Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine

This study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response system. Data on patients attended for cardiac arrest between January 1st, 2010 and December 31st, 2018 except babies at birth were included. Logistic regression analysis with start of CPR by physicians as the dependent variable and possible associated factors as independent variables adjusted for anonymised physician identifiers was conducted. 1525 patient data sets were analysed. Obvious signs of death were present in 278 cases; in the remaining 1247, resuscitation was attempted in 920 (74%) and were withheld in 327 (26%). Factors significantly associated with higher likelihood of CPR by physicians (OR 95% CI) were resuscitation efforts by EMS before physician arrival (60.45, 19.89–184.29), first monitored heart rhythm (3.07, 1.21–7.79 for PEA; 29.25, 1.93–442. 51 for VF / pVT compared to asystole); advanced patient age (modelled using cubic splines), physician response time (0.92, 0.87–0.97 per minute) and malignancy (0.22, 0.05–0.92) were significantly associated with lower odds of CPR. We thus conclude that prehospital physicians make decisions to start or withhold resuscitation routinely and base those mostly on situational information and immediately available patient information known to impact outcomes.

Fingertip pulse oximetry prevented premature declaration of death

ObjectiveWe describe a case of persisting readings from a fingertip pulse oximeter (FPO) in an elderly cachectic woman with pancreatic cancer, who fulfilled all classical criteria of death.MethodsIt is an instructive example of a home hospice patient who died during the physician’s intervention. Although all classical signs of death had been confirmed several times, a portable FPO continued to indicate satisfactory saturation and pulse readings for the following 30 min.ResultsOur case report confirms that the classical criteria of death might sometimes be faulty. The application of a portable FPO prevented a premature declaration of death.ConclusionIn exceptional cases, even the most careful physical examination may erroneously indicate that a person is dead. A residual cardiac output and gas exchange may be preserved and revealed by FPO readings. In doubtful situations, FPO can provide additional information and prevent a premature declaration of death.

FEATURES OF PROCESSING OF WATERFOWL EGGS DURING THE INCUBATION

The purpose of this work was to conduct a comparative evaluation of existing disinfectants for their use in the second half of incubation for irrigation of waterfowl eggs. Methods. The study was conducted at the State Poultry Research Station of NAAS on hatching eggs of ducks and incubation wastes. Pre-incubation disinfection of eggs was carried out by irrigation with 5.0% solution of "Lasept-forte". Eggs were incubated according to standard regimes in modernized laboratory incubators ILU-F-0.3 and ILB-0.5. According to the requirements of the current standard for the technological process of incubation of duck eggs from the 13th day of incubation air cooling of eggs twice a day (morning and evening) for 10-15 minutes was carried out, and from the 20th day – a wet one. Modern disinfectants in various concentrations were used to irrigate duck eggs during incubation. Irrigation of duck eggs of the control group was performed with clean water. According to the results of research, the efficiency of irrigation of eggs with «Lasept-forte» and «Brovadez Plus» has been proved, and their optimal concentrations have been selected. It was found that the use of 0.5 % "Lasept-forte" or 0.05 % "Brovadez plus" for irrigation of duck eggs from the 20th day of incubation is desirable because it increases the results of incubation by 1.5- 2.5% due to the improvement of the sanitary condition in the incubator and the reduction of embryo death in the later stages of development. The pathological autopsy of incubation wastes showed that the category of waste "dead" (embryos that died after 25 days of incubation) was in the control group at 7.0%, in the experimental 6.0-6.5 %. At the same time, at the autopsy of the “dead” from these groups, there were signs of death from damage to eggs by microflora and fungi. In the control group, 64.3 % of deaths had such symptoms, in the first experimental group - 53.8 %, in the second experimental group - 33.3 %, which also proves the effectiveness of the means used.

Jacob Winslow (1669–1760): The surprising legacy of an anatomist

Jacob Winslow (1669–1760), a celebrated anatomist in his day, made his name publishing numerous medical treatises and writing the four-volume Anatomical exposition of the structure of the human body. He gives his name to the foramen of Winslow, and is credited with numerous significant findings in neuroanatomy and biomechanics. His life is characterised by meticulous devotion to his discipline and divided by a torturous religious conversion. In addition to his contributions to anatomy, he is famously remembered for his treatise on the uncertainty of the signs of death, which has influenced practices surrounding death down to the present day.

