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1.
BMC Public Health ; 20(1): 473, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32272924

RESUMO

BACKGROUND: Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., Brough in Dead), and in most BiD cases, the CoD have not been fully analyzed. Therefore, this study was designed to evaluate the function of automated VA based on the Tariff Method 2.0 to identify the CoD among the BiD cases and the usefulness by comparing the data on the death notification form. METHODS: The target site was one third-level hospital in the Republic of Zambia's capital city. All BiD cases who reached the target health facility from January to August 2017 were included. The deceased's closest relatives were interviewed using a structured VA questionnaire and the data were analyzed using the SmartVA to determine the CoD at the individual and population level. The CoD were compared with description on the death notification forms by using t-test and Cohen's kappa coefficient. RESULTS: One thousand three hundred seventy-eight and 209 cases were included for persons aged 13 years and older (Adult) and those aged 1 month to 13 years old (Child), respectively. The top CoD for Adults were infectious diseases followed by non-communicable diseases and that for Child were infectious diseases, followed by accidents. The proportion of cases with a determined CoD was significantly higher when using the SmartVA (75% for Adult and 67% for Child) than the death notification form (61%). A proportion (42.7% for Adult and 46% for Child) of the CoD-determined cases matched in both sources, with a low concordance rate for Adult (kappa coefficient = 0.1385) and a good for Child(kappa coefficient = 0.635). CONCLUSIONS: The CoD of the BiD cases were successfully analyzed using the SmartVA for the first time in Zambia. While there many erroneous descriptions on the death notification form, the SmartVA could determine the CoD among more BiD cases. Since the information on the death notification form is reflected in the national vital statistics, more accurate and complete CoD data are required. In order to strengthen the death registration system with accurate CoD, it will be useful to embed the SmartVA in Zambia's health information system.


Assuntos
Causas de Morte , Adolescente , Adulto , Autopsia/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Adulto Jovem , Zâmbia/epidemiologia
2.
Int. j. morphol ; 38(2): 241-246, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1056429

RESUMO

El intervalo postmortem (IPM) es un importante desafío a resolver en patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiablidad de algunos métodos por la gran influencia de factores externos, la Histoquímica (HQ) y la Inmunohistoquímica (IHQ), entre otros, han recibido considerable atención por sus niveles de objetividad en la investigación forense. Se presenta una revisión con búsqueda sistemática de estudios experimentales que apliquen métodos HQs e IHQs para la estimación del IPM sobre material cadavérico humano. Se identificaron 1053 artículos de los cuales 12 cumplieron con los criterios, a los que se agregaron 4 mediante una búsqueda manual (n=16 artículos). Alemania fue el país con más publicaciones destacando con 8 artículos. Las técnicas HQs de AgNORs, TRAP y PAS fueron utilizadas en 5 estudios (glándulas sudoríparas, piel, hígado, médula ósea y mucosa labial), mientras que las IHQs fueron empleadas con diferentes grupos antigénicos en 12 estudios (páncreas, cerebro, pulmón, tiroides, hígado, glándulas pituitarias, glándulas sudoríparas y mucosa gingival). Las estimaciones del IPM fueron posibles con márgenes entre 2-3 h. hasta los 20 días dependiendo de la técnica. El análisis de tejidos provenientes de cavidad oral asegura una vía no invasiva, de fácil acceso y bajo resguardo natural a la influencia de factores ambientales. Si bien no existe un método único que permita de manera confiable estas estimaciones, la introducción de nuevas técnicas permitiría evitar la producción de errores.


The postmortem interval (IPM) is an important challenge to be solved in forensic pathology, and it consists in determine the time elapsed since death until the autopsy. Given the low reliability of some methods due to the great influence of external factors, Histochemistry (HQ) and Immunohistochemistry (IHQ), among others, have received considerable attention for their levels of objectivity in forensic investigation. A scoping review of experimental studies that apply HQs and IHQs methods to estimate the MPI on human cadaveric material is presented. We identified 1053 articles, of which 12 met the criteria; we added 4 articles through a manual search (n = 16 articles). Germany was the most productive country, with 8 articles. HQ techniques of AgNORs, TRAP and PAS were used in 5 studies (on sweat glands, skin, liver, bone marrow and labial mucosa), while IHQs techniques were used with different antigenic groups in 12 studies (on pancreas, brain, lung, thyroid, liver, pituitary glands, sweat glands and gingival mucosa). IPM estimates were possible with margins between 2-3 hours up to 20 days depending on the technique. The analysis of oral tissues ensures a non-invasive route, easily accessible and under natural protection to the influence of environmental factors. Although there is no single method that reliably allows these estimates, the introduction of new techniques would prevent the production of errors.


