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Indian Journal of Pathology &... 2023Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this...
BACKGROUND
Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy.
AIMS
To study the pathological features of SPE at autopsy.
MATERIALS AND METHODS
Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy.
STATISTICAL ANALYSIS
Nil.
RESULTS
According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis.
CONCLUSION
Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications.
Topics: Male; Humans; Female; Adult; Retrospective Studies; Sepsis; Pulmonary Embolism; Lung; Bacteremia
PubMed: 38084525
DOI: 10.4103/ijpm.ijpm_528_22 -
BMJ Global Health Dec 2023Causes of deaths often go unrecorded in lower income countries, yet this information is critical. Verbal autopsy is a questionnaire interview with a family member or...
INTRODUCTION
Causes of deaths often go unrecorded in lower income countries, yet this information is critical. Verbal autopsy is a questionnaire interview with a family member or caregiver to elicit the symptoms and circumstances preceding a death and assign a probable cause. The social and cultural aspects of verbal autopsy have gotten less attention than the technical aspects and have not been widely explored in South and Southeast Asia settings.
METHODS
Between October 2021 and March 2023, prior to implementing a verbal autopsy study at rural sites in Bangladesh, Cambodia, Laos, Myanmar and Thailand, focus group discussions were conducted with village heads, religious leaders and community members from varied demographic backgrounds. Thematic analysis elucidated customs and traditional views surrounding death to understand local ethnocultural sensitivities.
RESULTS
We found that death rituals varied greatly among religions, ethnicities and by socioeconomic status. Mourning periods were reported to last 3-100 days and related to the cause of death, age and how close the deceased person was to the family. Participants advised that interviews should happen after mourning periods to avoid emotional distress, but not long after so as to avoid recall bias. Interviewers should be introduced to respondents by a trusted local person. To provide reassurance and confidentiality, a family's residence is the preferred interview location. Interview questions require careful local language translation, and community sensitisation is important before data collection.
CONCLUSION
Verbal autopsy is acceptable across a wide range of cultural settings in Southeast Asia, provided that local norms are preidentified and followed.
Topics: Humans; Cause of Death; Autopsy; Family; Surveys and Questionnaires; Asia, Southeastern
PubMed: 38081771
DOI: 10.1136/bmjgh-2023-013462 -
Proceedings of the National Academy of... Nov 2023Dementia is a brain disease which results in irreversible and progressive loss of cognition and motor activity. Despite global efforts, there is no simple and reliable...
Dementia is a brain disease which results in irreversible and progressive loss of cognition and motor activity. Despite global efforts, there is no simple and reliable diagnosis or treatment option. Current diagnosis involves indirect testing of commonly inaccessible biofluids and low-resolution brain imaging. We have developed a portable, wireless readout-based Graphene field-effect transistor (GFET) biosensor platform that can detect viruses, proteins, and small molecules with single-molecule sensitivity and specificity. We report the detection of three important amyloids, namely, Amyloid beta (Aβ), Tau (τ), and α-Synuclein (αS) using DNA aptamer nanoprobes. These amyloids were isolated, purified, and characterized from the autopsied brain tissues of Alzheimer's Disease (AD) and Parkinson's Disease (PD) patients. The limit of detection (LoD) of the sensor is 10 fM, 1-10 pM, 10-100 fM for Aβ, τ, and αS, respectively. Synthetic as well as autopsied brain-derived amyloids showed a statistically significant sensor response with respect to derived thresholds, confirming the ability to define diseased vs. nondiseased states. The detection of each amyloid was specific to their aptamers; Aβ, τ, and αS peptides when tested, respectively, with aptamers nonspecific to them showed statistically insignificant cross-reactivity. Thus, the aptamer-based GFET biosensor has high sensitivity and precision across a range of epidemiologically significant AD and PD variants. This portable diagnostic system would allow at-home and POC testing for neurodegenerative diseases globally.
Topics: Humans; Amyloid beta-Peptides; Aptamers, Nucleotide; Graphite; Alzheimer Disease; Parkinson Disease; Biomarkers; tau Proteins
PubMed: 37956285
DOI: 10.1073/pnas.2311565120 -
Emerging Infectious Diseases Jul 2024Accurate and timely mortality surveillance is crucial for elucidating risk factors, particularly for emerging diseases. We compared use of COVID-19 keywords on death...