Assessment of HEMS Teams Performance in Out-of-Hospital Cardiac Arrest (OHCA)

Introduction:The Out of Hospital Cardiac Arrest (OHCA) procedures constitute one of the most quantifiable indicators of the quality of Emergency Medical Services (EMS). In Poland, HEMS teams perform such procedures both during primary missions and when they support EMS teams.Aim:To carry out a retrospective analysis of OHCA related calls received from January 1, 2011, to December 31, 2016.Methods:During the relevant period there were 2,447 OHCA related calls. Of those, 308 cases were excluded from the analysis because no cardiac arrest was confirmed or the patients showed signs of death that prevented any emergency procedures.Results:The Return of Spontaneous Circulation (ROSC) was achieved in 1,119 cases. Resuscitation was clearly much more effective if CPR procedures were commenced prior to the arrival of the HEMS team. The groups in which higher survival rates were obtained included women, patients younger than 40 and patients who had signs of shockable rhythms. The use of HEMS team allowed for faster transport of patients to relevant specialist institutions, specifically if an invasive cardiological intervention was needed.Discussion:The use of HEMS teams in OHCA related calls indicates that such actions are highly effective both in primary missions and when HEMS teams support other EMS terms. An additional advantage is the possibility of quick transportation to a relevant specialist medical center.

Gambaran Mikrokopik Serebelum pada Hewan Coba Postmortem

After death, there will be cellular changes that cause definite signs of death. These changes could be used to determine the time of death. This study was aimed to determine the microscopic changes of the cerebellum during 1 hour to 24 hours postmortem. This was a descriptive study. Four domestic pigs of more than 90 kg were used as animal models. After being killed, we made slices in the pig heads to expose and observe cerebellar microscopic changes in several time intervals, as follows: 90 minutes, 2 hours, 3 hours, 4 hours, 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, 10 hours, 11 hours, 12 hours, 13 hours, 14 hours, 15 hours, 16 hours, 17 hours, 18 hours, 19 hours, 20 hours, 21 hours, 22 hours, 23 hours, and 24 hours postmortem. The results showed that the cerebellum became progressively pale and softened at 8 hours postmortem. Congestion in all tissues occured at 2 hours postmortem, however 69.2% of the Purkinje cells still had normal nuclei. At 7 hours postmortem, Purkinje cells began to enlarge associated with karyorrhexis, and at 21 hours postmortem most of the cells shrank. Albeit, at 24 hours postmortem the cerebellar layers could still be identified and some Purkinje cells with normal morphology could be found. Conclusion: Microscopic changes could be identified at 2 hours postmortem in the form of congestion of the cerebellar layers. Purkinje cells underwent karyorrhexis at 7 hours postmortem and shrank at 21 hours postmortem.Keywords: Purkinje cells, cerebellar layers, postmortemAbstrak: Setelah kematian, terjadi perubahan pada sel-sel yang menimbulkan tanda-tanda pasti kematian. Perubahan-perubahan yang terjadi dapat membantu menentukan saat kematian dalam suatu kasus hukum. Penelitian ini bertujuan untuk mengetahui perubahan mikroskopik serebelum selama interval waktu 1 jam hingga 24 jam postmortem. Jenis penelitian ialah deskriptif. pada hewan coba babi dengan rerata berat lebih dari 90 kg. Setelah hewan coba dimatikan, dibuat irisan di bagian kepala untuk menampakkan serebelum dan mengamati perubahan mikroskopiknya pada rentang waktu 90 menit, 2 jam, 3 jam, 4 jam, 5 jam, 6 jam, 7 jam, 8 jam, 9 jam, 10 jam, 11 jam, 12 jam, 13 jam, 14 jam, 15 jam, 16 jam, 17 jam, 18 jam, 19 jam, 20 jam, 21 jam, 22 jam, 23 jam, dan 24 jam postmortem. Hasil penelitian mendapatkan serebelum tampak pucat dan melunak secara progresif pada 8 jam postmortem. Kongesti di semua jaringan mulai terjadi pada 2 jam postmortem dan ditemukan 69,2% sel Purkinje berinti yang masih normal. Sel Purkinje mulai membesar dan inti mengalami karioreksis pada 7 jam postmortem tetapi pada 21 jam postmortem sel-sel tersebut tampak menyusut. Meskipun demikian hingga 24 jam postmortem struktur lapisan serebelum masih dapat diidentifikasi dan sel Purkinje dengan morfologi normal masih ditemukan. Simpulan: Perubahan mikroskopik serebelum sudah dapat diidentifikasi pada 2 jam postmortem yaitu berupa kongesti lapisan serebelum. Sel Purkinje mengalami karioreksis pada 7 jam postmortem dan menyusut pada 21 jam postmortem.Kata kunci: sel Purkinje, lapisan serebelum, postmortem