Assuntos
Humanos , Mudanças Depois da Morte , Autopsia/métodos , Imuno-Histoquímica/métodos , Fatores de Tempo , Cadáver , Medicina Legal
3.
Zhonghua Bing Li Xue Za Zhi ; 49(5): 406-410, 2020 May 08.
Artigo em Chinês | MEDLINE | ID: mdl-32153166

RESUMO

COVID-19 has been included in Category B infectious diseases and is prevented and controlled according to Category A infectious diseases. In order to establish a diagnosis or conduct further research, a post-mortem examination may be desired on a possible COVID-19 death. To guide the personnel engaged in the autopsy to carry out the correct operation, and ensure the safety of the pathologists and disease control staffs during the epidemic, the Chinese Pathological Society, the Chinese Pathologist Association and the Pathology and Pathophysiology national key discipline at Shantou University Medical College, formulated this guidance for the autopsy for deaths associated with COVID-19 during the prevention and control period of COVID-19 in China.


Assuntos
Autopsia , Infecções por Coronavirus , Controle de Infecções , Pandemias , Pneumonia Viral , Autopsia/métodos , Autopsia/normas , Betacoronavirus , China , Infecções por Coronavirus/epidemiologia , Humanos , Controle de Infecções/métodos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto
4.
Medicine (Baltimore) ; 99(11): e19182, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176043

RESUMO

RATIONALE: Postmortem forensic imaging technologies provide a noninvasive/minimally invasive approach for imaging of internal organ structures of the human body to detect injuries, diseases, and other morphologic changes. Currently, postmortem forensic imaging methods have been widely used in determination of the cause of death. However, these methods do not allow histologic examinations. Endoscopic autopsy emerged in the 1990s. Thoracoscopy and laparoscopy are mainly used to examine organs and tissues in the thoracic and abdominal cavity. Target tissues are also sampled for histologic examination. By combining postmortem forensic imaging with endoscopic autopsy, comprehensive examination of the corpse, organs, and sampling for histologic examination can be carried out. PATIENT CONCERNS: A 34-year-old woman was witnessed jumping into the river, sinking after struggling in the water. The body was found 24 hours later and confirmed with no vital signs. No preexisting medical conditions were known. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: Postmortem computed tomography, target coronary postmortem computed tomography angiography, and endoscopic autopsy were performed before conventional autopsy. Laparoscopic examination was used to examine the abdominal organs. The diaphragm and pericardium were cut open from the abdominal cavity to allow access to the examination of lungs and heart. Tissue samples were collected from various organs for histologic examination, and a diatom test was carried out on lung samples. Postmortem computed tomography revealed fluid in the paranasal sinuses, airways, stomach, and duodenum; emphysema aquosum; and mosaic pattern of the lung parenchyma. Endoscopic examination additionally detected Paltauf spots. The results were consistent with those of conventional autopsy. Histologic examination revealed pulmonary congestion, pulmonary edema, pulmonary emphysema, pulmonary hemorrhage, and congestion in multiple organs such as the liver, spleen, and kidneys. Diatoms were detected in lung tissues, which were identical in morphology to diatoms in water samples collected from the scene. The cause of death was determined as drowning. CONCLUSION: Combining forensic imaging and endoscopic autopsy for postmortem examination yields a more comprehensive and scientific finding, and the combination is minimally invasive and more acceptable to the family members. This method can be used as an alternative for conventional autopsy under specific circumstances.


