Changes in SARS-CoV-2 viral load and titers over time in SARS-CoV-2-infected human corpses.

High viral titers of infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected in human corpses long after death. However, little is known about the kinetics of infectious SARS-CoV-2 in corpses. In this case series study, we investigated the postmortem kinetics of infectious SARS-CoV-2 in human corpses by collecting nasopharyngeal swab samples at multiple time points from six SARS-CoV-2-infected patients after their death. SARS-CoV-2 RNA was detected by quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swab samples collected from all six deceased patients. A viral culture showed the presence of infectious virus in one deceased patient up to 12 days after death. Notably, this patient had a shorter time from symptom onset to death than the other patients, and autopsy samples showed pathological findings consistent with viral replication in the upper respiratory tract. Therefore, this patient died during the viral shedding phase, and the amount of infectious virus in the corpse did not decrease over time up to the date of autopsy (12 days after death). The findings of this study indicate that the persistence of SARS-CoV-2 in corpses can vary among individuals and may be associated with the stage of the disease at the time of death. These important results complement many previously reported findings on the infectivity of SARS-CoV-2 at postmortem.

COVID-19 Analysis in Tissue Samples Acquired by Minimally Invasive Autopsy in Out-of-Hospital Deaths with Postmortem Degeneration.

Minimally invasive autopsy (MIA) is an alternative to a full autopsy for the collection of tissue samples from patients' bodies using instruments such as a biopsy needle. MIA has been conducted in many cases of coronavirus disease 2019 (COVID-19) and has contributed to the elucidation of the disease pathogenesis. However, most cases analyzed are hospital deaths, and there are few reports on the application of MIA in out-of-hospital deaths with varying extents of post-mortem changes. In this study, MIA and autopsies were performed in 15 patients with COVID-19 2-30 days after death, including 11 out-of-hospital deaths. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome detection by reverse transcriptase quantitative polymerase chain reaction using MIA samples was mostly consistent with autopsy samples, particularly lung tissue, even in out-of-hospital cases. MIA had high sensitivity and specificity (> 0.80). Histological examination of lung tissue obtained by MIA showed characteristics of COVID-19 pneumonia, with 91% agreement with autopsy samples, whereas localization of SARS-CoV-2 protein in lung tissue was indicated by immunohistochemistry, with 75% agreement. In conclusion, these results suggest that MIA is applicable to out-of-hospital deaths due to COVID-19 with various postmortem changes, especially when autopsies are not available.

Detection of SARS-CoV-2 and Its Related Factors on the Mucosal Epithelium of the Tongue.

SARS-CoV-2 infects a variety of tissues, including the oral cavity. However, there are few reports examining the association of SARS-CoV-2 with tongue mucosal tissues with sticky tongue debris. This study investigated the presence of SARS-CoV-2 and its associated molecules by dissecting tongue tissue from autopsy specimens of 23 patients who died of COVID-19-related illness (pneumonia). Immunohistochemical staining, electron microscopy, and PCR analysis were performed on the tongue tissue specimens. The mucosal epithelium of the tongue formed a very thick keratinized with well-developed filiform papillae in all cases. ACE2 and TMPRSS2 were consistently co-expressed in all samples in the epithelium. The S-protein was strongly expressed in basal cells and the epithelial surface. S-protein-positive viral particles were detected in the tongue's stratified squamous epithelium via an immunoelectron microscope. Based on PCR amplification of the N1 and N2 regions, the SARS-CoV-2 gene was detected on the tongue epithelium, tongue submucosa, and in tongue debris. This suggests that tongue debris, including the squamous epithelial tissue, could be a source of SARS-CoV-2 in saliva. Furthermore, removing tongue debris may decrease the amount of SARS-CoV-2 in the oral cavity.

High titers of infectious SARS-CoV-2 in corpses of patients with COVID-19.

OBJECTIVES: The prolonged presence of infectious SARS-CoV-2 in deceased patients with COVID-19 has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses. The aim of this study was to assess the level of SARS-CoV-2 infectivity in the corpses of patients with COVID-19. METHODS: We collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation. RESULTS: Infectious virus was present in six of 11 (55%) cases, four of 11 (36%) nasopharyngeal swabs, and nine of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units/ml to 2.09E + 06 plaque-forming units/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days. CONCLUSION: The corpses of patients with COVID-19 may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.

Diabetic ketoacidosis after the second dose of SARS-CoV-2 mRNA vaccination in a patient with pembrolizumab-induced fulminant type 1 diabetes.

We report a case of 77-year-old woman with fulminant type 1 diabetes (T1D) who developed diabetic ketoacidosis (DKA) after the second dose of SARS-CoV-2 vaccine tozinameran. The patient had been diagnosed as having T1D associated with an immune-related adverse event caused by pembrolizumab at the age of 75. After the second dose of tozinameran, she developed DKA and needed intravenous insulin infusion and mechanical ventilation. Although the direct causal relationship between the vaccination and the DKA episode could not be proven in this case, published literatures had suggested the possibility of developing DKA after SARS-CoV-2 vaccination in patients with T1D. As the magnitude of the risk of the combination of the known adverse drug reactions of SARS-CoV-2 mRNA vaccine and T1D patients' vulnerability to sick-day conditions is not yet thoroughly assessed, future studies such as a non-interventional study with adequate sample size would be required to address this issue.

Effects of long- and short-term experiences on stress during identification works of dead bodies: Rapid stress level measurement using voice.

