Multiple Organ Pathologies Underlying in Sudden Natural Deaths

We aimed to investigate the relationships between Polycystic Ovary Syndrome (PCOS) and oxidative stress status, metabolic profile and cardiovascular risk factors in patients with  polycystic ovary syndrome Methods: We measured Body Mass Index (BMI), glucose, cholesterol, triglyceride, HDL, LDL, high sensitive CRP (hsCRP), insulin, AST and ALT, Malondialdehyde (MDA), erythrocyte reduced glutathione (GSH), Nitric Oxide (NO) levels in PCOS patients and in normal individuals. We used spectrophotometrical method to determine glucose, cholesterol, triglyceride, HDL, LDL, AST and ALT levels.  Nepholometrical method was used to measure hsCRP.  Immunoassay method was used for insulin. Oxidant status was evaluated by using erythrocyte MDA and NO levels, while antioxidant status was evaluated by GSH levels. Results: Study population were consist of 32 women with PCOS (Study group) and 32 healthy volunteers (Control group). In study group, we found statistically higher levels of MDA, NO (p<0.001) and lower levels of GSH (p<0.001) compared to those of controls. hsCRP, insulin (p<0.001) and triglyceride (p<0.05) levels were statistically higher in study group. We also observed a statistically higher BMI in women with PCOS (p<0.05). Conclusion: Our results revealed that PCOS is associated with imbalanced oxidative/antioxidative status, impaired metabolic profile and increased cardiovascular risk factors.
Anahtar Kelimeler:

PCOS, oxidants, antioxidants, MDA, NO, GSH

Multiple Organ Pathologies Underlying in Sudden Natural Deaths

We aimed to investigate the relationships between Polycystic Ovary Syndrome (PCOS) and oxidative stress status, metabolic profile and cardiovascular risk factors in patients with  polycystic ovary syndrome Methods: We measured Body Mass Index (BMI), glucose, cholesterol, triglyceride, HDL, LDL, high sensitive CRP (hsCRP), insulin, AST and ALT, Malondialdehyde (MDA), erythrocyte reduced glutathione (GSH), Nitric Oxide (NO) levels in PCOS patients and in normal individuals. We used spectrophotometrical method to determine glucose, cholesterol, triglyceride, HDL, LDL, AST and ALT levels.  Nepholometrical method was used to measure hsCRP.  Immunoassay method was used for insulin. Oxidant status was evaluated by using erythrocyte MDA and NO levels, while antioxidant status was evaluated by GSH levels. Results: Study population were consist of 32 women with PCOS (Study group) and 32 healthy volunteers (Control group). In study group, we found statistically higher levels of MDA, NO (p<0.001) and lower levels of GSH (p<0.001) compared to those of controls. hsCRP, insulin (p<0.001) and triglyceride (p<0.05) levels were statistically higher in study group. We also observed a statistically higher BMI in women with PCOS (p<0.05). Conclusion: Our results revealed that PCOS is associated with imbalanced oxidative/antioxidative status, impaired metabolic profile and increased cardiovascular risk factors.