Assuntos
Autopsia/métodos , Afogamento/diagnóstico , Adulto , Angiografia por Tomografia Computadorizada , Afogamento/diagnóstico por imagem , Afogamento/patologia , Endoscopia/métodos , Feminino , Patologia Legal/métodos , Humanos , Tomografia Computadorizada por Raios X
5.
Mymensingh Med J ; 29(1): 92-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915342

RESUMO

A cross sectional descriptive study was performed on 40 postmortem vermiform appendix (male 24 and female 16) to find out the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique and were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). For this purpose, about 3mm long of whole thickness transverse section was taken from the middle of the vermiform appendix and thus the permanent slides were made for microscopic examination. To measure the diameter of the lymphoid follicle two measurements were taken. One was taken at the maximum diameter and another was perpendicular to it by ocular micrometer. Diameter of one largest and one smallest lymphoid follicles were measured and find out the mean diameter of lymphoid follicle between them. Diameter of lymphoid follicle = (Maximum transverse diameter + perpendicular diameter) /2. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. It was observed that diameter of lymphoid follicle of vermiform appendix gradually decreased as age advanced. The mean±SD diameter of lymphoid follicle was 580.31±37.07, 545.58±38.37, 485.68±40.20 and 428.12±68.41µm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of diameter of lymphoid follicle between A&B, C&D were statistically non significant at p= or >0.05 level, difference between Group B&C was statistically moderately significant at p<0.01 level and differences between Group A&C, B&D, A&D were statistically highly significant at p<0.001 level. Mean diameter of lymphoid follicle of vermiform appendix in male was higher (584.30±12.65µm in Group A, 549.42±38.36µm in Group B, 487.38±39.91µm in Group C, 430.68±70.30µm in Group D) than in female (576.31±53.77µm in Group A, 536.61±45.14µm in Group B, 483.14±46.68µm in Group C, 424.28±75.95µm in Group D) but mean difference between sexes in the different groups was statistically non significant at p=or >0.05 level. The present study will help to increase the information pool on the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people.


Assuntos
Apêndice , Autopsia/métodos , Tecido Linfoide , Adulto , Fatores Etários , Idoso , Apêndice/anatomia & histologia , Apêndice/patologia , Grupo com Ancestrais do Continente Asiático , Bangladesh , Cadáver , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Tecido Linfoide/anatomia & histologia , Tecido Linfoide/patologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
6.
Am J Forensic Med Pathol ; 41(1): 56-59, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31929321

RESUMO

Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.


Assuntos
Fogo , Hérnia Inguinal/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Autopsia/métodos , Queimaduras/patologia , Impressões Digitais de DNA , Medicina Legal/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
7.
J Forensic Sci ; 65(1): 274-275, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31469426

RESUMO

A 29-year-old man died at the scene of an altercation from a stab wound to the left side of the neck. At autopsy, careful in situ examination of the common carotid artery did not reveal any evidence of hemorrhage or apparent vascular injury. However, applying pressure to the chest wall and underlying thoracic viscera (lungs and heart) resulted in filling of the collapsed vessel with blood causing hemorrhage from a small incision on the medial aspect of the common carotid artery. Release of pressure and drying of the dissection field enabled the artery to be opened and the small defect to be identified. This technique may be used to temporarily restore blood to a vessel to help identify a small bleeding point that may otherwise be difficult to detect.


Assuntos
Lesões das Artérias Carótidas/patologia , Hemorragia/patologia , Pressão , Tórax , Ferimentos Perfurantes/patologia , Adulto , Autopsia/métodos , Artéria Carótida Primitiva/patologia , Exsanguinação/etiologia , Humanos , Masculino
8.
Virchows Arch ; 476(2): 179-194, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31522288

RESUMO

Ischemic heart disease is one of the leading causes of morbidity and death worldwide. Consequently, myocardial infarctions are often encountered in clinical and forensic autopsies, and diagnosis can be challenging, especially in the absence of an acute coronary occlusion. Precise histopathological identification and timing of myocardial infarction in humans often remains uncertain while it can be of crucial importance, especially in a forensic setting when third person involvement or medical responsibilities are in question. A proper post-mortem diagnosis requires not only up-to-date knowledge of the ischemic coronary and myocardial pathology, but also a correct interpretation of such findings in relation to the clinical scenario of the deceased. For these reasons, it is important for pathologists to be familiar with the different clinically defined types of myocardial infarction and to discriminate myocardial infarction from other forms of myocardial injury. This article reviews present knowledge and post-mortem diagnostic methods, including post-mortem imaging, to reveal the different types of myocardial injury and the clinical-pathological correlations with currently defined types of myocardial infarction.


