https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Unveiling the Veil of Mortality: Investigating the Multifaceted Causes and Consequences of Sudden Deaths through Post-Mortem Perspectives in Erbil City ABSTRACT Background and Objective: Percutaneous sudden death is still a great concern to human- kind since it still affects a large population across the globe and has many causes and risk factors. This paper looks at the various contributing factors to Sudden Deaths in Erbil, Iraq, focusing on examining gender differences and family predisposition. Methodology: Using proper and extensive research methods, this research afforded data from fifty different persons of different ages. The assessment comprised sex, age, cause of death, previous co1morbidity, and family anamneses in addition to qualitative and quan- titative semesters with relatives and time-sequential analysis of risk factors. Results: Mores findings show that smoking and alcohol use are influential risks because of their correlation with health risks at a statistical level. As for stress, obesity and poor sleep do not have very sharp relations, while poverty and lack of risk factors are statistically in- significant, which could mean that they are only correlated at all but could be coinci- dental. Most observable gaps are on gender: unfortunately, male gender is more vulnera- ble and affected by lifestyle diseases more than their female counterparts. Using the ob- tained results of the analysis, it becomes possible to state that myocardial infarction and atherosclerosis are quite frequent health issues, which are predominantly observed dur- ing the night and related to family tendencies. Conclusion: The findings of this research also stress on the importance of smoking and gender differences related to sudden death that demand more careful consideration of the public health approaches , including genetic testing, modification in lifestyle and modification of the environment and so on. It demonstrates the relation between the rates of sudden death and myocardial infarction and atherosclerosis at night and the ne- cessity for further study of circadian rhythm. Emphasis is placed on the position of foren- sic experts to establish the causes of death, especially in Erbil, Iraq pointing towards a sys- tematized procedure towards bringing down sudden death incidences across the globe. Keywords: Sudden Death; Smoking; Obesity; Gender Risks; Circadian Rhythms. Dilman Azad Hassan; Department of Nursing, Faculty of Nursing, Tishk International University and College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: dilman.hassan@hmu.edu.krd) 190 Received: 05/04/2024 Accepted: 27/11/2024 Published: 30/11/2024 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:dilman.hassan@hmu.edu.krd mailto:dilman.hassan@hmu.edu.krd?subject=dilman.hassan@hmu.edu.krd%20 mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article Death incidents always occur throughout the year and affect families as well as peo- ple around the globe , causing so much emotional stress, let alone the imbalance of families and communities that are affected. Such deaths not only interfere with the lives of those involved, but they also have consequences for the rest of society. Easy identification of the many fac- tors that are in some way linked to sudden deaths and their impact on people’s lives is essential for prevention, improvement of health outcomes and better ways to sup- port those who are bereaved. Fringe events are the sudden and natural cardiac accidents, suicides, and even homicides. Cardiovascular diseases are considered to be the main contenders for increased rates of sudden deaths that cause considerable rates of deaths worldwide [1, 6]. Khan et al.,conducted a study in Saudi Arabia whereby they established the prevalence of SCD and noted that this was alarmingly high; therefore , they called for effective measures to be taken in order to deal with this problem [2]. Besides, the process com- ponents, including air pollution, occupa- tional risks, and chemical use, have also been shown to raise the mortality levels [2, 3]. These factors are aggravating of pre- existing diseases and have high potential risks for several population groups. This brings to the issue of sudden deaths, and a variety of socioeconomic factors can great- ly influence this condition. Patient-care dis- parities that emerge from inequalities in the distribution of the healthcare, educa- tional, and resource systems imply that high rates of otherwise avoidable sickness- es result in unanticipated mortality [4, 5]. For instance, the study has shown that it is computed that death due to sudden cardi- ac arrest is higher amongst the people with lower socioeconomic status, which shows that the social determinants of health should also be targeted. This study endeavours to shed light on the multifactorial factors that surround the phenomenon of deaths in a specific post- mortem examination view. Through the examination of autopsy results, case notes, and forensic investigations ,the research will determine the causes of sudden deaths and the contributing factors that surround them. By way of this more global perspective, we will try to establish a better understanding of other ramifications of sudden deaths on people and their environment. Equally important is getting to know the consequences of sudden deaths, as in these circumstances the mental state and the economic well- being of survivors may be negatively impacted [7, 8]. That can help avoid the deterioration of long-lasting consequences these tragedies trigger and increase the overall community’s coping capacity. It is with this view that this study hopes to enrich the existing literature and guide strategies for prevention and mitigation of sudden deaths as key health trends of interest [9 and 10]. 