OBJECTIVE: The mental health issues of personnel dealing with the deceased at times of disasters is a problem and techniques are needed that allow for real-time, easy-to-use stress checks. We have studied techniques for measuring mental state using voice analysis which has the benefit of being non-invasive, easy-to-use, and can be performed in real-time. For this study, we used voice measurement to determine the stress experienced during body identification training workshops for dentists. We studied whether or not stress levels were affected by having previous experience with body identification either in actual disaster settings or during training. DESIGN: Since participants training using actual dead bodies in particular are expected to suffer higher stress exposure, we also assessed their mental state pre- and post-training using actual dead bodies. RESULTS: The results confirmed marked differences in the mental state between before and after training in participants without any actual experience, between participants who engaged in training using manikins before actual dead bodies and participants who did not. CONCLUSIONS: These results suggest that, in body identification training, the level of stress when coming into contact with dead bodies varies depending on participants' experience and the training sequence. Moreover, it is believed that voice-based stress assessment can be conducted in the limited time during training sessions and that it can be usefully implemented in actual disaster response settings.

Electrosynthesis of Layered Organo-Manganese Dioxide Framework-Doped with Cobalt for Iodide Sensing.

Aqueous Mn2+ ions were anodized at 70 °C with Co2+ in the presence of cationic surfactant, cetyltrimethylammonium (CTA). X-ray diffraction (XRD) analysis revealed that the deposited film possesses a layered structure of MnO2, the interlayer of which is occupied with the assembled CTA molecules. Inclusion of Co ions in the MnO2 film was evidenced by X-ray photoelectron spectroscopy (XPS). They were located in the MnO2 framework, not in the interlayer. The thus-obtained film, CTA-intercalated Co-framework-doped layered MnO2 (CTA/Co-MnO2), was applied as an electrochemical sensor toward iodide (I-), a hydrophobic anion. The organic phase between MnO2 layers could extract I- ions from solution, providing a better sensitivity than a film consisting of layered MnO2 with hydrated alkali metals. On the other hand, the Co-doped layers of MnO2 achieved faster electron transfer kinetics for the oxidation of I-, which resulted in a drastic reduction in response time compared to the nondoped CTA/MnO2.

Selective sorption of iodide onto organo-MnO2 film and its electrochemical desorption and detection.

This paper reports an electrochemically grown film consisting of layered MnO2 intercalated with hexadecylpyridinium cations (HDPy(+)), which can selectively sorb and detect iodide anions in aqueous solution amperometrically. Sorption of iodide by the HDPy/MnO2 film did not occur via ion exchange, but through hydrophobic interactions between the interlayer organic phase of the film and iodide ions in solution. The sorption rate increased with the deposited amount of MnO2. During the sorption process, the interlayer spaces expanded, and new diffraction peaks appeared that were attributed to the incorporated species. Anodic polarization of the iodide-sorbed HDPy/MnO2 film led to electron transfer from the incorporated iodide to the underlying substrate through the MnO2 sheets. The oxidized iodide was expelled from the film as molecular I2, while the expanded interlayer spaces were restored to their original state. Thus, the MnO2 layers and the incorporated HDPy can synergistically sorb/desorb iodide anions, resulting in a unique "self-cleaning" function that can operate electrochemically. This property allowed amperometric detection of iodide at a concentration as low as 0.0186 µM, which was below the detection limits reported for previous iodide sensors.

Effective appropriate use of dental remains and forensic DNA testing for personal identity confirmation.

Two severely burned human male bodies, possibly those of a parent and child, were recovered from the scene of a house fire and positive identification of the bodies was accomplished. This report describes the appropriate use of effective identification methods that made this possible. Identification of a body involves comparison of antemortem and postmortem X-ray films or dental records. In cases of poorly preserved dental remains, or in the absence of antemortem dental records, forensic DNA testing can be done. In the present case the male thought to be the son was identified from an antemortem panoramic X-ray film provided by the family dentist, which matched every significant detail in the body. On the other hand, forensic DNA testing of a sample obtained from the father's burned body was done in comparison with a swab obtained from his older brother, as the victim had no dental records for the 5 years before his death. This was able to confirm his identity. Thus positive identification was established through a combination of these methods. Although positive identification from dental records is rapid and certain, it requires antemortem dental records. If these are not available, forensic DNA testing should be attempted. In laboratories of forensic odontology, facilities for identity confirmation from both dental characteristics and forensic DNA testing should be made available.

Evaluation of myopathy risk for HMG-CoA reductase inhibitors by urethane infusion method.

Purpose of the present study was to evaluate the myopathy risk using a urethane infusion method following oral administration of five kinds of commercial HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors (HCRIs), (pravastatin (PV), simvastatin (SV), cerivastatin (CeV), atorvastatin (AV), and fluvastatin (FV)) alone or with coadministration of bezafibrate (BF). The solubility of HCRIs in various solvents was determined as a criterion of the physicochemical property. The plasma creatine phosphokinase (CPK) level as a marker of myopathy in normal rats was screened under urethane infusion after oral administration of HCRI alone or with BF coadministration. Also, renal tissue specimens were prepared and the myoglobin remaining in the tissue was visualized by the labeled avidin-biotin technique. The plasma CPK level in normal rats under urethane infusion following oral administration of five kinds of HCRI increased as the dose of HCRI increased, and coadministration of BF further increased the CPK level for each drug. The risk of myopathy evaluated from the CPK level was ranked as follows: CeV>FV>AV>SV>PV. Myoglobin deposition was observed in the cast of proximal tubules, cytoplasm of distal tubules and collecting ducts of rat kidney extracted from rats treated with HCRIs under urethane infusion. Histopathological findings showed that the extent of myoglobin deposition increased on coadministration of BF with each drug. The correlation was found for myopathy risk evaluated by CPK level using the urethane infusion method and drug lipophilicity, ie., the water/n-octanol partition coefficient except for the case of SV. Histopathological findings for the kidney following HCRI treatment also reflected the CPK level in rats under urethane infusion.