Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases

AbstractCoronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

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Dying From Or With SARS-CoV-2 – Prospective Postmortem Evaluation of 735 Consecutive Death Cases –

10.21203/rs.3.rs-670066/v1 ◽

2021 ◽

Author(s):

Antonia Fitzek ◽

Julia Schädler ◽

Eric Dietz ◽

Alexandra Ron ◽

Moritz Gerling ◽

...

Keyword(s):

Diffuse Alveolar Damage ◽

Accurate Information ◽

Postmortem Computed Tomography ◽

Global Pandemic ◽

Conventional Autopsy ◽

Minimally Invasive Autopsy ◽

Death Cases ◽

Mortality Surveillance ◽

Postmortem Examinations ◽

Annual Mortality

Abstract BackgroundCoronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce.MethodsTo distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts.Findings84.1% (n=618) were classified as COVID-19 deaths, 6.4% (n=47) as non-COVID-19 deaths, 9.5% (n=70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n=283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n=187). Thromboses were found in 39.2% (n=62/158 cases), pulmonary embolism in 22.1% (n=56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n=618) represented COVID-19 deaths.InterpretationOur study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

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Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

Pathogens ◽

10.3390/pathogens10040412 ◽

2021 ◽

Vol 10 (4) ◽

pp. 412

Author(s):

Natalia Rakislova ◽

Lorena Marimon ◽

Mamudo R. Ismail ◽

Carla Carrilho ◽

Fabiola Fernandes ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Diffuse Alveolar Damage ◽

The Body ◽

Protective Equipment ◽

Safe Alternative ◽

Minimally Invasive Autopsy ◽

Postmortem Studies ◽

Death Investigation ◽

Insight Into

Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, b) compare the performance of MIA versus complete autopsy, and c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.

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Assessing viability of a minimally invasive autopsy technique in ascertaining the probable cause of death in patients who were SARS CoV19 positive at the time of their demise

Surgical and Experimental Pathology ◽

10.1186/s42047-021-00094-3 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Ajay H. Bhandarwar ◽

Girish D. Bakhshi ◽

Eham Arora ◽

Nikhil Dhimole ◽

Sanjay R. Bijwe ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Histopathological Examination ◽

Health Hazard ◽

World Health ◽

Invasive Technique ◽

Tissue Samples ◽

Conventional Autopsy ◽

Minimally Invasive Autopsy ◽

Health Organization

Abstract Background SARS CoV-19 was declared as a pandemic by the World Health Organization (WHO), raising up challenges on various levels ranging from therapeutics to diagnostics. The conventional autopsy technique may pose a health hazard to health care workers. A minimally invasive autopsy technique can diminish this hazard. Materials and methods Between August and November 2020, 51 patients who were suffering from Covid-19 at the time of their demise were included. A novel minimally invasive ultrasound-guided technique for procuring tissue samples of major organs was employed which were thereafter subject to histopathological examination. A detailed review of the course in hospital was noted. An analysis was performed to correlate the cause of death ascertained from our minimally invasive technique with the cause of death ascertained clinically. Results There was adequate tissue sampling in 45 cases, where the minimally invasive autopsy technique confirmed the cause of death in all 45 cases (100%) and made it more specific in 5 cases (11.11%). Conclusion Minimally Invasive Autopsy is an easily reproducible technique which has the potential to strengthen the probable the cause of death with reasonable certainty while ensuring safety and ethics.

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COVID-19 Social Media Information and Misinformation: a Geospatial Analysis of Inter-regional Tweet Disparities in Ghana

10.21203/rs.3.rs-783507/v1 ◽

2021 ◽

Author(s):

Richmond Takyi Hinneh ◽

Alex Barimah Owusu

Keyword(s):

Social Media ◽

Information Dissemination ◽

Accurate Information ◽

False Information ◽

Global Pandemic ◽

Study Results ◽

Other Information ◽

Spatial Differences ◽

Social Media Platforms ◽

Precautionary Measures

Abstract BackgroundIn an era of the global pandemic and social media dominance, trying to control the narrative on COVID-19 has been a challenging task for most governments particularly with news about the disease on various social media platforms. There have even been instances where people have sent false information about the number of confirmed cases, precautionary measures, drugs that boost the immune system which can threaten the lives of some users who are accessing this false information and misconceptions.Method This study analyzed spatial differences in Twitter misinformation on COVID-19 across 16 regions of Ghana by scraping 1,167 tweets from Twitter using API access. A total of 514 tweets were analyzed. The data were categorized into three namely; accurate information, misinformation, and other information. ResultsThe study results show that 72% of the tweets were accurate, 14% were misinformation and 14% represented other information. Among the regions, Greater Accra had the highest number of accurate information (45 tweets), and the Upper West Region recording the highest number of misinformation (12 tweets).ConclusionSpatial monitoring and management of information dissemination are useful for target setting and achievement of direct results in terms of diffusing misinformation and propagating accurate information. We, therefore, recommend official usage of Twitter for COVID-19 information dissemination as this usage will help offset possible misinformation from unformed individuals.

