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2.
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
3.
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
4.
J Am Coll Cardiol ; 76(16): 1815-1826, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32860872

RESUMO

BACKGROUND: Thromboembolic disease is common in coronavirus disease-2019 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and postmortem findings. OBJECTIVES: The purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies. METHODS: This retrospective analysis examined the association of AC with mortality, intubation, and major bleeding. Subanalyses were also conducted on the association of therapeutic versus prophylactic AC initiated ≤48 h from admission. Thromboembolic disease was contextualized by premortem AC among consecutive autopsies. RESULTS: Among 4,389 patients, median age was 65 years with 44% women. Compared with no AC (n = 1,530; 34.9%), therapeutic AC (n = 900; 20.5%) and prophylactic AC (n = 1,959; 44.6%) were associated with lower in-hospital mortality (adjusted hazard ratio [aHR]: 0.53; 95% confidence interval [CI]: 0.45 to 0.62 and aHR: 0.50; 95% CI: 0.45 to 0.57, respectively), and intubation (aHR: 0.69; 95% CI: 0.51 to 0.94 and aHR: 0.72; 95% CI: 0.58 to 0.89, respectively). When initiated ≤48 h from admission, there was no statistically significant difference between therapeutic (n = 766) versus prophylactic AC (n = 1,860) (aHR: 0.86; 95% CI: 0.73 to 1.02; p = 0.08). Overall, 89 patients (2%) had major bleeding adjudicated by clinician review, with 27 of 900 (3.0%) on therapeutic, 33 of 1,959 (1.7%) on prophylactic, and 29 of 1,530 (1.9%) on no AC. Of 26 autopsies, 11 (42%) had thromboembolic disease not clinically suspected and 3 of 11 (27%) were on therapeutic AC. CONCLUSIONS: AC was associated with lower mortality and intubation among hospitalized COVID-19 patients. Compared with prophylactic AC, therapeutic AC was associated with lower mortality, although not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may inform trials to determine optimal AC regimens.


Assuntos
Anticoagulantes , Autopsia/estatística & dados numéricos , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral , Profilaxia Pós-Exposição , Tromboembolia , Idoso , Anticoagulantes/classificação , Anticoagulantes/uso terapêutico , Betacoronavirus/isolamento & purificação , Coagulação Sanguínea , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Mortalidade Hospitalar , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Profilaxia Pós-Exposição/métodos , Profilaxia Pós-Exposição/estatística & dados numéricos , Risco Ajustado/métodos , Tromboembolia/tratamento farmacológico , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle , Tromboembolia/virologia
6.
Hamostaseologie ; 40(3): 264-269, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32498097

RESUMO

The novel coronavirus, SARS-CoV-2, is causing a global pandemic of life-threatening multiorgan disease, called COVID-19. Accumulating evidence indicates that patients with COVID-19 are at significant risk of thromboembolic complications, mainly affecting the venous, but also the arterial vascular system. While the risk of venous thromboembolism (VTE) appears to be higher in patients requiring intensive care unit support compared to those admitted to general wards, recent autopsy findings and data on the timing of VTE diagnosis relative to hospitalization clearly suggest that thromboembolic events also contribute to morbidity and mortality in the ambulatory setting. In addition to a severe hypercoagulable state caused by systemic inflammation and viral endotheliitis, some patients with advanced COVID-19 may develop a coagulopathy, which meets established laboratory criteria for disseminated intravascular coagulation, but is not typically associated with relevant bleeding. Similar to other medical societies, the Society of Thrombosis and Haemostasis Research has issued empirical recommendations on initiation, dosing, and duration of pharmacological VTE prophylaxis in COVID-19 patients.


Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Autopsia/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Transtornos da Coagulação Sanguínea/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/fisiopatologia , Heparina de Baixo Peso Molecular/uso terapêutico , Hospitalização , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Sobreviventes/estatística & dados numéricos , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Trombofilia/etiologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/mortalidade
7.
Forensic Sci Int ; 313: 110365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32563134

