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Biomedical subjects

A Busuttil

Publications and source records attributed to A Busuttil.

At least 37 records · Page 2Linked to original sources
PubMed1994

A review of completed suicides in the Lothian and Borders Region of Scotland (1987-1991).

A review of 400 completed suicides encountered during a 5-year period (January 1987-December 1991) in the Lothian and Borders Region of Scotland (LBRS) was conducted. The incidence was 9.4 per 100,000 with a M:F ratio of 2.4:1; the elderly had a significantly higher (P < 0.001) rate (9.9 per 100,000) compared to adolescents (3.3 per 100,000). Significantly (P < 0.001) more cases occurred in the rural communities. Overall, the peak incidence was in the 45- to 54-year age group. Drug overdose was the most common (39%) method used by both sexes and in both urban and rural communities; it was the first choice for virtually all age groups, and females exhibited greater preference. Analgesics and tricyclic antidepressants were the most common drugs used. Hanging (19.8%) was popular among the young and the elderly (> 64 years) suicides. Inhalation of car exhaust (13.3%) was a rural phenomenon and was common in the 25- to 54-year age group. Jumping from heights (9.8%) was more common in the urban areas; an increasing trend in the use of this method by females was possibly emerging. Drowning (8.3%) exhibited no particular pattern and the use of firearms was relatively uncommon (2.8%). This study and any subsequent assessment of socio-medical factors associated with completed suicide in this region should provide a basis for the formulation of preventive strategies. A continuous monitoring of the trends in the LBRS is necessary.

Adolescent↗
PubMed1994

Dextropropoxyphene-related deaths--a problem that persists?

A total of 48 cases of dextropropoxyphene-related deaths that occurred over a 6-year period (1987-1992) in the Lothian and Borders region of Scotland were reviewed. No significant gender difference was found but a significantly greater proportion of the deaths occurred in the urban areas (P < 0.05). Suicide accounted for 81.3% of cases while the other deaths were caused accidentally and involved drug addicts, alcoholics and those who had taken their dextropropoxyphene-containing prescriptions following consumption of alcohol. Overall concomitant alcohol abuse was identified in 41.7% of all the victims. Compound analgesic preparations containing dextropropoxyphene are still widely prescribed and the persistence of deaths from its overdose may suggest the need for stricter prescription control and for educational programmes for users.

Accidents↗
PubMed1994

A semi-automated micro-method for the histological assessment of fat embolism.

A method of quantitatively determining the volume of fat emboli in a tissue using an image analysis system (I.B.A.S.) was developed. This procedure is an interactive, semi-automated tool allowing the quick and accurate gathering of large quantities of data from sections of different tissue samples stained by osmium tetroxide. The development of this procedure was aimed at producing a system which is reliable, reproducible and semi-automated thereby enabling epidemiological and serial studies to be made of a large number of histological sections from different tissues. The system was tested in a study of tissue sections from a series of fatalities from an aircraft crash in an attempt at correlating the incidence of fat emboli with the presence of multiple fractures and soft tissue injuries, the correlation to be made being between the quantitative presence of fat emboli and the extent and severity of injuries suffered.

Accidents, Aviation↗
PubMed1994

Sudden unexpected nocturnal deaths among Thai immigrant workers in Singapore. The possible role of toxigenic bacteria.

Sudden Unexpected Nocturnal Deaths (SUND) occur in young, apparently healthy immigrant workers from Thailand, the Philippines and Bangladesh living among ex-patriot labour forces in countries such as Singapore and Saudi Arabia. Several factors associated with these deaths are similar to those observed for Sudden Infant Death Syndrome (SIDS): sleep related and mainly nocturnal occurrence; no prodromal illnesses other than mild respiratory tract infection; exposure to cigarette smoke; absence of invasive microorganisms at autopsy. The hypotheses proposed to explain these deaths in adults are examined. Based on our studies of the role toxigenic bacteria might play in some cases of SIDS, we suggest a new approach to the investigation of SUND.

Adult↗
PubMed1994

Lewis antigen expression on human monocytes and binding of pyrogenic toxins.

Toxigenic bacteria such as Bordetella pertussis and Staphylococcus aureus have been implicated in some cases of sudden infant death syndrome (SIDS). We have previously demonstrated that the Lewis(a) antigen is an epithelial cell receptor for S. aureus, and this study demonstrated that Lewis(a) on human monocytes is also a receptor for staphylococcal enterotoxin B (SEB). Values obtained in assays for production of TNF-alpha and nitric oxide were greater for monocytes treated with SEB compared with those treated with lipopolysaccharide (LPS). Exposure to LPS increased the expression of Lewis(a) on monocytes. These results are discussed with reference to the reported enhancement of endotoxic shock by pyrogenic toxins.