Înmormântarea în Maramureș după răspunsurile la chestionarele lui Ion Mușlea

Our work is based on the material provided by the answers to Ion Muşlea's questionnaires on the funeral in Maramureş, which raises a special interest to the researcher due to the rich ritual and ceremonial acts, beliefs and superstitions that give complexity, individuality and also the status of regional variant to the funeral in this area. After brief general considerations about the funeral, in which we emphasized its characteristic traits, especially the historical evolution of this custom, we proceeded to synthesize and systematize the information obtained in the localities Vadu Izei, Rona de Jos, Hărniceşti and Giuleşti, following the succession of the sequences in the funeral ceremony. The first part of our paper was reserved for the signs of death, then we talked about the period before the agony, and finally about the agony of the dying person. The largest part of our work concerns the burial itself, as it is the basic sequence of the funeral ceremony and it has a very rich repertoire, made up of all kinds of ritual-magical acts related to different sequences of the custom, some of them complex - such as the wake ceremony. We included information about the post-burial sequence, where the ritual funeral repasts are predominant. Our work ends with the beliefs and superstitions that once circulated intensely during the funeral, the emphasis being on the superstitions - reproduced separately by the investigator - about male or female ghosts; then the beliefs related to the soul, to the afterlife, to apparitions and to death. In the context of using the material investigated by Ion Muşlea's correspondents, we have made some interpretations focusing on decoding the symbols of some magical instruments or vegetal elements used in the magical practices and ritual acts of the funeral in Maramures. Our guidelines throughout the work was our concern to show the entire complexity, richness and variety of the funeral habits in this area.

A particular case of accidental asphyxiation

The case reported involved a 60-year-old man with psychiatric illness who was found dead at his home. He was almost naked and showed signs of death by violent asphyxiation, which led to the suspicion of homicide. Autopsy findings showed foreign material in the trachea and larynx. However, the partially digested content in his stomach, the study of the gastric content and the microscopic analysis of the airways made it possible to define this as accidental death due to inhalation of material from a diaper. Toxicological analysis detected the presence of phenytoin, valproic acid, and phenobarbital in his blood, with values within the therapeutic ranges. This is certainly a peculiar case, as particularly evident after careful review of the literature on deaths by asphyxiation in psychiatric patients. Furthermore, this study highlights the importance of a full autopsy and microscopic evaluation of any foreign bodies.

Trinity Homily XXIX De Sancto Andrea between Tradition and Innovation

Recent scholarship has challenged the view of the late twelfth-century Trinity Homilies, and of the contemporary Lambeth Homilies, as two collections that merely continue the earlier Old English vernacular homiletic tradition. This study aims to contribute to the scholarly debate on the Trinity Homilies by considering the elements of tradition and innovation featured in the twenty-ninth sermon of the collection, De Sancto Andrea. Through a discussion on the passage on the ‘Soul’s Address to the Body’ preserved in this homily, I shall show that Trinity XXIX includes both elements of continuity with the ‘Soul and Body’ literature attested in Old English homiletic texts (like the antithetical rhetorical pattern developed in the damned soul’s speech) and new features (like the motif of the ‘Signs of Death’ and the theme of ‘neglectful friends’) which reflect early Middle English developments in the ‘Soul and Body’ theme. I shall argue that the Trinity XXIX homilist probably adapted and reworked a lost Latin source into a poetic passage metrically and thematically consistent with contemporary ‘Soul and Body’ poetry. In the Appendix, I shall discuss the sources for the Latin material embedded in Trinity XXIX.1

iBH3: simple, fixable BH3 profiling to determine apoptotic priming in primary tissue by flow cytometry

Dysregulation of the mitochondrial pathway of apoptosis, controlled by the BCL-2 family of proteins, leads to disease states including cancer. Rapid analysis of a cell’s dependency on the BCL-2 family of proteins is hindered by the complex interactions of more than a dozen proteins. Transcript or even protein levels are therefore generally insufficient to predict a cell’s response to perturbations like chemotherapy. Previously, we developed the JC-1 BH3 method to provide a same day functional assay to assess a cell’s propensity to undergo apoptosis and demonstrated its utility in predicting response to chemotherapy. We have now improved upon these methods to create a robust assay amenable to high throughput platforms using cytochrome c retention in formaldehyde fixed cells to remove the time sensitivity of JC-1 potential measurements. BH3 profiling by intracellular staining (iBH3) is suitable for 96- and 384-well formats, and can be used to directly screen candidate BH3-mimetic compounds for activity. When used as the final component of dynamic BH3 profiling (DBP), which uses a drug pretreatment prior to iBH3 to assess the change in profile due to treatment, it can predict the response of cells to chemotherapy days before they show signs of death.