RESUMO

In order to reduce transmission of COVID-19, social distancing measures were proposed, including spatial distancing (2m distance), or even generalized lockdown. Main concern was to prevent overwhelming of the healthcare systems, mainly of the intensive care units (ICUs) by decreasing the spreading of the disease. In Greece, the Government, after consulting with experts in the fields of infectious disease and epidemiology, implemented a rather aggressive stance with an early lockdown. Aim of our study, is to identify and compare the characteristics of cases referred for autopsy during the first month of the lockdown period for the COVID-19 outbreak, versus the cases referred during the same period in 2019. 231 autopsy cases were included in our study, 125 in 2019 and 106 in 2020. Regarding gender, age and nationality, no significant differences were detected between the two time periods. Age subgroup analysis demonstrated increased number of cases within the age group 70-79 years, in 2020. As to the place of death, the increase in the percentage of out-of-hospital deaths was not confirmed as statistically significant. Regarding type of death (violent, sudden/unexpected), the drop of violent deaths in the 2020 examined period, was not confirmed as statistically significant; however, further subgroup analysis showed a significant drop of fatal injuries resulting from road traffic accidents in the 2020 period. The slight increase of sudden/unexpected deaths, especially myocardial infarction cases, did not reach statistical significance. One month after lockdown, we cannot detect significant differences in the two time periods examined. Further study should be conducted soon when more data will become available. Frequency of fatal myocardial infarction seems to remain unaffected by the COVID-19 pandemic while deaths resulting from road traffic accidents exhibit a significant decrease. Homicides and suicides remain at low levels, in our jurisdiction area, seemingly unaffected by the COVID-19 outbreak and the subsequent lockdown. It appears that since sudden/unexpected deaths, statistically remain unaffected, the preventive measures taken by the Greek authorities prevented overwhelming of the healthcare system, which could function properly.


Assuntos
Autopsia/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Mortalidade/tendências , Pandemias/estatística & dados numéricos , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Adulto , Fatores Etários , Idoso , Causas de Morte , Medicina Legal , Grécia/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
8.
Medicine (Baltimore) ; 99(19): e20130, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384493

RESUMO

To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ±â€Š8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.


Assuntos
Autopsia/métodos , Autopsia/estatística & dados numéricos , Causas de Morte , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Pré-Escolar , Feminino , Cardiopatias/diagnóstico , Mortalidade Hospitalar , Humanos , Lactente , Japão , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/mortalidade , Sensibilidade e Especificidade , Centros de Atenção Terciária
10.
Niger Postgrad Med J ; 27(2): 83-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32295937

RESUMO

Objectives: Diabetes mellitus (DM) is a global health problem with associated high morbidity and mortality. This study was a retrospective review of post-mortem examination findings of hospitalised patients with DM for causes of death. Materials and Methods: A retrospective, cross-sectional autopsy review of all the patients with DM in our hospital between January 2008 and December 2017 was conducted. The causes of death were classified into cardiovascular, cerebrovascular, acute diabetic emergencies, infection, cancers and unnatural deaths. The demographic data and clinicopathological parameters were extracted, and the data were analysed using the SPSS software version 23. Results: A total of 1092 cases of autopsy were done within the study period, of which 91 cases were on patients with diabetes accounting for 8.3%. Infections with sepsis were the major cause of death, accounting for 51.6% followed by cardiovascular diseases (16.5%), cancers (14.3%), acute diabetic emergencies (6.6%) and cerebrovascular accidents (6.6%), with renal complications and road traffic accidents accounting for 2.2% each. Patients' age ranged from 31 to 84 years, with a modal age of 57 years. There was a male predominance with a male-to-female ratio of 1.5:1. Systemic hypertension co-morbidity was statistically significantly more common in patients aged 60 and above (P = 0.035). The most common lesion observed in the kidneys was benign nephrosclerosis (43.2%). Conclusions: This study suggests that majority of our patients with diabetes mellitus die from infections with attendant sepsis. Older patients appear to have co-morbid systemic hypertension. Patient education on infection prevention and prompt treatment might be life-saving.


Assuntos
Autopsia/estatística & dados numéricos , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Hipertensão/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Causas de Morte , Transtornos Cerebrovasculares/mortalidade , Comorbidade , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Masculino , Doenças Metabólicas/mortalidade , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças Respiratórias/mortalidade , Estudos Retrospectivos , Sepse/epidemiologia , Caracteres Sexuais , Distribuição por Sexo , Centros de Atenção Terciária
11.
J Forensic Leg Med ; 70: 101915, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32090970

