Klára Töro

Fatal Traffic Injuries Among Children and Adolescents in Three Cities (Capital Budapest, Vilnius, and Tallinn)

Abstract:  Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico‐legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One‐hundred and forty‐one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2–5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.

Expression and Function of C5a Receptor in a Fatal Anaphylaxis After Honey Bee Sting

Abstract:  The mechanisms leading to death from anaphylaxis after insect sting involve antigen cross‐linkage of antibody molecules that activate immunoglobulin receptors on inflammatory cells. The aim of our study was to investigate the pathomorphology and the expression of C5aR in fatal anaphylaxis in a patient after a fatal insect sting. A 38‐year‐old women was stung by a honeybee. C5R1 expression was detected in many dilated capillaries in the lungs. Pulmonary epithelial cells did not bind the monoclonal antibody for C5R1; however, intensive cytoplasmic staining was detected in endothelial cells. The findings of this case provide evidence for an active role of complement in fatal anaphylaxis elicited by bee venom. C5aR detection could be useful in the identification of sudden death cases because of unwitnessed fatal insect sting cases. Authors can recommend this immunohistochemical analysis on all sudden unexpected deaths outdoors where a possible bee sting might occur.

Distribution of prenatal and postnatal risk factors for sudden infant death in Budapest

Objective - To study the distribution of prenatal and postnatal risk factors for sudden infant death syndrome (SIDS). Design - A questionnaire-based survey for SIDS risk factors; family interviews were performed among the parents of SIDS victims and symptom-free infants. Setting - The survey was conducted in paediatric primary health care units in Budapest, Hungary in the period 1996 to 1998. Subject - Eighteen SIDS cases and 74 symptom-free healthy infants aged 7-365 days were investigated. Main outcome measures - Occurrence of risk factors and impact of social environment were analysed using conditional logistic regression. Results - In this study, the classic risk factors of small birth weight, maternal smoking, bottle-feeding did not reflect differences between the investigated groups. The prone position did not demonstrate a difference between SIDS cases and controls (p =0.86). Short intervals between pregnancies (OR =4.8, CI =1.2?19.9, p =0.025) and social disadvantage (OR =6.7, CI =1.3?35.7, p =0.015) indicated significant differences between SIDS cases and controls. Conclusion ? The outcome of our survey shows that infants from a lower social and economic environment may be at higher risk for SIDS.

Forensic evaluation of sudden death due to tuberculosis

Abstract:  The emergence of drug‐resistant tuberculosis (TB) poses a major threat to TB control efforts. We report a case of a 50‐year‐old man with pulmonary TB. The scene investigation had initially suspected for homicide; however, the result of medico‐legal autopsy demonstrated natural cause of death. Statistical data suggest that the rates of national mortality by respiratory TB decreased in the last decades in Hungary; however, an increasing TB mortality was detected in the capital Budapest. Facing a new mortality trend in TB, the forensic scene investigation and determination of manner of death represent new challenges for practitioners.

Suicidal Hanging on High‐Voltage Line Pylon

Abstract:  Hanging is one of the most frequent methods for suicides among young males. This report presents two cases of suicide by hanging on pylons carrying high‐voltage power lines. The male victims suffered electrocution while committing suicide. Electrocution was the cause of death in both cases, however in one case blunt force injuries from hanging contributed to death. In these two cases hanging was the intentional method of suicide and it was followed by electrocution. The cases demonstrate that scene investigation, a detailed autopsy with histology, and amamnestic data are essential in the evaluation of suicides by hanging and that the determination of the cause of death remains a challenge in investigating such cases.

Pathological and biochemical investigation of a woman diagnosed with genetic Creutzfeldt–Jakob disease shortly after parturition