Antibodies, Monoclonal↗
PubMed1994

Identification in the Lockerbie air disaster.

In the aftermath of the Lockerbie air disaster, identification of the victims (plane occupants and local residents) was established by two primary methods: odontology and dactylography. Scottish law requires corroboration of evidence of identity, so both primary methods were used whenever possible, with further evidence occasionally derived from the matching of physical characteristics, personal effects and details from past medical records. Of the 270 victims, 253 were positively identified. Of these, 209 were identified with the aid of odontology.

Accidents, Aviation↗
PubMed1994

Isolation of an adhesin from Staphylococcus aureus that binds Lewis a blood group antigen and its relevance to sudden infant death syndrome.

A 67 kDa protein was isolated from cell membrane preparations of Staphylococcus aureus (NCTC 10655) by affinity adsorption with synthetic Lewis a antigen conjugated to Synsorb beads. Pre-treatment of buccal epithelial cells expressing Lewis a with the purified protein reduced binding of the staphylococcal strain to a greater extent than the material not bound to the Synsorb beads. The significance of this work is discussed with reference to expression of Lewis a antigen in infants and the proposed role of toxigenic strains of staphylococci in some cases of sudden infant death syndrome.

Adhesins, Bacterial↗
PubMed1994

Detection of microbial surface antigens that bind Lewis(a) antigen.

There is evidence that the Lewis(a) blood group antigen is one of the receptors for a number of potentially pathogenic microorganisms. To determine how widely distributed the microbial adhesins are that bind this antigen, anti-idiotypic antibodies produced against monoclonal anti-Lewis(a) were used in coagglutination assays to screen a variety of species. The following were agglutinated: 7/7 strains of Staphylococcus aureus; 10/19 (53%) strains of Neisseria meningitidis; 8/13 (62%) strains of Haemophilus influenzae; 1/3 strains of Helicobacter pylori; 1/2 strains of Neisseria gonorrhoeae; 1/2 strains of Candida albicans. The application of the anti-idiotypic antibodies to studies of host cell receptors, isolation of adhesins and development of new epidemiological typing reagents is discussed.

Adhesins, Bacterial↗
PubMed1994

The role of infectious agents in sudden infant death syndrome.

Epidemiological factors associated with susceptibility to respiratory infections are similar to those associated with Sudden Infant Death Syndrome. Here we review the evidence that respiratory pathogens might be involved in some cases of Sudden Infant Death Syndrome in the context of factors identified in epidemiological studies of cot deaths: the age range affected; mother' smoking; respiratory viral infections; immunisation status. Both laboratory and epidemiological evidence suggests that vulnerability of infants to infectious agents depends on interactions between genetic, developmental and environmental factors that contribute to colonisation by microorganisms, the inflammatory and specific immune responses and the infants' physiological responses to inflammatory mediators. A model is proposed to explain how microorganisms might trigger a series of events resulting in some of these unexpected deaths and discusses how the the present recommendations regarding child care practices might help reduce the numbers of Sudden Infant Death Syndrome cases associated with infectious agents.

Bacterial Infections↗
PubMed1994

Clinical contact preceding suicide.

Of the 400 consecutive completed suicides investigated over a 5-year period, 114 (28.5%) who had consulted a doctor in the week preceding death were specifically reviewed and compared with those who did not. The study comprised an analysis of the medical history, the scene of death and a complete autopsy with histological and toxicological examination and the identification of features which occurred more frequently in this group when compared with other suicides not contacting their doctors. Suicide-associated factors include psychiatric illness (58.8%), deteriorating health (16.7%), and a loss of spouse (7.0%); all these features were manifested by this group of suicides more frequently than by those who made no clinical contact (P < 0.001). A pre-indication of suicidal intention was made by 45% of these patients. This feature, as with previous attempts, occurred more commonly in patients who consulted a doctor (P < 0.001). Drug overdose was the most common suicidal method chosen (50.9%) and anti-depressants predominated (35%); 78% of those who overdosed ingested prescribed drugs. Poisoning was more common in this group (P < 0.001). Half of the victims committed suicide within 24 hours following consultation; of these, 51% overdosed on drugs with 61% of them ingesting their prescribed drugs. Of these 114 cases, the final consultation in 43% was to collect more drugs. All suicidal threats should be taken seriously, and particular care should be taken in prescribing and dispensing medication which may be fatal in overdose.

Aged↗
PubMed1994

Deaths of amateur scuba divers.