RESUMO

INTRODUCTION: Custody-related death is an internationally key sensitive issue with respect to Human Rights. The causes of death and associated factors in this vulnerable population vary according to country and region. The present study attempted to analyze the different causes of custody-related deaths and associated factors and identify the areas of intervention for prevention of such deaths. MATERIAL AND METHODS: This retrospective study was conducted using files of custody-related deaths in the Department of Forensic Medicine of Shri V. N. Government Medical College, Yavatmal, Maharashtra State (India). A total of 108 cases were autopsied by the Department during the period of 2000-2018. We used a pre-formed proforma to extract data from files of these cases; the data obtained tabulated and coded in to charts, following which they were analyzed in detail. RESULTS: Male preponderance (105) was observed, with there only being 3 female cases (Male: Female ratio 1:0.028). The most common age group among deaths in police custody/action was 31-40 years whereas; age group of 41-50 years was most common among prisoners. A majority of deaths occurred due to natural causes (69.44%); among these, 89.33% were prisoners, with cardiac causes being the most common. Many individuals died due to cardiac causes were brought dead at tertiary care hospital. Suicides were a common cause of unnatural deaths among individuals in police custody/action. The majority of victims committed suicide in police custody did so by hanging. All cases of suicide by insecticide poisoning were observed in police action, and hanging was the only cause of suicide in prison. Blunt force injuries were frequent cause of homicide in police custody, which were result of force used by police during interrogation. CONCLUSION: Lack of knowledge regarding the causes of death and careless attitude towards the suicidal behavior and, the health and welfare of detainees are avoidable reasons for custody-related deaths.


Assuntos
Homicídio/estatística & dados numéricos , Aplicação da Lei , Prisioneiros/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Idoso , Autopsia/estatística & dados numéricos , Causas de Morte , Doença da Artéria Coronariana/mortalidade , Feminino , Medicina Legal , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Pulmonar/mortalidade
13.
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 74-82, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1089366

RESUMO

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.


Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Orelha Média/anatomia & histologia , Endoscopia/métodos , Variação Anatômica/fisiologia , Autopsia/estatística & dados numéricos , Estapédio/diagnóstico por imagem , Membrana Timpânica/anatomia & histologia , Distribuição por Sexo , Colesteatoma da Orelha Média/patologia , Dissecação/estatística & dados numéricos , Orelha Externa/anatomia & histologia
14.
Ann Pathol ; 40(1): 2-11, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31928795

RESUMO

INTRODUCTION: The profession of pathologist exposes to various risks, notably infectious, physical and chemical. The objective of this study was to make an inventory of these occupational risks to which pathologists are subjected and to evaluate the pathologies that they presented. A particular attention was given to microscopic and screen work as they can induce musculoskeletal or ophthalmic disorders, and stress-related psychological disorders. METHOD: An anonymous online questionnaire containing 54 questions had been sent by mail to pathologists via the French Society of Pathology and the Syndicate of French Pathologists. RESULTS: Five hundred and twelve pathologists responded to the survey. Thirty-eight percent reported musculoskeletal disorders in the last 6 months. Visual disturbances concerned 73.4% of respondents. In the last 12 months, 33.3% of pathologists had been injured or had had mucosal projections during macroscopic or autopsy specimens. The frequency of infectious diseases was low (6.2%) as well as that of cancers (3.9%). Psychological disorders such as depression or burnout were reported by 16.7% of respondents. Pathologists seemed happy at work and had a good overall lifestyle. Few doctors had medical follow-up and few had benefited from ergonomic advice and training on the risks of chemicals. CONCLUSION: The results of this study showed the interest of a medical surveillance adapted to the pathologies presented by the pathologists. Educational and preventive measures should be introduced early in the career, focusing on ergonomics and learning about chemical and biological hazards.


Assuntos
Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Patologistas/estatística & dados numéricos , Acidentes de Trabalho/estatística & dados numéricos , Adulto , Idoso , Autopsia/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Depressão/epidemiologia , Ergonomia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Infecções/epidemiologia , Satisfação no Emprego , Estilo de Vida , Masculino , Microscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Neoplasias/epidemiologia , Doenças Profissionais/prevenção & controle , Exposição Ocupacional/efeitos adversos , Equipamento de Proteção Individual/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Transtornos da Visão/epidemiologia , Local de Trabalho/organização & administração , Local de Trabalho/normas , Adulto Jovem
15.
N Z Med J ; 133(1508): 65-71, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945043