Assuntos
Autopsia , Infarto do Miocárdio/diagnóstico , Miocárdio/patologia , Autopsia/métodos , Morte Súbita Cardíaca/patologia , Patologia Legal/métodos , Humanos , Infarto do Miocárdio/patologia , Patologia Clínica/métodos
9.
Kathmandu Univ Med J (KUMJ) ; 17(65): 25-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734674

RESUMO

Background Hanging is one of the common forms of violent mechanical asphyxial deaths. When compared to other forms of unnatural death all over the world this method stands on top as death is instantaneous. Death due to hanging is always suicidal until and unless otherwise specified. Objective To explore the socio-demographic characteristics in cases of death due to completed hanging in Nepal. Method This prospective study of death due to hanging was conducted during the period of July 2011 to July 2013. Meticulous autopsy of the body was done in all cases with bloodless dissection of the neck was carried out. Result During the study period medico legal autopsy of 91 cases of death due to hanging was conducted, out of which 57 (63%) were males and 34 (37%) were females. Majority of the deceased were suspended at their own house or peri-domestic settings. Based upon the circumstantial evidences 95.61% (n=87) cases attributed to suicide in nature. Conclusion Hanging undoubtedly is one of the most preferred methods to commit suicide, popular for its lethality. Lack of suicide surveillance system and national data bank in Nepal has resulted into equivocal findings. More studies should be encouraged based upon autopsy findings to get a clear picture on mortality rates.


Assuntos
Asfixia , /estatística & dados numéricos , Adulto , Autopsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Nepal , Estudos Prospectivos , Fatores Sexuais , Suicídio
10.
Virchows Arch ; 475(6): 781-788, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691009

RESUMO

The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.


Assuntos
Autopsia , Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Autopsia/métodos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Prevalência , Estudos Retrospectivos , Suécia
11.
Pan Afr Med J ; 33: 318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692720

RESUMO

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.


Assuntos
Autopsia/métodos , Mortalidade da Criança , Política de Saúde , África ao Sul do Saara , Causas de Morte , Criança , Humanos , Formulação de Políticas , Reprodutibilidade dos Testes
13.
Autops. Case Rep ; 9(3): e2019103, July-Sept. 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1016864

RESUMO

The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases. Microbiological examinations identified Neisseria meningitidis, which was accountable for Waterhouse­Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen. We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.


Assuntos
Humanos , Autopsia/métodos , Síndrome de Waterhouse-Friderichsen/patologia , Técnicas Microbiológicas , Evolução Fatal , Neisseria meningitidis
14.
Eur. j. anat ; 23(5): 369-376, sept. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183867

RESUMO

Hepatic organogenesis is a complex process involving various molecular and cellular determinants. Knowledge of the anatomical and functional structure of the liver and its relationship with other abdominal organs is fundamental from a surgical point of view. Clinical autopsies were performed upon twelve fetal specimens. Photographic footage was reviewed for fetal livers presenting macroscopic abnormalities, and relevant cases were included. A search was conducted employing terms pertaining hepatic malformations’ morphogenetic, anatomical and pathological features. A thorough review was elaborated introducing an updated classification based on autopsy findings and available literature. Twelve fetal specimens underwent clinical autopsies. Gestational age ranged between 18 and 38 weeks (mean 28 weeks). All livers displayed symmetrical lobes. Seven of them presented at least one dysmorphic feature on macroscopic examination. Hepatic malformations can be classified into anomalies due to excessive development, defective development or extrinsic factors. The relevance of the proper identification of liver malformations lies in the broad spectrum of clinical manifestations with different degrees of morbidity associated with them


No disponible


Assuntos
Humanos , Feto/anormalidades , Feto/anatomia & histologia , Fígado/anormalidades , Fígado/anatomia & histologia , Cadáver , Morfogênese , Autopsia/métodos , Fígado/patologia , Organogênese
15.
Virchows Arch ; 475(4): 499-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420733

RESUMO

Fetal and perinatal growth charts and tables are essential for proper interpretation of autopsy anthropometric parameters. These parameters depend on factors that may vary between populations; thus, it is recommended that standards be developed from local target populations to ensure that they are truly representative. In this study, we established standards for a complete set of autopsy fetal parameters, including biometrical measurements, organ weights and long bone lengths, based on autopsy data collected retrospectively from a sample of Portuguese fetuses and neonates. Using a robust statistical regression methodology, to fit mean and standard deviation models, we constructed growth curves for gestational ages between 12 and 42 weeks, which aim to be useful for autopsy examination, particularly in the Portuguese population.