Four scuba diving deaths investigated by the Forensic Medicine Unit, University of Edinburgh Medical School, are reported. The pathological investigation of such deaths requires that a detailed history of the events prior to death is obtained and that the site of the accident is fully examined with underwater photographic recording where possible. The diving suits, breathing apparatus and other diving accessories also have to be examined carefully by experts and a complete autopsy with toxicological and histological examination is essential. The causes and mechanisms of death are discussed, as are the importance of special autopsy techniques and investigations. Possible interpretative problems are highlighted.

Adult↗
PubMed1994

A biopsied vaginal lesion in a child alleging abuse.

In a six-year-old child presenting with vaginal bleeding, considered to be the consequence of sexual abuse by a stepfather, a colposcopically identified vaginal lesion was biopsied. This showed a chronic inflammatory lesion which could have been the consequence of recurrent, self-inflicted, masturbatory injury. Various controversial aspects of this case are discussed.

Child↗
PubMed1994

A five year review of fatal self-ingested overdoses involving amitriptyline in Edinburgh 1983-'87.

One hundred and twelve cases of fatal self-ingested overdoses were investigated in the Forensic Medicine Unit of the Department of Pathology of the University of Edinburgh in the period 1983-'87 (inclusive). Of these, 24 cases involved amitriptyline as either the sole agent or in combination with another drug, the most common of which was ethanol. The mean age of the latter group was 43 years with a marked female preponderance. The social history was documented with six out of the 24 cases living alone and five out of the 24 cases divorced. The number previously referred for psychiatric treatment and the number of cases where over 100 tablets of the drug had been prescribed at any one time (where known) was recorded: eight out of 24 cases. The fact that amitriptyline was by far the commonest of the tricyclic antidepressants to be encountered in a fatal overdose situation raises the important question of the prescribing of amitriptyline as a first line therapy in mental depression.

Adolescent↗
PubMed1994

Deaths from substance overdose in the Lothian and Borders region of Scotland (1983-1991).

1. A retrospective analysis of 352 consecutive cases of fatal substance overdose that occurred in the Lothian and Borders region of Scotland (LBRS) between 1983 and 1992 (inclusive) is presented. All these cases were subjected to a full forensic autopsy with histological and toxicological studies. 2. The overall male:female ratio is 1.2:1. Males significantly predominate (1.9:1) in the 21-30 year age group, but females significantly predominate (0.7-0.9:1) above the age of 50 years (P < 0.001). A significant progressive alteration in the sex ratio is noted: from 0.7:1 in 1988 to 2.4:1 in 1992 (P < 0.001). 3. Analgesics account for 43.2% of all overdose deaths with narcotic analgesics representing 32.4%. Dextropropoxyphene is the commonest (38.2%) narcotic analgesic and fatal overdoses on it have been increasing since 1989; methadone deaths also showed an increase. Death from heroin overdose fell sharply in 1985. 4. Antidepressants account for 20.2% of deaths (tricyclics representing 19.3%): Amitriptyline is the commonest (75.0%) tricyclic and its use, particularly by female suicides, has been increasing since 1989. Barbiturate poisoning has declined considerably since 1986. 5. Temazepam comprises 65.4% of all benzodiazepines overdose deaths; two-thirds of fatal benzodiazepine abuse involve males. 6. This study once more emphasises that physicians, and especially general practitioners, must prescribe cautiously for their patients. Control through legislation of the sale of non-narcotic analgesics is worth serious consideration.

Acetaminophen↗
PubMed1994

Suicidal inhalation of vehicular exhaust in the Lothian and Borders region of Scotland.

1. A 6-year retrospective study of the features of 79 consecutive completed suicides from exhaust fume inhalation (SEFI) in the Lothian and Borders region of Scotland was conducted. Full forensic autopsies with histological and toxicological studies were carried out. 2. The mean incidence is 2.0/100,000 population (M = 3.7; F = 0.4; P <> 0.001); increasing since 1990. The age peak is in the 35-44 years age group (especially among males) and a significant (P < 0.001) proportion reside in rural areas. 3. SEFI is significantly (P < 0.05) higher during spring and summer; outdoor locations are prevalent during summer. 4. Most (75.6%) of the victims were in current employment. Psychiatric illness (30.7%), problems in marriage or relationships (28.2%) and financial difficulties (16.7%) were the major associated socio-medical factors. 5. The mean carboxyhaemoglobin (COHb) saturation was 74 +/- 11.2%; fatal COHb saturation levels were still detectable in severely decomposed bodies. The blood alcohol concentration (BAC) in 37 of the victims ranged from 14-397 mg dl-1. No significant correlation exists between COHb saturation and the victim's age or BAC. 6. Attempts to reduce the incidence of SEFI must be directed principally to dealing with associated sociomedical problems. The reduction of the potential of vehicles to produce carbon monoxide and of directing exhaust fumes into the interior of the vehicle are important secondary preventative measures.

Adolescent↗