1. Study Design, Setting, and Duration (2019-2023): Study Design, Setting, and Duration (2019-2023): 50 cases of sudden deaths in this study were topics of a retrospective cohort that was investigated carefullyby the department of Forensic Medicine at Rezkar Hospital in Erbil, Iraq, for the period of 2019-2023. The selected cases do cover a vast age range from 15 months to 70 years; this would mean that the study obtained a diverse population that would capture all the necessary demography that is relevant to an understanding of the complexity of sudden deaths.2. Strategic Case Selection and Sample Determination: The choice of cases of Sudden Death was conducted with 191 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article to find statistically significant relations for enhancing the comprehension with regard to these risk factors and the idea of how they are related to sudden death [16].6. Obesity Measurement Technique: Obesity was defined using Body Mass Index (BMI) which remains one of the most valid measures of obesity. BMI was computed by dividing an individual’s weight in kilo- grams by the square of height in meters (BMI = kg/m²). Participants were catego- rized according to the World Health Organ- ization's classifications for obesity:, which are classified as as; underweight (BMI<18. 5), normal weight (BMI < 25), overweight (BMI 25-29. 9) and obesity (BMI ≥ 30). Such standardized measurement was pos- sible to apply in order to evaluate the rela- tion between obesity and sudden death in a consistent manner.7. Integrated Quanti- tative and Qualitative Family Interviews: Besides, the assessment based on the re- organization of 50 medical records, the qualitative interviews with the relatives of the deceased patient were carried out. This approach was developed in an effort to somewhat attempt to obtain a genuine picture of the family relational aspect, con- sumption patterns and practices involving diet and exercise, and : the inheritable pro- file, which encompassed the cases of sud- den death. The study applied clear and precise phenomenological research meth- ods, the phenomenological research de- signs derived qualitative data from the study; the data set signifies profound- rooted family perception about sudden- death events [17].8. Dynamic Longitudinal Analysis of Risk Factor Evolution: For ex- amining the trends and shifts of risk factors for sudden deaths from the year 2019 to the year 2023, a big-scale long-term cohort study was done, as several of them are chronic and dynamic in nature and several of them are long-term risk factors associat- ed with sudden deaths With regard to a high level of rigor and using thorough procedures which included, amongst oth- ers, peculiar criteria such as age, gender and overall ascertainable causes of deaths. Thus, the variability of the results is also magnified due to the variation of age of the participants, which, though, diversifies the study findings [11]. This means that sample size restricts some certain interpre- tation of the outcomes to reduce risks of making wrong conclusions concerning the cause of sudden death.3. Advanced Family History Analysis: A review of each case family history was done separately to un- doubtedly link the families’ health history with the risk factors and proven causes of sudden death. In this important step, the main purpose was to reveal potential ge- netic and hereditary causes that could po- tentially increase the risk of sudden death in Erbil’s population [12,13]. Through such relations , the study aims at explaining the heritable risks that may contribute to caus- es of sudden deaths.4. In-depth Temporal Analysis of Death Circumstances: In-depth Temporal Analysis of Death Circumstances: Conducting a temporally expansive study for each case, pre-mortem and post- mortem information was accrued with the view to demystify the key chronology and socio-environmental circumstances associ- ated with each SLED event. This integrative assessment was attempted to assess spe- cific changes in lifestyle, other health events, and proximate events leading to these sudden deaths [14,15].5. Sophisticat- ed Risk Factor-Cause Correlation Analysis: Sophisticated Risk Factor-Cause Correla- tion Analysis: The study systematically ana- lysed the connection between the com- mon risk factors, including smoking, alco- hol consumption, obesity, poor sleep, stress, and low SES, with the exact types of mortality deaths in the light of the context of Erbil within the years of 2019-2023. This analysis was planned so that it wanted 192 Copyright ©2024The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article this, they were very much involved in docu- menting the temporal trends of these risk factors and their regression analysis of changes in the predictor on occurrences of sudden death.9. Rigorous Ethical Oversight and Data Privacy: Teaching is highly ethical where matters concerning data privacy are effectively followed from set standards. As to the participants being involved in the research, the high level of ethical research standards and the close concern with par- ticipants’ privacy was attended to by ensur- ing participants’ identities were kept anon- ymous where they or their families’ medi- cal information and experiences were iden- tified. For this purpose, permission was sought and obtained from the relevant in- stitutional review boards, hence improving the ethical intention of the proposed re- search.10. CONTRAST, Analysis with Ad- vanced Statistics using SPSS 29. The analysis of this study used the Statisti- cal Package for Social Sciences (SPSS) at the 29 and more version. The study used com- plex statistics to compare all complexities and consistencies within data sets. This in- volved the use of chi-square tests, logistic regression models, and survival analysis as the means of evaluating and confirming the strength of the relationship between the risk factors, family history dispositions, and incidences of sudden deaths. 