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COVID-19 Autopsies, Oklahoma, USA

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa062 ◽

2020 ◽

Vol 153 (6) ◽

pp. 725-733 ◽

Cited By ~ 261

Author(s):

Lisa M Barton ◽

Eric J Duval ◽

Edana Stroberg ◽

Subha Ghosh ◽

Sanjay Mukhopadhyay

Keyword(s):

Diffuse Alveolar Damage ◽

Nasopharyngeal Swab ◽

Protective Equipment ◽

Chain Reaction ◽

Polymerase Chain Reaction Testing ◽

Standard Procedures ◽

History Of ◽

Polymerase Chain ◽

Viral Inclusions ◽

Postmortem Examinations

Abstract Objectives To report the methods and findings of two complete autopsies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals who died in Oklahoma (United States) in March 2020. Methods Complete postmortem examinations were performed according to standard procedures in a negative-pressure autopsy suite/isolation room using personal protective equipment, including N95 masks, eye protection, and gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcriptase polymerase chain reaction testing on postmortem swabs. Results A 77-year-old obese man with a history of hypertension, splenectomy, and 6 days of fever and chills died while being transported for medical care. He tested positive for SARS-CoV-2 on postmortem nasopharyngeal and lung parenchymal swabs. Autopsy revealed diffuse alveolar damage and chronic inflammation and edema in the bronchial mucosa. A 42-year-old obese man with a history of myotonic dystrophy developed abdominal pain followed by fever, shortness of breath, and cough. Postmortem nasopharyngeal swab was positive for SARS-CoV-2; lung parenchymal swabs were negative. Autopsy showed acute bronchopneumonia with evidence of aspiration. Neither autopsy revealed viral inclusions, mucus plugging in airways, eosinophils, or myocarditis. Conclusions SARS-CoV-2 testing can be performed at autopsy. Autopsy findings such as diffuse alveolar damage and airway inflammation reflect true virus-related pathology; other findings represent superimposed or unrelated processes.

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Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

Clinics ◽

10.6061/clinics/2014(10)06 ◽

2014 ◽

Vol 69 (10) ◽

pp. 683-687 ◽

Cited By ~ 7

Author(s):

T Zerbini ◽

LF Silva ◽

AC Ferro ◽

FU Kay ◽

E Amaro Jr ◽

...

Keyword(s):

Computed Tomography ◽

Postmortem Computed Tomography ◽

Conventional Autopsy

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Impact of the COVID-19 pandemic on life expectancy in Madrid (Spain)

10.31219/osf.io/s53jx ◽

2020 ◽

Author(s):

Sergi Trias-Llimós ◽

Usama Bilal

Keyword(s):

Life Expectancy ◽

Surveillance System ◽

Excess Mortality ◽

Daily Mortality ◽

Life Expectancy At Birth ◽

The World ◽

Using Data ◽

The Impact ◽

Mortality Surveillance ◽

Annual Mortality

The COVID-19 pandemic is causing substantial increases in mortality across populations, potentially causing stagnation or decline in life expectancy. We explored this idea by examining the impact of excess mortality linked to the COVID-19 crisis on life expectancy in the region of Madrid (Spain). Using data from the Daily Mortality Surveillance System (MoMo), we calculated excess mortality (death counts) for the weeks 10th to 14th in 2020 using data on expected and observed mortality, assuming no further excess mortality during the rest of the year. The expected annual mortality variation was +6%, +21% and +25% among men aged under 65, between 65 and 74 and over 75, respectively, and +5%, +13%, and 18% for women, respectively. This excess mortality during weeks 10th to 14th resulted in a life expectancy at birth decline of 1.6 years among men and 1.1 years among women. These estimates confirm that Madrid and other severely hit regions in the world may face substantial life expectancy declines.

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Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient

CEN Case Reports ◽

10.1007/s13730-020-00456-y ◽

2020 ◽

Vol 9 (4) ◽

pp. 308-312

Author(s):

Rin Asao ◽

Kazumasa Nishida ◽

Hiromichi Goto ◽

Yoshikazu Goto ◽

Noriatsu Ichiba ◽

...

Keyword(s):

Computed Tomography ◽

Dialysis Patient ◽

Case Reports ◽

Fatal Case ◽

Ascending Aorta ◽

Gas Gangrene ◽

Common Finding ◽

Postmortem Computed Tomography ◽

Postmortem Imaging ◽

Conventional Autopsy

Abstract Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.

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REVIEW OF CARDIOPULMONARY AUTOPSY FINDINGS IN DECEASED COVID-19 POSITIVE PATIENTS IN A TERTIARY CARE CENTER IN CENTRAL INDIA

10.36106/3200611 ◽

2021 ◽

pp. 18-23

Author(s):

Ganguly S ◽

Barpande CP ◽

Singh BP

Keyword(s):

Diffuse Alveolar Damage ◽

Care Center ◽

Multiorgan Failure ◽

Recovery Period ◽

Tertiary Care ◽

Central India ◽

The Elderly ◽

Long Term Effects ◽

Global Pandemic ◽

Cardiopulmonary Complications

COVID-19 is global pandemic caused by the SARS-CoV-2 virus. COVID-19 is a systemic multiorgan disorder with major involvement of the lungs and heart leading to Interstitial Pneumonia, Diffuse Alveolar Damage (DAD) and Acute Respiratory Distress Syndrome (ARDS). An important mechanism responsible for the widespread COVID-associated mortality is presumed to be the ineffective immune responses to the SARS-CoV-2 virus along with an associated thrombotic microangiopathy that ultimately leads to multiorgan failure and death. Even COVID-19 survivors with preexisting comorbidities; especially the elderly, run a risk of secondary neurologic and cardiopulmonary complications and might sometimes succumb to sudden death. Autopsy ndings are crucial to gaining a better understanding of the pathobiology of this “novel” disease as well as analyzing its long-term effects on target organs. In India, due to the prohibitive regulations regarding COVID autopsies; very little data is available on autopsy histopathology of patients dying of COVID-19; as well as those recovering from the disease, only to pass away during the recovery period. The present study aims to document the cardiopulmonary abnormalities found in autopsies of COVID-positive patients conducted at our institution while simultaneously conducting a review of the available international literature on the related topic. This will be particularly of interest for clinicians treating COVID-19 in Central India, as; of now, no similar studies have been reported from this region.

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