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3.
Arch. prev. riesgos labor. (Ed. impr.) ; 23(3): 357-362, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194121

RESUMO

Navarra cuenta con el primer y más exhaustivo Registro de trabajadores expuestos laboralmente a amianto de España. Desde 1996 son remitidos por los Servicios de Prevención y pasan al Servicio Navarro de Salud_Osasunbidea para la vigilancia de patología neumológica relacionada, al jubilarse. Actualmente constan 2858 trabajadores, 395 mujeres y 2463 hombres. La práctica totalidad ya no ocupan puestos de riesgo. Durante años ha ayudado al reconocimiento de la contingencia profesional de los daños. Paradógicamente, en este caso, un trabajador fallecido por cáncer de pulmón con patología intersticial previa, un resultado negativo de necropsia, 425CF (cuerpos ferruginosos)/gr de tejido seco de pulmón se utilizó como argumento para rechazar el origen profesional. Es necesario considerar que un resultado positivo confirma exposición pasada pero uno negativo, si era crisotilo, no la descarta, dada la baja persistencia en tejidos. Una historia laboral detallada y, cuando existan, los Registros han de ser el principal argumento causal


Navarra has the first and most exhaustive Record of workers exposed to asbestos in Spain. Since 1996, referred by the Prevention Services and transferred to the Servicio Navarro de Salud_Osasunbidea for related pulmonary pathology surveillance upon retirement. There are currently 2,858 workers, 395 women and 2,463 men. Almost no longer occupy positions of risk. For years it has helped to recognize the professional contingency of damages.Paradoxically, in this case, a worker who died of lung cancer with previous interstitial pathology, a negative result of an autopsy, 425ferruginous bodies/gr dry lung tissue was used to deny the professional origin. It is necessary to consider that a positive result confirms past exposure but the negative one should not be evaluated when it was chrysotile, given the low temporal persistence in tissues. A reliable work history and, when they exist, the Records must be the main causal argument


Assuntos
Humanos , Masculino , Feminino , Asbestos/efeitos adversos , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/patologia , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/patologia , Autopsia
4.
Rev. esp. med. legal ; 46(3): 93-100, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192310

RESUMO

La medicina forense debe contemplar la posibilidad de que fallecidos por causas violentas o desconocidas puedan estar infectados por el virus SARS-CoV-2, o que el diagnóstico de la enfermedad tenga implicaciones legales, lo que exige un conocimiento adecuado de la epidemiología de la enfermedad, de las medidas de protección, de la toma de muestras y de las características anatomopatológicas. La práctica de autopsias en fallecidos por COVID-19 se ha visto limitada por las obligadas medidas preventivas frente al contagio y por la necesidad de disponer de instalaciones con nivel de protección frente a riesgos biológicos de nivel 3, de modo que las series publicadas hasta la fecha son escasas, y parciales, con abordajes limitados (autopsia mínimamente invasiva o biopsia con aguja gruesa). En este artículo se hace una revisión de los aspectos de la fisiopatología de la enfermedad que tienen repercusión en la infectividad de los tejidos y fluidos del cadáver, de las medidas de prevención del riesgo biológico, de la toma de muestras y de los hallazgos patológicos, tanto macroscópicos como microscópicos, asociados a la muerte provocada por la infección por el virus SARS-CoV-2


Forensic physicians should consider the possibility that people who have died from violent or unknown causes may be infected by the virus SARS-CoV-2, or that the diagnosis of the disease has legal implications, which requires adequate knowledge of the epidemiology of the disease, protective measures, adequate sampling and the pathological characteristics. The practice of autopsies on people who have died from COVID-19 has been limited by the mandatory preventive measures against contagion and by the need for facilities with a level of protection against level-3 biological risk, and therefore series published to date are scarce and partial,with limited approaches (minimally invasive autopsy or needle biopsy). This article reviews the aspects of the pathophysiology of the disease that have an impact on the infectivity of the body's tissues and fluids, measures for preventing biological risk, taking samples and pathological findings, both macroscopic and microscopic, associated with death caused by infection with the SARS-CoV-2 virus


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico , Autopsia/estatística & dados numéricos , Causas de Morte , Patologia Legal/métodos , Síndrome Respiratória Aguda Grave/diagnóstico , Vírus da SARS/isolamento & purificação , Infecções por Coronavirus/mortalidade , Pandemias/legislação & jurisprudência , Precauções Universais/legislação & jurisprudência
5.
Rev. esp. patol ; 53(3): 188-192, jul.-sept. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-192406

RESUMO

The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed changes typical of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy


El nuevo coronavirus SARS-CoV-2, identificado inicialmente en China en diciembre de 2019 puede cursar con un Síndrome Respiratorio Agudo Severo (SARS) con daño alveolar masivo y fracaso respiratorio progresivo. Presentamos los hallazgos más relevantes encontrados en la autopsia clínica efectuada en nuestro hospital (Hospital Arnau de Vilanova-Lliria de Valencia) a fecha de 14 de febrero de 2020, al primer paciente fallecido conocido en España por neumonía COVID-19. A nivel pulmonar, la autopsia revela cambios típicos de daño alveolar difuso (DAD) en fase exudativa y fase proliferativa. Se observan células multinucleadas gigantes, células tipo smudge intraalveolares y trombosis vasculares. El diagnóstico microbiológico confirmativo mediante PCR se realizó 15 días después de la autopsia sobre la muestra faríngea del enfermo tomada durante su ingreso


Assuntos
Humanos , Masculino , Idoso , Autopsia/métodos , Infecções por Coronavirus/mortalidade , Síndrome Respiratória Aguda Grave/mortalidade , Vírus da SARS/isolamento & purificação , Técnicas Histológicas/métodos , Alvéolos Pulmonares/patologia , Espanha/epidemiologia , Causas de Morte , Pandemias
6.
Rev. esp. patol ; 53(3): 182-187, jul.-sept. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-192407

RESUMO

We describe the implementation of a COVID-19 Autopsy Programme in our Hospital, report the main findings from the first autopsy of the programme and briefly review the reports of lung pathology of these patients


En este artículo presentamos el proceso de implementación de un Programa de Autopsias COVID-19 en nuestro hospital, presentamos los principales hallagos de la primera autopsia realizada y revisamos brevemente la patología pulmonar publicada previamente en estos pacientes


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Autopsia/estatística & dados numéricos , Causas de Morte , Infecções por Coronavirus/patologia , Alvéolos Pulmonares/patologia , Síndrome Respiratória Aguda Grave/complicações , Vírus da SARS/isolamento & purificação , Apneia Obstrutiva do Sono/complicações , Hipertensão/complicações , Reação em Cadeia da Polimerase/métodos , Esteroides/uso terapêutico , Pandemias , Técnicas Histológicas/métodos , Espanha/epidemiologia
8.
BMC Infect Dis ; 20(1): 708, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993546

RESUMO

BACKGROUND: Intravesical administration of Bacillus Calmette-Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy. CASE PRESENTATION: A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident. CONCLUSIONS: We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.


Assuntos
Antituberculosos/uso terapêutico , Vacina BCG/efeitos adversos , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Esteroides/uso terapêutico , Exacerbação dos Sintomas , Administração Intravesical , Idoso , Autopsia , Vacina BCG/administração & dosagem , Vacina BCG/uso terapêutico , Carcinoma in Situ/tratamento farmacológico , Carcinoma in Situ/prevenção & controle , Evolução Fatal , Humanos , Doenças Pulmonares Intersticiais/microbiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium bovis/genética , Resultados Negativos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/prevenção & controle , Pulsoterapia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/prevenção & controle
9.
J Forensic Leg Med ; 74: 102028, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32990601

RESUMO

COVID-19 has swamped the entire world and turned into a pandemic. Its high contagiousness compelled authorities to categorize all autopsies as 'high risk' considering the risk of exposure to the healthcare workers. In India, the Criminal Procedure Code authorizes investigating police officer to hold an inquest into suspicious deaths. The present article draw attention towards the 'needless autopsies' in times of COVID-19 and emphasizes on causes and recommendations.


Assuntos
Autopsia/normas , Infecções por Coronavirus/epidemiologia , Médicos Legistas/organização & administração , Pneumonia Viral/epidemiologia , Polícia/legislação & jurisprudência , Betacoronavirus , Médicos Legistas/legislação & jurisprudência , Médicos Legistas/normas , Humanos , Índia , Pandemias , Equipamento de Proteção Individual
11.
J Forensic Leg Med ; 74: 102028, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: covidwho-651346

RESUMO

COVID-19 has swamped the entire world and turned into a pandemic. Its high contagiousness compelled authorities to categorize all autopsies as 'high risk' considering the risk of exposure to the healthcare workers. In India, the Criminal Procedure Code authorizes investigating police officer to hold an inquest into suspicious deaths. The present article draw attention towards the 'needless autopsies' in times of COVID-19 and emphasizes on causes and recommendations.


Assuntos
Autopsia/normas , Infecções por Coronavirus/epidemiologia , Médicos Legistas/organização & administração , Pneumonia Viral/epidemiologia , Polícia/legislação & jurisprudência , Betacoronavirus , Médicos Legistas/legislação & jurisprudência , Médicos Legistas/normas , Humanos , Índia , Pandemias , Equipamento de Proteção Individual
13.
16.
Cardiovasc Pathol ; 49: 107263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32784110