RESUMO

AIM: Sudden unexpected death in epilepsy (SUDEP) is well recognised and widely reported but remains poorly understood. SUDEP in young adults is 27 times more common than sudden death in control populations. The incidence of SUDEP in New Zealand is not known but up to 40 people with epilepsy may die from SUDEP every year. A review of coroner's reports of SUDEP was undertaken to learn more about SUDEP in New Zealand. METHOD: Coroner's reports of all cases of possible SUDEP in New Zealand from 2007-2016 (n=190) were obtained and post-mortem and toxicology results were reviewed. Cases were categorised using published criteria. RESULTS: We obtained reports of 190 cases from the coroner's office. Of these 190 cases, we determined that 123 were definite SUDEP, 40 were definite SUDEP plus, three were probable SUDEP, seven were possible SUDEP and 17 were probably not SUDEP. The number of cases per year varied from 11-26 (2013). Cases were aged 1.5-67 years, with 63% aged 15-45 (mean 37 years). Sixty-one percent were male. Eighty-seven percent of the deaths occurred at home, with 74% found dead in their bed or bedroom. The majority were not employed, with only 33% working or retired at the time of death; 15% were children or students. Information regarding work status was not available for 11%. Toxicology results were available for 155 cases; antiepileptic drug (AED) use was detected in 67% of these cases, with a single AED detected in 44%, two AEDs in 21%, and three AEDs in 3% of samples taken at autopsy. Approximately half who took an AED were taking either sodium valproate or carbamazepine. CONCLUSION: This study suggests that people with epilepsy who die from SUDEP in New Zealand are young and are often compliant with their medication. We plan to establish a nationwide SUDEP registry using the EpiNet database to determine the incidence of SUDEP in New Zealand, and to track changes in SUDEP rates. We are also planning to take part in an international case-control study of SUDEP in the hope that we might learn more about risk factors that predispose people with epilepsy to SUDEP, and factors that might reduce the risk.


Assuntos
Morte Súbita/epidemiologia , Epilepsia/mortalidade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Autopsia/estatística & dados numéricos , Causas de Morte/tendências , Criança , Pré-Escolar , Médicos Legistas/estatística & dados numéricos , Epilepsia/tratamento farmacológico , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 532-537, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969458

RESUMO

OBJECTIVE: To identify factors associated with the offer of and consent to perinatal post-mortem. DESIGN: National population-based cohort study SETTING: The UK. POPULATION: 26 578 perinatal deaths born between 1 January 2013 and 31 December 2017. MAIN OUTCOME MEASURES: Postmortem offer by clinical staff; parental consent to post-mortem. RESULTS: Postmortem offer rates were high but varied significantly with time of death from 97.8% for antepartum deaths to 88.4% for neonatal deaths following neonatal admission. Offer rates did not significantly vary by gestation, year of birth, mother's socioeconomic deprivation, ethnicity or age. Only 44.5% of parents consented to a postmortem. Mothers from the most deprived areas were less likely to consent than those from the least deprived areas (relative risk (RR)=0.76, 95% CI 0.71 to 0.80). Consent rates were similar for mothers of white, mixed, Asian Indian, black Caribbean and black African ethnicity (43%-47%), but significantly lower for mothers of Asian Pakistani (20%) and Asian Bangladeshi (18%) ethnicity. Consent increased with increasing gestation (p<0.001) and was lower for deaths following neonatal unit admission than for antepartum death (RR 0.71, 95% CI 0.67 to 0.75). CONCLUSIONS: The current profile of cause of perinatal deaths in the UK is likely to be biased with less postmortem information available for babies dying in the neonatal period and those born to mothers from deprived areas and of Asian Pakistani or Asian Bangladeshi ethnicity. Such bias severely limits the design of effective strategies for reducing mortality in these high-risk groups. These findings have implications for high-income countries seeking to explore and improve the understanding of perinatal deaths.


Assuntos
Autopsia/estatística & dados numéricos , Mães/estatística & dados numéricos , Consentimento dos Pais/estatística & dados numéricos , Morte Perinatal , Natimorto , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
17.
Scand J Public Health ; 48(5): 486-490, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30632904

RESUMO

A clinical as well as forensic autopsy is a uniform medical investigation of the deceased, which mainly serves to verify the plausibility of information on the cause, mode and mechanism of death provided by the police and/or medical personnel. Despite its importance in the context of a conclusive assessment of a person's medical history and in detecting any criminal correlation or malpractice, a significant decline in autopsies is evident in Iceland. This article gives an overview on autopsy rates in Iceland and compares the situation with European countries.