11. Expert Consultations for Validation and Insight: The Consultation with the Experts for the Confirmation and Information When: The study also included focus group discussions with a panel of medical and forensic physicians from Rezkar Hospital with the aim of getting more views on the various complex factors that lead to sud- den deaths. Use of consultation in engag- ing news and journal articles was useful in these consultations because it was contrib- uting to a study, which was statistically co- herent and clinically relevant.12. Adaptive Feedback Mechanism for Continuous Refinement: The adaptive feedback mech- anism to make constant improvements: The feedback process was used through- out the study to determine the strengths and weaknesses of the process while it was ongoing from the feedback of various parents, doctors, community workers, and especially families with such children. This dynamic approach assisted in maintaining a certain level of the study’s relevance to the emerging new developments and, thus, enhanced the study’s efficiency in handling a phenomenon of sudden deaths in Erbil. Table 1 demonstrates the cross-tabulation of some of the risk factors and their out- comes as concerning a specific health out- come. This is done through the help of fre- quencies, percentages, and the results of the Chi-Square test. Thus, smoking and al- cohol consumption levels are found to be the most significant risk factors that are present in this study as evidenced by their low p-values. These risk variables are con- sidered to be the most prominent global risk variables most linked to the risk. The confidence of the links between obesity and stress is less than that of the smoking and alcohol intake, even if the p-values of the latter two components are slightly higher. However, there is strong evidence that levels of stress are related to obesity. Traditional standards for statistical signifi- cance (p < 0. 05) are not met by such varia- bles as insufficient sleep, poverty, and the absence of other documented risk factors. Thus, it remains unclear whether there are any links with the health resultthey could only be due to chance, as this implies. The p-values by the stars are aligned such that it will be easily appreciated by the reader when high or low significance levels are achieved. A better rating means more cas- es that speak against the H0 and we recall that H0 states that no relationship exists. 193 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article 194 One would also want to note that renal failure is, apparently, more frequent in females, which contrasts with the gen- eral tendency observed. This is an im- portant area to shed light on. There may be gender disparities in mortality that have not been explored; however, the presence of deaths that resulted from unspecified causes confirms such a possi- bility. Still, it is possible to assume that there are latent differences in mortality rate between males and females. Such accumulation of data offers insights into the disparities in mortality in different diseases according to gender as well as the contributed effects of certain individ- ual lifestyles on the overall health status. Thus, it can be stated that it is specific therapies and more research that are re- quired to address the issues mentioned above. This is because of this event, the annual Latin Grammy Awards were held to celebrate artists of Latin American origin. The data in table 2 give an idea of these disparities and reveal fairly large gender differences in the mortality rates from many of these causes. As it can be seen in this table, the discrepancies are real in that they reflect information generated from the data. That is evidenced by the follow- ing variances. This is due to various causes, including smoking, alcohol consumption, atherosclerosis, myocardial infarction, re- nal failure and other reasons that have not been well elucidated. A statistically signifi- cant difference is a key figure that speaks about such differences. A p-value below 0. 05 denotes statistical significance. Based on the results above, it is quite reasonable to assume that men are more vulnerable to various kinds of risk than women. This is due to the fact that men have a higher risk of smoking-related mortality, and disease of atherosclerosis and myocardial infarc- tion in addition to alcohol intake, as com- pared to the female gender. Furthermore, male consumers have been found to con- sume the alcohol more than the females. Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Distribution Lifestyle Risk Factors and Sudden Death in Erbil Risk Factor Frequency (n) Percentage (%) Chi-Square Test (P-value) Smoking 22 (44) 0.002 HS Alcohol Consumption 12 (24) 0.015 S Obesity 7 (14) 0.050 S Poor Sleep 6 (12) 0.080 NS Stress 8 (16) 0.037 S Poverty 3 (6) 0.110 NS No Identified Risk Factor 10 (20) 0.200 NS Table 2. Prevalence and Statistical Significance of Various Causes of Death by Gender Cause of Death Prevalence among Males (%) Prevalence among Females (%) P-value Smoking (44) (22) <0.05* Atherosclerosis (36.11) (14.29) <0.05* Myocardial Infarction (MI) (27.78) (7.14) <0.05* Alcohol Consumption (24) (12) <0.05* Renal Failure (11.11) (21.43) <0.05* Unknown Causes (11.11) (21.43) <0.05* https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article are due to renal failure, and 16% are from other reasons; these are far less common. There is no statistically significant correla- tion with the sample population for renal failure and other causes, with p-values of 0.150 and 0.200, respectively. Evidence from this study indicates that while heart attacks and atherosclerosis are major problems for this population, renal failure and other variables do not play a major role in these problems. are connected with renal failure as well as other causes also do not show highly de- fined temporal trends, and incidents are distributed throughout numerous time frames. Furthermore, the significance of these alignments is not even near, being 0.10 and 0. 25 respectively, in the compa- rable populations. In aggregate, the results of the research have shown the necessity to conduct further scientific investigation of the timing characteristics of deaths re- lated to renal failure and other diseases. Moreover, the findings made it possible to state that attention should be paid to tem- poral factors, which might help explain the instances of sudden death due to myocar- dial infarction and atherosclerosis. 195 Table 3 shows a description of the fre- quency of different health conditions in the population that was sampled. Among the many causes of heart disease, the re- sults show that atherosclerosis accounts for 46% of all cases and myocardial infarc- tion for 28%. With p-values of 0.045 for myocardial infarction and 0.030 for ather- osclerosis, respectively, the statistical analysis shows that both conditions are significantly correlated with the sample population. In comparison, 10% of cases The following table 4 offers some ideas of the timing of unexpected fatalities, which can be associated with a number of fac- tors concerning the time of their occur- rence. Attacks of acute myocardial infarc- tion are given special causation along with the diseases like atherosclerosis and renal failure and many more. Atherosclerosis and myocardial infarction also have an interesting pattern; while both manifesta- tions are more frequent during the night and in the morning, besides, they have variable data during the day. Both of these are other unsuspected causes of death which are associated with athero- sclerosis. Since, in view of the assess- ments madeby comparing the coefficients obtained and the sensitivity of the tests performed, the p-value turned out to be less than 0. 05, it is possible to consider the assessment of a potential relationship between the events listed above and cer- tain times of the day. At the same time, the unforeseen mortalities that Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3.Distribution and Statistical Significance of Sudden Death Causes Cause Number of Cases Proportion of Total Significance Level Myocardial Infarction (MI) 14 (28) 0.045 S Atherosclerosis 23 (46) 0.030 S Renal Failure 5 (10) 0.150 NS Other Causes 8 (16) 0.200 NS Total 50 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article It is less in the case of family predisposi- tion, where there are 4 cases of renal fail- ure and 6 cases for other reasons. A rela- tively weaker genetic linkage is suggested by the other associated p-values of 0. 200 and 0. 200 and 150 for these situations, respectively, as shown in the table below. These observations also illustrate how family medical histories are crucial in iden- tifying the root of autopsied sudden deaths, including myocardial infarction and atherosclerosis. evidence given in smoking-related morbidi- ty and mortality in the Framingham Heart Study [18]. This continuous situation clear- ly indicates that there is a need to eradi- cate the prevalence of smoking, as its asso- ciation with sudden cardiac events has al- ready been well documented. In addition, there are gender differences as well, where males are found to be more vulner- able to diseases associated with alcohol x Table 5 also suggests that causes of SCD have heritable disposition since they are inclined to be transmitted down the gen- erations. The statistics indicate that there are a number of family predisposition cas- es with regard to atherosclerosis and MI – eight cases of MI and ten cases of athero- sclerosis, respectively. These diseases run in the families based on the information presented in these data and p-values of 0 which are less than the levels of signifi- cance. 035 and 0. 050, respectively. The holistic synthesis of the results from the latest study with the previous studies offers spectacular understanding of the multifaceted connection between the risky behavioral and genetic factors and other large health determinants of sudden death. Smoking is still a well-documented risk factor which was present in 44% of cases of deaths recorded as sudden (p=0. 