RESUMO

Since its recognition in December 2019, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has rapidly spread globally causing a pandemic that represents the greatest medical challenge in decades. The aim of the study was to evaluate the spectrum of cardiopulmonary pathology of COVID-19 based on (non-minimal invasive) autopsies performed on 14 COVID-19 decedents. Bilateral diffuse alveolar damage (DAD) was found in all patients. Superimposed acute bronchopneumonia was present in 11 of 14 (78.6%) patients and was considered the major cause of death in 2 patients. A key finding was the presence of thrombotic/thromboembolic vascular occlusions. We classified 5 types of pulmonary thrombi: 1. capillary microthrombi (11/14, 78.6%); 2. partially organized thrombi in mid-sized pulmonary arteries with complete vessel occlusion; 3. non-organized thrombi in mid-sized pulmonary arteries that did not completely fill out the vessel lumen and probably represented thromboemboli rather than thrombosis; 4. bone marrow emboli (1/14, 7.1%); and 5. septic pulmonary thromboemboli (1/14, 7.1%). Pulmonary thrombi in mid-sized arteries were noted in 5 of 14 (35.7%) patients, causing pulmonary infarction and/or pulmonary hemorrhage. All patients had evidence of chronic cardiac disease, including myocardial hypertrophy (13/14, 92.9%), mild to marked coronary artery atherosclerosis (14/14, 100%) and focal myocardial fibrosis (3/14, 21.4%). Acute myocardial infarction was found as concurrent cause of death in 3 (21.4%) patients, and significant cardiac hypertrophy (heart weight 750 g) was present in 1 (7.1%) patient with ATTR-positive cardiac amyloidosis. The autopsy findings confirm that COVID-19 is a systemic disease, with major involvement of the lungs, that increases the risk of cardiac and vascular complications including acute myocardial injury and thrombotic/thromboembolic events. Secondary acute bronchopneumonia is a common complication in patients with COVID-19 and may be the major cause of death.


Assuntos
Broncopneumonia/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Artéria Pulmonar/patologia , Trombose/patologia , Idoso , Idoso de 80 Anos ou mais , Autopsia , Betacoronavirus , Broncopneumonia/virologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/patologia , Embolia Pulmonar/virologia , Trombose/virologia
17.
Tuberk Toraks ; 68(2): 160-167, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32755116

RESUMO

Novel coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) was first identified in December 2019 in Chinese town Wuhan and considered as a pandemic by World Health Organization. The disease has variety of symptoms including fever, shortness of breath, cough, fatigue, loss of smell and taste and diarrhea. While the majority of cases have mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm and mortality is mostly caused by hypoxemic respiratory failure. Until now, more than 3.5 million people worldwide were infected and more than 240.000 mortality has been occurred. Thus, there is now evidence the disease may affect variety of organs according to accumulating biopsy and autopsy studies. Such pathological studies have potential role on the understanding of clinical outcomes and in the development of novel targeted therapeutic approaches. Given these aforementioned data, in the current manuscript we have summarized the pathological features of COVID-19 derived from biopsy and autopsy series.


Assuntos
Betacoronavirus , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Síndrome Respiratória Aguda Grave/patologia , Autopsia , Biópsia , Humanos , Pandemias
18.
Ugeskr Laeger ; 182(28)2020 07 06.
Artigo em Dinamarquês | MEDLINE | ID: mdl-32734876

RESUMO

In this case report, a 53-year old man died after ten days with fever and coughing and was tested positive for coronavirus disease 2019 (COVID-19). A post-mortem CT disclosed ground-glass opacities with focal consolidation in both lungs. At autopsy, the lungs were dark and heavy with increased consistency and without pleural fibrin. Microscopy of lung tissue showed diffuse alveolar damage with hyaline membranes, sparse chronic interstitial inflammation and foci of bronchopneumonia. The deceased was a non-smoker, who did not suffer from a serious illness. He was overweight (BMI = 34 kg/m2), an emerging predictor for poor outcome of COVID-19.


Assuntos
Infecções por Coronavirus/patologia , Pulmão/patologia , Pneumonia Viral/patologia , Autopsia , Betacoronavirus , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Tomografia Computadorizada por Raios X
20.
Yonsei Med J ; 61(8): 731-735, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734738

RESUMO

Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a recently established neurodegenerative disease entity. LATE neuropathological change (LATE-NC) is characterized by a TDP-43 proteinopathy that mainly involves the amygdala and medial temporal structures, with or without hippocampal sclerosis. LATE-NC is typically observed in individuals aged 80 years or older and manifests clinically as amnestic memory decline. Herein, we report a case of LATE diagnosed by brain autopsy in an 82-year-old male who had an 11-year history of memory impairment. Pathological examination revealed high Alzheimer disease neuropathological changes, as well as amygdala-predominant Lewy body pathology. In addition, immunohistochemistry for TDP-43 revealed neuronal and glial cytoplasmic inclusions in the dentate gyrus of the hippocampus, amygdala, and inferior temporal cortex. Increasing awareness of the newly defined entity LATE will enhance our understanding of the neurodegenerative processes that occur in the oldest individuals.


Assuntos
Autopsia , Sistema Límbico/patologia , Proteinopatias TDP-43/patologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Comorbidade , Humanos , Masculino , Tomografia Computadorizada por Raios X
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