Assuntos
Autopsia/estatística & dados numéricos , Humanos , Islândia
18.
Arch Pathol Lab Med ; 144(5): 644-649, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31365286

RESUMO

CONTEXT.­: Grant Medical College and Sir J. J. Hospital, Mumbai (India), have a long tradition of clinical autopsies, wherein autopsy records have existed since 1884. The old autopsy records from 1884 to 1966 were discovered during a refurbishing drive of the pathology department in 2007. OBJECTIVE.­: To know the relative causes of deaths in Sir J. J. Hospital Mumbai from 1884 through 1966. To determine the rate of antemortem and postmortem discrepancies in the prehistology and posthistology era. DESIGN.­: The reports of clinical autopsies in the archives of the Department of Pathology from January 1884 to December 1966 were reviewed. Data such as sex, age, and clinical and autopsy diagnoses were collected, based on the autopsy records of 13 024 patients. RESULTS.­: Of 13 024 patients, 10 197 (78%) were male and 2827 (22%) were female. Most deaths (55%) involved individuals ages 21 to 40 years. Infections were the cause of death in 7281 of 13 024 patients (56%), followed by cardiovascular diseases in 2138 (16%) and neoplasms in 963 (7%). The overall disagreement between clinical diagnoses and postmortem findings was 4105 of 13 024 patients (31%). Discrepancy between antemortem and postmortem diagnoses in the prehistology era (before 1950) was found in 3053 of 8951 patients (34%), whereas in the posthistology era (after 1950), discrepancy was found in 1019 of 4073 patients (25%). CONCLUSIONS.­: Historical collections provide baseline data against which modern observations can be compared. Such collections also offer a window on the past and often provide a less biased account of events. Historical collections of museum materials such as ours are valuable because they can serve as potential biorepository materials to facilitate future research. Apart from providing reliable data on the occurrence of diseases, the autopsy has an important role in providing information about conditions that are no longer prevalent. Medical institutes possessing old autopsy records, wet specimens, paraffin blocks, and slides should preserve such historical collections.


Assuntos
Autopsia/estatística & dados numéricos , Causas de Morte , Adulto , Feminino , Hospitais , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Braz J Otorhinolaryngol ; 86(1): 74-82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30472004

RESUMO

INTRODUCTION: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. OBJECTIVE: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. METHODS: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. RESULTS: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. CONCLUSION: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.


Assuntos
Variação Anatômica/fisiologia , Orelha Média/anatomia & histologia , Endoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia/estatística & dados numéricos , Colesteatoma da Orelha Média/patologia , Dissecação/estatística & dados numéricos , Orelha Externa/anatomia & histologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Estapédio/diagnóstico por imagem , Membrana Timpânica/anatomia & histologia , Adulto Jovem
20.
Rev. esp. med. legal ; 46: 0-0, 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194392

RESUMO

El nuevo coronavirus SARS-CoV-2 ha causado miles de muertes alrededor del mundo. La mayoría de los fallecimientos ocurren en instalaciones sanitarias; sin embargo, un número indeterminado de enfermos fallecen de manera súbita, inesperada o repentina en diversos lugares y representan casos de interés médico legal. Compartimos los hallazgos del estudio microscópico de muestras de pulmón de un caso de muerte inesperada de un paciente positivo por COVID-19 que permanecía en aislamiento domiciliario. Nuestras observaciones corroboran la endotelialitis, trombosis y angiogénesis como distintivos de la patología pulmonar de esta nueva enfermedad, hallazgos con implicaciones clínicas y terapéuticas


The new SARS-CoV-2 coronavirus has caused thousands of deaths around the world. Most deaths occur in healthcare facilities. However, an undetermined number of patients die suddenly, unexpectedly in a variety of places and are cases of medical legal interest. We share the findings of the microscopic study of lung samples from a COVID-19 positive patient who died unexpectedly at home in quarantine. Our observations confirm endothelialitis, thrombosis and angiogenesis as microscopic hallmarks of the lung pathology of this new disease. These findings have clinical and therapeutic implications


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Coronavirus/complicações , Síndrome Respiratória Aguda Grave/patologia , Vírus da SARS/patogenicidade , Endotélio Vascular/patologia , Trombose/patologia , Neovascularização Patológica/patologia , Patologia Legal/métodos , Evolução Fatal , Pulmão/patologia , Autopsia/estatística & dados numéricos , Reação em Cadeia da Polimerase/métodos , Histocitoquímica/métodos
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