Assuntos
Autopsia/métodos , Autopsia/normas , Recém-Nascido/crescimento & desenvolvimento , Biometria , Desenvolvimento Ósseo , Osso e Ossos/embriologia , Desenvolvimento Fetal , Feto/embriologia , Humanos , Tamanho do Órgão , Valores de Referência
16.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451466

RESUMO

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism; however, MBD in a non-alcoholic diabetic patient has rarely been reported. The aetiology or pathophysiology of MBD is still unknown. A 50-year-old man with a history of untreated diabetes mellitus underwent on-pump beating coronary artery bypass graft surgery (CABG) surgery for three-vessel and left main coronary disease. 3 days after the surgery, he developed a fever over 40°C and entered a coma state. MRI revealed multiple lesions, including in the corpus callosum, globus pallidus, brain stem and upper cervical spinal cord, which suggested MBD. The patient did not respond to thiamine therapy, but partly responded to steroid therapy. He ultimately died of respiratory failure. The autopsy revealed MBD and haemophagocytic lymphohistiocytosis. It is rare, but systemic inflammatory response syndrome induced by on-pump beating CABG could develop these complication.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Corpo Caloso/diagnóstico por imagem , Linfo-Histiocitose Hemofagocítica , Doença de Marchiafava-Bignami , Complicações Pós-Operatórias , Autopsia/métodos , Encéfalo/diagnóstico por imagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Evolução Fatal , Humanos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Doença de Marchiafava-Bignami/diagnóstico , Doença de Marchiafava-Bignami/etiologia , Doença de Marchiafava-Bignami/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia
17.
PLoS Negl Trop Dis ; 13(7): e0007625, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31329590

RESUMO

BACKGROUND: New strategies for collecting post-mortem tissue are necessary, particularly in areas with emerging infections. Minimally invasive autopsy (MIA) has been proposed as an alternative to conventional autopsy (CA), with promising results. Previous studies using MIA addressed the cause of death in adults and children in developing countries. However, none of these studies was conducted in areas with an undergoing infectious disease epidemic. We have recently experienced an epidemic of yellow fever (YF) in Brazil. Aiming to provide new information on low-cost post-mortem techniques that could be applied in regions at risk for infectious outbreaks, we tested the efficacy of ultrasound-guided MIA (MIA-US) in the diagnosis of patients who died during the epidemic. METHODOLOGY/PRINCIPAL FINDINGS: In this observational study, we performed MIA-US in 20 patients with suspected or confirmed YF and compared the results with those obtained in subsequent CAs. Ultrasound-guided biopsies were used for tissue sampling of liver, kidneys, lungs, spleen, and heart. Liver samples from MIA-US and CA were submitted for RT-PCR and immunohistochemistry for detection of YF virus antigen. Of the 20 patients, 17 had YF diagnosis confirmed after autopsy by histopathological and molecular analysis. There was 100% agreement between MIA-US and CA in determining the cause of death (panlobular hepatitis with hepatic failure) and main disease (yellow fever). Further, MIA-US obtained samples with good quality for molecular studies and for the assessment of the systemic involvement of the disease. Main extrahepatic findings were pulmonary hemorrhage, pneumonia, acute tubular necrosis, and glomerulonephritis. One patient was a 24-year-old, 27-week pregnant woman; MIA-US assessed the placenta and provided adequate placental tissue for analysis. CONCLUSIONS: MIA-US is a reliable tool for rapid post-mortem diagnosis of yellow fever and can be used as an alternative to conventional autopsy in regions at risk for hemorrhagic fever outbreaks with limited resources to perform complete diagnostic autopsy.


Assuntos
Autopsia/métodos , Epidemias , Ultrassonografia de Intervenção/métodos , Febre Amarela/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mudanças Depois da Morte , Estudos Prospectivos , Febre Amarela/epidemiologia , Adulto Jovem
18.
J Glob Health ; 9(2): 020501, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360450

RESUMO

Background: The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods: Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results: Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions: The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real-world cohorts with detailed, time-varying information on neonatal mortality.