Creutzfeldt–Jakob disease (CJD) is a rare fatal neurodegenerative condition that most commonly occurs in a sporadic form, predominantly in the elderly. Genetic and acquired forms of CJD also occur, and these may affect younger age groups, including women of childbearing age. The transmissible nature of CJD makes horizontal secondary transmission a concern generally; however, a foetus born to a mother carrying a pathogenic mutation associated with CJD might be at risk of developing CJD as a result either of genetic inheritance or potential intrauterine exposure to infectivity. Here, we report on the pathological investigation of a woman who developed a severe neuropsychiatric illness shortly after giving birth and who was diagnosed with genetic CJD. Human prion diseases are uniformly fatal neurodegenerative conditions that occur in idiopathic, acquired and genetic forms. All are transmissible, including the genetic forms, of which CJD E200K-129M is the most common [1]. There are analogous diseases in animals, such as scrapie in sheep, and the epidemiology of scrapie suggests both horizontal and vertical transmission [2], but the exact mechanism of maternal transmission in scrapie is a matter of debate, with evidence for in utero exposure in addition to infection via the oral route around the time of birth [3]. The infectious agent in human and animal prion diseases is thought to be a misfolded and aggregated form of the prion protein (PrP) that undergoes a self-perpetuating conformational transition from the normal cellular isoform (PrP) to the disease-associated isoform (PrP) that deposits in the brain and, in some prion diseases, at lower levels in peripheral tissues. The expression of PrP within a tissue is therefore considered a precondition for both PrP accumulation and prion replication. The presence of PrP in human blood [4] and human reproductive tissues, notably the placenta, has been documented [5,6] and is suggestive of a possible route of exposure. Evidence of vertical transmission in human prion disease is absent, but the evidence base is not large. A priori, variant CJD might be supposed to present the greatest risk of maternal transmission because of the younger age distribution of affected individuals, the disseminated nature of PrP, and infectivity in peripheral tissues and the transmission of variant CJD infectivity by blood or blood products on five separate occasions (http://www.cjd.ed.ac.uk/TMER/ TMER.htm). Despite the comparatively large numbers of parents with variant CJD known to the National CJD Research & Surveillance Unit, including nine women with clinical variant CJD while pregnant, no evidence of vertical transmission has been found, although further follow-up was recommended considering the potentially lengthy incubation periods involved [7]. Nevertheless, it remains important to consider the possibility of secondary transmission in all forms of CJD, including the possibility of maternal transmission in the rare circumstances of a pregnancy in a person with clinical or preclinical CJD. The patient presented at the age of 32 years, after she gave birth at term with no complications. The baby subsequently showed developmental delay; investigations for a possible underlying metabolic disorder are being undertaken. The first symptoms were somewhat nonspecific comprising anxiety attacks, insomnia, psychotic symptoms and irritability during her pregnancy, which grew worse and resulted in admission to a psychiatric hospital. Before admission to the hospital, she had experienced a seizure. Within weeks, her state deteriorated: severe insomnia, cognitive decline and progressive gait imbalance were observed; she was unable to communicate properly with the physicians or to read. Myoclonic jerks were noted in all extremities. Cranial CT did not reveal atrophy or a space-occupying lesion; however, cranial MRI performed 1 month after her admission revealed symmetric high signal intensity in the caudate nucleus and putamen. EEG showed periodic sharp waves including those with a triphasic morphology. A search for neoplastic disease and paraneoplastic antibodies did not show positive results. Immunoblotting of the cerebrospinal fluid sample for protein 14-3-3 showed strong positivity (there was no blood contamination or elevated cell count), while genetic analysis of the PRNP revealed an E200K mutation and MM homozygosity at codon 129. Further progression to akinetic mutism was observed, and the patient died 4 months after the onset of clinical symptoms.

Infant Mortality and Ischemic Heart Disease in Hungary

Hungarian mortality rate is one of the highest in Europe. We have investigated the association between poor living standards and ischemic heart disease by a detailed geographical comparison of infant mortality in 1920-1939 and death in adults from ischemic; heart disease and other leading causes of death in 1990-1994. Ischemic heart disease [r = 0.325] and malignant tumors of digestive apparatus [r = 0.562] are strongly correlated with infant mortality. A significant difference was observed in both infant and overall mortality rates between the western and eastern counties. Our results suggest that the geographical distribution of ischemic heart disease in Hungary reflects later dietary influences.

Infant mortality and ischaemic heart disease in Hungary

Hungarian mortality rate is one of the highest in Europe. We have investigated the association between poor living standards and ischemic heart disease by a detailed geographical comparison of infant mortality in 1920-1939 and death in adults from ischemic; heart disease and other leading causes of death in 1990-1994. Ischemic heart disease [r = 0.325] and malignant tumors of digestive apparatus [r = 0.562] are strongly correlated with infant mortality. A significant difference was observed in both infant and overall mortality rates between the western and eastern counties. Our results suggest that the geographical distribution of ischemic heart disease in Hungary reflects later dietary influences.