was attacked by a Brazilian tapir (Tapirus terrestris) after surprising and stabbing the animal in his corn plantation. The victim received deep bites in the thighs, neck, and cervical areas, resulting in severe hemorrhage and death. This is the first report of a tapir incident resulting in death and is of interest because of the severity of the contusions and lacerations caused by the provoked animal.

Marine catfish sting causing fatal heart perforation in a fisherman

Many marine catfish have serrated bony stings (spines), which are used in defense against predators, on the dorsal and pectoral fins. While catfish-induced injuries are generally characterized by the pain associated with envenomation, the stings in some species are sufficiently long and sharp to cause severe penetrating trauma. Most injuries are to the hands of victims, commonly fishermen. We report the death of a fisherman caused by myocardial perforation from a catfish sting. To our knowledge, this is the first such description in the medical literature.

A fatal attack on a child by a black caiman (Melanosuchus niger)

We describe a fatal attack by a black caiman (Melanosuchus niger) on an 11-year-old child with comments on the reptile's aggression mechanisms and the conditions under which this kind of incident takes place in the Amazon region. © 2011 Wilderness Medical Society.

Fatal bothropic snakebite in a horse: a case report

The present study reports a snakebite in a horse in the state of Pará, Brazil. At initial evaluation the animal was reluctant to walk and had tachycardia, tachypnea, severe lameness, bleeding on the pastern and swelling around the left hind leg. Blood samples from the bleeding sites, took on the first day, showed leukocytosis and neutrophilia, whereas biochemical values of urea and creatinine were significantly increased. The chosen treatment was snake antivenom, fluid therapy, antibiotics, anti-inflammatory agents and diuretic drugs. On the fourth day of therapy, the hematological values were within normal parameters. There was improvement related to the clinical lameness and swelling of the limb. However, a decrease in water intake and oliguria were observed. On the seventh day the animal died. Necropsy revealed areas of hemorrhagic edema in the left hind limb and ventral abdomen; the kidneys presented equimosis in the capsule, and when cut they were wet. Moreover, the cortex was pale, slightly yellow and the medullary striae had the same aspect. Based on these data, we concluded that the snakebite in the present study was caused by Bothrops spp. and that renal failure contributed to death.

Calciphylaxis: a rare but potentially fatal event of chronic kidney disease. Case report

Calciphylaxis or calcific uremic arteriolopathy is a rare cutaneous-systemic disease occurring in patients with advanced chronic kidney disease. The classical clinical picture is that of a necrotic and progressive skin ulcer of reticular pattern, mostly in the lower legs and susceptible to local infection. It is a product of mural calcification and occlusion of cutaneous and sub-cutaneous arteries and arterioles. The authors report the case of a 73-year-old male patient in his late stage of renal disease presenting severe necrotic cutaneous ulcers on lower legs followed by local and systemic infection and death due to sepse after parathyroidectomy.

Brazilian spotted fever: Real-time PCR for diagnosis of fatal cases

Suspicion of Brazilian spotted fever (BSF) should occur in endemic regions upon surveillance of the acute febrile icteric hemorrhagic syndrome (AFIHS). However, limitations associated with currently available laboratory tests pose a challenge to early diagnosis, especially in fatal cases. Two real-time PCR (qPCR) protocols were evaluated to diagnose BSF in 110 fatal AFIHS cases, collected in BSF-endemic regions in 2009-2010. Of these, 24 were positive and 86 negative by indirect immunofluorescence (IFA) assay (cutoff IgG and/or IgM >= 128). DNA from these samples was used in the qPCR protocols: one to detect Rickettsia spp. (Citrate synthase gene) and another to determine spotted fever group (SFG) Rickettsia species (OmpA gene). Of the 24 IFA-positive samples, 5 (21%) were positive for OmpA and 9 (38%) for citrate synthase. In the IFA-negative group (n = 86), OmpA and citrate synthase were positive in 23 (27%) and 27 (31%), respectively. These results showed that the 2 qPCR protocols were about twice as sensitive as the IFA test alone (93% concordance). In conclusion, qPCR is a sensitive method for the diagnosis of fatal BSF cases and should be considered for routine surveillance of AFIHS in places like Brazil, where spotted fever-related lethality is high and other endemic diseases like dengue and leptospirosis can mislead diagnosis. (C) 2012 Elsevier GmbH. All rights reserved.

Nursing diagnoses in trauma victims with fatal outcomes in the emergency scenario

The objective of this study was to identify and analyze the nursing diagnoses that constitute risk factors for death in trauma victims in the first 6 hours post-event. This is a cross-sectional, descriptive and exploratory study using quantitative analysis. A total of 406 patients were evaluated over six months of data collection in a tertiary hospital in the municipality of Sao Paulo, according to an instrument created for this purpose. Of the total, 44 (10.7%) suffered death. Multivariate analysis indicated the nursing diagnoses ineffective respiratory pattern, impaired spontaneous ventilation, risk of bleeding and risk of ineffective gastrointestinal tissue perfusion as risk factors for death and ineffective airway clearance, impaired comfort, and acute pain as protective factors, data that can direct health teams for different interventionist actions faced with the complexity of the trauma.

Toll-like receptors 2, 3 and 4 and thymic stromal lymphopoietin expression in fatal asthma

Background Airway inflammation in asthma involves innate immune responses. Toll-like receptors (TLRs) and thymic stromal lymphopoietin (TSLP) are thought to be involved in airway inflammation, but their expression in asthmatics both large and small airways has not been investigated. Objective To analyse the expression of TLR2, TLR3, TLR4 and TSLP in large and small airways of asthmatics and compare their expression in smoking and non-smoking asthmatics; to investigate whether TLR expression is associated with eosinophilic or neutrophilic airway inflammation and with Mycoplasma pneumoniae and Chlamydophila pneumoniae infection. Methods Using immunohistochemistry and image analysis, we investigated TLR2, TLR3, TLR4 and TSLP expression in large and small airways of 24 victims of fatal asthma, FA, (13 non-smokers, 11 smokers) and nine deceased control subjects (DCtrl). TLRs were also measured in 18 mild asthmatics (MA) and 12 healthy controls (HCtrl). M. pneumoniae and C. pneumoniae in autopsy lung tissue were analysed using real-time polymerase chain reaction. Airway eosinophils and neutrophils were measured in all subjects. Results Fatal asthma patients had higher TLR2 in the epithelial and outer layers of large and small airways compared with DCtrls. Smoking asthmatics had lower TLR2 levels in the inner and outer layers of the small airways than non-smoking asthmatics. TSLP was increased in the epithelial and outer layers of the large airways of FA. FA patients had greater TLR3 expression in the outer layer of large airways and greater TLR4 expression in the outer layer of small airways. Eosinophilic airway inflammation was associated with TLR expression in the epithelium of FA. No bacterial DNA was detected in FA or DCtrls. MA and HCtrls had only a small difference in TLR3 expression. Conclusions and Clinical Relevance Increased expression of TLR 2, 3 and 4 and TSLP in fatal asthma may contribute to the acute inflammation surrounding asthma deaths.