Assuntos
Mortalidade Infantil/tendências , Autopsia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
19.
Int J Mol Sci ; 20(14)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340557

RESUMO

Background: Several biophysical techniques have been successfully implemented to detect G protein-coupled receptors (GPCRs) heteromerization. Although these approaches have made it possible to ascertain the presence of GPCR heteromers in animal models of disease, no success has been accomplished in pathological human post-mortem brains. The AlphaScreen technology has been consistently used to quantify small analyte accumulation or depletion, bimolecular interactions, and post-translational modifications. The high signal-to-background, dynamic range and sensitivity exhibited by this technology support that it may be suitable to detect GPCR heteromers even under non-optimal conditions. Methods: Here, we describe the development of a new AlphaScreen assay to detect GPCR oligomers in human post-mortem brain. Results: Adenosine A2A-dopamine D2 receptor (A2AR/D2R) heteromer formation was monitored in caudate from healthy and Parkinson's disease (PD) subjects. The approach was first validated using striatal membranes from wild type and A2AR deficient mice. Secondly, we took advantage of the 6-hydroxydopamine hemiparkinsonian rat model to validate previous results. In addition, finally, A2AR/D2R heteromer formation was assessed in caudate membranes from human post-mortem brains. Importantly, our preliminary results revealed an increase in A2AR/D2R heteromer formation in PD brains. Conclusions: The new AlphaScreen assay allowed assessing GPCR heteromers in human post-mortem brains with high sensitivity.


Assuntos
Autopsia/métodos , Corpo Estriado/metabolismo , Ensaios de Triagem em Larga Escala/instrumentação , Doença de Parkinson Secundária/genética , Doença de Parkinson/genética , Receptor A2A de Adenosina/genética , Idoso , Idoso de 80 Anos ou mais , Animais , Autopsia/instrumentação , Estudos de Casos e Controles , Corpo Estriado/patologia , Modelos Animais de Doenças , Feminino , Expressão Gênica , Humanos , Masculino , Camundongos , Camundongos Knockout , Oxidopamina/administração & dosagem , Doença de Parkinson/diagnóstico , Doença de Parkinson/patologia , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson Secundária/patologia , Multimerização Proteica , Ratos , Ratos Sprague-Dawley , Receptor A2A de Adenosina/química , Receptor A2A de Adenosina/metabolismo
20.
Cancer Sci ; 110(8): 2386-2395, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206934

RESUMO

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer by providing new options in addition to existing therapies. However, peptide vaccination therapies still represent an attractive approach, because of the antigen specificity. We identified survivin 2B peptide (SVN-2B), a 9-mer antigenic peptide encoded by survivin, and an SVN-2B peptide vaccine-based phase II randomized clinical trial targeting unresectable and refractory pancreatic carcinoma was undertaken. The SVN-2B peptide vaccine did not have any statistically significant clinical benefits in that study. Therefore, we undertook an autopsy study to analyze the immune status of the pancreatic cancer lesions at the histological level. Autopsies were carried out in 13 patients who had died of pancreatic cancer, including 7 who had received SVN-2B peptide vaccination and 6 who had not, as negative controls. The expression of immune-related molecules was analyzed by immunohistochemical staining. Cytotoxic T lymphocytes were analyzed by tetramer staining and enzyme-linked immunospot assay. Histological analysis revealed dense infiltration of CD8+ T cells in some lesions in patients who had received the SVN-2B peptide vaccine. A high rate of programmed cell death ligand 1 expression in cancer cells was observed in these cases, indicating that CTLs were induced by SVN-2B peptide vaccination and had infiltrated the lesions. The lack of a significant antitumor effect was most likely attributable to the expression of immune checkpoint molecules. These findings suggest that the combination of a tumor-specific peptide vaccine and an ICI might be a promising approach to the treatment of pancreatic carcinoma in the future.


Assuntos
Vacinas Anticâncer/imunologia , Neoplasias Pancreáticas/imunologia , Neoplasias Pancreáticas/terapia , Peptídeos/imunologia , Survivina/imunologia , Adulto , Idoso , Antígenos de Neoplasias/imunologia , Autopsia/métodos , Linfócitos T CD8-Positivos/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Citotóxicos/imunologia , Vacinação/métodos
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