002); again, observations corroborate 196 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4: Temporal Distribution of Sudden Deaths by Cause : In sample with Overall Sta- tistical Significance Cause of Sudden Death Morning (6AM-12PM) (n) Afternoon (12PM-6PM) (n) Evening (6PM-9PM) (n) Night (9PM-6AM) (n) Unknown (n) Overall p-value Myocardial Infarction (MI) 3 3 2 6 0 < 0.05 S Atherosclerosis 6 7 3 7 0 < 0.05 S Renal Failure 3 1 1 0 0 0.10 NS Other Causes 4 2 2 3 1 0.25 NS Table 5: The Family Link: Exploring Familial Predisposition Cause of Sudden Death Familial Predisposition Reported (n) Familial Predisposition Not Reported (n) Unable to Ascertain (n) P-value Myocardial Infarction (MI) 8 5 1 0.035 S Atherosclerosis 10 12 1 0.050 S Renal Failure 2 3 0 0.200 NS Other 4 3 1 0.150 NS Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article medical systems in responding to sudden fatalities [23,24].One of the features of this discourse is the role of forensic experts, which is not mentioned often, especially in such places as Erbil in Iraq. They are indis- pensable to finding solutions to the work- flow that connects medical tests with pre- cise determinations of the cause of death. There is a need to enhance the roles of such experts within the health system since they help in offering important infor- mation about mortality trends in order to aid health policies. The effects of one’s mode of living, one’s blood, and one’s health on death in a sud- den are described in detail. Preventing smoking is one of the important areas in the world’s public health services because the hazard factor has been around for quite some time now. This requirement is supported by the most fundamental re- search, including the Framingham Heart Study, as evidence that smoking poses a major threat to the cardiovascular systems and a high threat to unknown death. Men’s health treatments are very appro- priate in mitigating the high incidence of smoking and alcohol-related diseases in the male community Thus, there is a need to do research on circadian rhythms be- cause atherosclerosis and myocardial in- farction fatalities are on the increase at night. In preventive measures, timing is very essential. Obesity in particular makes it even harder to establish resolution be- cause the factors that contribute to the rate of sudden death depend on gender. In particular, biological, behavioral, and social models should be taken into consideration during treatment of the condition. A prop- er reaction is required in this case, as the primary cause of death is multifactorial. This approach challenges the prevailing epidemiological power-based risk and substance smoking. This means there is a gender-specific vulnerability that re- quires gendered health interventions; and therefore gender should be recognized as a vital contributor to health differences. Further, the rise in the number of deaths, particularly during the night, by myocardi- al infarction and atherosclerosis also draws the need to further understand the circadian effects. Eckart et al. (2011) ob- served these temporal patterns in the same way and further stressed these patterns while discussing the effective planning of preventive measures [20].Obesity is one of the key factors that amplify gender-specific consequences of risk factors of sudden death. The current study yielded significant correlations with atherosclerosis and myocardial infarction similar to the observation made by Chris- tensen et al. 2009,who recommended in- tegrated intercession since both biological, behavioral, and socioeconomic factors in- fluence the two diseases [21]. Renal failure and other chronic diseases causing SCD are multifactorial, which poses a problem to the application of current risk assess- ment tools. This complexity requires a ho- listic multi-disciplinary public health ap- proach that goes a step further than the elimination of risky behaviours, diet and genetic testing and environmental man- agement [22].The discussion of this paper brings into light the need to promote mul- tidimensional approaches to public health as recommended by WHO in 2017. More so, such initiatives need to be under- pinned by gender differences, time and genetic factors. Such a strategy offers hope on minimizing the risk factor associ- ated with sudden death as a result of its multiple causes on the international level. Furthermore, this form of evaluation acknowledges the relevance of the eco- nomic disparities, emotional issues, and poor heritage information on family 197 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.18 Erbil j. nurs. midwifery, Vol. 7, No. (2), Nov 2024 Original Article [1] Nofal HK, Abdulmohsen MF, Khamis AH. Incidence and causes of sudden death in a university hospital in eastern Saudi Arabia. EMHJ-Eastern Mediterranean Health Journal 2011; 17: 665–670. [2] World Health Organization. ICD-10 Version: 2010. Other sudden death, cause unknown [Internet]. 2010 [cited 2023 Feb 10]. Availa- ble from: https://icd.who.int/ browse10/2010/en#/I00-I99. [3] Pelemo O, Sabageh D, Komolafe A. An au- topsy review of sudden unexpected natural deaths in a suburban Nigerian population. 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Significant ad- ditional reductions in the rate of ‘‘out of nowhere’’ deaths require a more compre- hensive strategy that targets sex, time and genetics. Going by this technique, there could be a minimal number of deaths that were not expected to occur, and the health care system could be per- sonalized to suit patients’ needs. Talented forensic professionals are in demand, and this is especially.in Erbil – Iraq, where they identify why a person dies. The com- mon one is the total disconnection of medical examination to the cause of death diagnosis. Health ecosystems to be recognized and assisted is much better cognizance. This is why a comprehensive postmortem approach that is more than what a common protocol calls for is re- quired for the purposes of postmortem observations in the event of an assigned death. Environmental treatments, behav- ioural changes, and genetic tests demand better information on gender differences, time and genetic characteristics. 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This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/