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  • Saukko P, Knight B. Knight’s forensic pathology. 3rd ed. London: Arnold; 2004.
  • DiMaio WJ, DiMaio D. Forensic pathology. 2nd ed. London, New York, Washington: CRC Press; 2001.
  • Simpson K, Knight B. Forensic medicine. 11th ed. London: Hodder Arnold Publication; 1997.
  • Soysal Z, Eke SM, Çağdır AS. Adli otopsi (in Turkish). Istanbul: Istanbul Universitesi Cerrahpasa Tip Fakultesi Yayinlari; 1999.
  • de la Grandmaison GL, Durigon M. Sudden adult death: a medico-legal series of 77 cases between 1995 and 2000. Med Sci Law. 2002;42(3):225-32.
  • Spooner PM, Priori SG, Myerburg RJ. Spotlight on sudden cardiac death. Cardiovasc Res. 2001;50(2): 173-6.
  • Chen K. The coroner’s necropsy: an epidemiological treasure trove. J Clin Pathol. 1996;49(9):698-9.
  • O’Sullivan JP. The coroner’s necropsy in sudden death: an under-used source of epidemiological information. J Clin Pathol. 1996;49(9):737-40.
  • Nemetz PN, Ludwig J, Kurland LT. Assessing the autopsy. Am J Pathol. 1987;128(2):362- 79.
  • Escoffery CT, Shirley SE. Autopsy rates at the University hospital of the West Indies, 1968- 1997. West Indian Med J. 2000;49(2):164-8.
  • Escoffery CT, Shirley SE. Causes of sudden natural death in Jamaica: a medicolegal (coroner’s) autopsy study from the University Hospital of the West Indies. Forensic Sci Int. 2002;129(2):116-21.
  • Cohle SD, Sampson BA. The negative autopsy: Sudden cardiac death or other? Cardiovasc Pathol. 2001;10(5):219-22.
  • Fragkouli K, Vougiouklakis T. Sudden cardiac death: an 11-year postmortem analysis in the region of Epirus, Greece. Pathol Res Pract. 2010;206(10):690-4.
  • Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol. 2001;10(5):211-8.
  • Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol. 2001;10(6):275-82.
  • Pinto Carvalho FL, Cordeiro JA, Cury PM. Clinical and pathological disagreement upon the cause of death in a teaching hospital: analysis of 100 autopsy cases in a prospective study. Pathol Int. 2008;58(9):568-71.
  • Roulson J, Benbow EW, Hasleton PS. Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology. 2005;47(6):551–9.
  • Davies MJ, Popple A. Sudden unexpected cardiac death—a practical approach to the forensic problem. Histopathology. 1979;3(4):255-77.
  • Michaud K, Romain N, Taroni F, Horisberger B, Mangin P. Evaluation of a simplified method of the conduction system analysis in 110 forensic cases. Forensic Sci Int. 2002;130(1):13-24.
  • Yayci N, Uzun I, Arslan M, Iris M. The Value of the autopsy in the case of postoperative deaths with suspicion of malpractice (in Turkish). Turkiye Klinikleri J Foren Med. 2004;1(2):57-61.
  • Tavora F, Crowder C, Kutys R, Burke A. Discrepancies in initial death certificate diagnoses in sudden unexpected out-of-hospital deaths: the role of cardiovascular autopsy. Cardiovasc Pathol. 2008;17(3):178-82.
  • Ramu M. A 3 year review of medicolegal autopsies performed at the Kingston Public Hospital, Jamaica (1973-1975). West Indian Med J. 1976;25(4):235-40.
  • Hirsch CS. Forensic pathology and the autopsy. Arch Pathol Lab Med. 1984;108(6):484-9.
  • Amakiri CNT, Akang EEU, Aghadiuno PU, Odesanmi WO. A prospective study of coroner’ autopsies in University College Hospital, Ibadan, Nigeria. Med Sci Law. 1997;37(1):69-75.
  • Salacin S. An analysis of the medicolegal autopsies performed in Adana, Turkey, in 1983- 1988. Am J Forensic Med Pathol. 1991;12(3):191-3.
  • Puranik R, Chow CK, Duflou JA, Kilborn MJ, McGuire MA. Sudden death in the young. Heart Rhythm. 2005;2(12):1277-82.
  • Di Maio VJ, Di Maio DJ. Natural death as viewed by the medical examiner: a review of 1000 consecutive autopsies of individuals dying of natural disease. J Forensic Sci. 1991;36(1):17- 24.
  • Murai T, Baba M, Ro A, Murai N, Matsuo Y, Takada A, Saito K. Sudden death due to cardiovascular disorders: a review of the studies on the medico-legal cases in Tokyo. Keio J Med. 2001;50(3):175-81.
  • Manfredini R, Portaluppi F, Grandi E, Fersini C, Gallerani M. Out-of-hospital sudden death referring to an emergency department. J Clin Epidemiol. 1996;49(8):865-8.
  • Loire R, Tabib A. Unexpected sudden cardiac death. An evaluation of 1000 autopsies. Arch Mal Coeur Vaiss. 1996;89(1):13-8.
  • Vanbrabant P, Dhondt E, Sabbe M. What do we know about patients dying in the emergency department? Resuscitation. 2004;60(2):163-70.
  • Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Hearth. 2006;92(3):316-20.
  • Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD, Thomas KL, Hayes DL, Al-Khatib SM. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011;15;57(7):794-801.
  • Orlandi A, Bochaton Piallat ML, Gabbiani G, Spagnoli LG. Aging, smooth muscle cells and vascular pathobiology: implications for atherosclerosis. Atherosclerosis. 2006;188(2):221-30.
  • Celbis O, Aydin NE, Mizrak B, Ozdemir B. Arrhythmogenic right ventricular dysplasia cases in forensic autopsies. Am J Forensic Med Pathol. 2007;28(3):235-7.
  • Celbis O, Aydin NE, Usta U, Selcuk MA. Hemoptysis due to pulmonary tuberculosis causing sudden death. JIUMF. 2004;11(4): 251-3.
  • Yilmaz R, Yuksekbas O, Erkol Z, Bulut ER, Arslan MN. Postmortem findings after anaphylactic reactions to drugs in Turkey. Am J Forensic Med Pathol. 2009;30(4):346-9.
  • Roschlau G. Drug-induced liver damage from the morphologic viewpoint [Article in German]. Gastroenterol J. 1990;50(1):6-11.
  • Hoek JB, Pastorino JG. Cellular signaling mechanisms in alcohol-induced liver damage. Semin Liver Dis. 2004;24(3):257-72.
  • Usta U, Mizrak B, Celbis O. Evaluation of the incidence of HBsAg and HBcAg expressions by immunohistochemically in adult forensic autopsy livers. Turkish Bulletin of Pathology. 2002;19(2):63-5.
  • Kunin CM. Does kidney infection cause renal failure? Annu Rev Med. 1985;36:165-76.
  • Cheung CM, Ponnusamy A, Anderton JG. Management of acute renal failure in the elderly patient: a clinician's guide. Drugs Aging. 2008;25(6):455-76.
  • Corrado D, Basso C, Thiene G. Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res. 2001;50(2):399-408.
  • Basso C, Carturan E, Pilichou K, Rizzo S, Corrado D, Thiene G. Sudden cardiac death with normal heart: molecular autopsy. Cardiovasc Patho. 2010;19(6):321-5.