Accurate and timely mortality surveillance is crucial for elucidating risk factors, particularly for emerging diseases. We compared use of COVID-19 keywords on death certificates alone to identify COVID-19 deaths in Minnesota, USA, during 2020-2022, with use of a standardized mortality definition incorporating additional clinical data. For analyses, we used likelihood ratio χ and median 1-way tests. Death certificates alone identified 96% of COVID-19 deaths confirmed by the standardized definition and an additional 3% of deaths that had been classified as non-COVID-19 deaths by the standardized definition. Agreement between methods was >90% for most groups except children, although agreement among adults varied by demographics and location at death. Overall median time from death to filing of death certificate was 3 days; decedent characteristics and whether autopsy was performed varied. Death certificates are an efficient and timely source of COVID-19 mortality data when paired with SARS-CoV-2 testing data.
Topics: Humans; COVID-19; Minnesota; Male; Middle Aged; Female; Death Certificates; Adult; Aged; Child; SARS-CoV-2; Adolescent; Child, Preschool; Young Adult; Infant; Aged, 80 and over; Cause of Death; Autopsy; COVID-19 Testing
PubMed: 38916546
DOI: 10.3201/eid3007.231522 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2024Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with...
BACKGROUND
Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with fatal THIs.
METHODS
In this study, a total of 311 patients with fatal THIs, who underwent postmortem examinations and/or autopsies, were retrospectively analyzed. Cases were evaluated based on sex, age group, incident origin, cause of the incident, presence of skull fracture, type of fractured bone (if any), fracture localization and pattern, presence and type of intracranial lesion (if any), and cause of death.
RESULTS
Out of the patients, 242 (77.8%) were male and 69 (22.2%) were female. Accidents accounted for 235 (75.6%) of the incidents, with in-vehicle traffic accidents causing 117 (37.6%). In 221 cases (71.1%), intracranial lesions and skull fractures were observed together. The most common fractures were base fractures (171 cases) and temporal bone fractures (153 cases). The rate of intracranial hemorrhage was lower in the adult age group (69.7%) compared to the older age group (92.6%).
CONCLUSION
The results obtained in this study indicate that the cause of the incident, type of fracture, presence of skull base fracture, and multiple skull fractures increase the likelihood of fatalities. The occurrence of skull fractures reduces intracranial pressure, thereby decreasing the incidence of intracranial lesions. The development and effective enforcement of road traffic safety policies and regulations will reduce the incidence of fatalities.
Topics: Adult; Humans; Male; Female; Aged; Retrospective Studies; Craniocerebral Trauma; Skull Fractures; Incidence; Autopsy; Accidents, Traffic
PubMed: 38506383
DOI: 10.14744/tjtes.2024.32463 -
Brain Pathology (Zurich, Switzerland) Nov 2023
Topics: Humans; COVID-19; Nervous System Diseases; Neuropathology; Autopsy; Brain
PubMed: 37563942
DOI: 10.1111/bpa.13204 -
Cureus Jul 2023To consider death by suicide, as a method to escape their problems, is accepting defeat. Before embarking on the journey of marriage, one envisions the best of life and...
To consider death by suicide, as a method to escape their problems, is accepting defeat. Before embarking on the journey of marriage, one envisions the best of life and has a lot of hope for their future life. However, demands of dowry and domestic abuse by the husband can cut such visions short. Suicidal deaths among women especially married women have been increasing in Indian society. Various cultural, religious, and social values have a major role to play. In our study, we analyzed suicidal deaths in married women and tried to find the socio-demographic findings that have led these women to commit suicide. The autopsies were conducted from January 2014 to July 2015 at Kempegowda Institute of Medical Sciences, Bangalore. The highest incidence of suicide was found in the age group of 26-32 years, who were homemakers and within seven years of marriage. In a maximum of cases, abuse for dowry or other reasons was quoted as the reason to commit suicide. We also found that most of the decedents choose to hang themselves to commit suicide followed by the consumption of poison.
PubMed: 37426409
DOI: 10.7759/cureus.41510 -
Acta Neuropathologica Communications Dec 2023Amyotrophic lateral sclerosis (ALS) displays considerable clinical and genetic heterogeneity. Machine learning approaches have previously been utilised for patient...
Amyotrophic lateral sclerosis (ALS) displays considerable clinical and genetic heterogeneity. Machine learning approaches have previously been utilised for patient stratification in ALS as they can disentangle complex disease landscapes. However, lack of independent validation in different populations and tissue samples have greatly limited their use in clinical and research settings. We overcame these issues by performing hierarchical clustering on the 5000 most variably expressed autosomal genes from motor cortex expression data of people with sporadic ALS from the KCL BrainBank (N = 112). Three molecular phenotypes linked to ALS pathogenesis were identified: synaptic and neuropeptide signalling, oxidative stress and apoptosis, and neuroinflammation. Cluster validation was achieved by applying linear discriminant analysis models to cases from TargetALS US motor cortex (N = 93), as well as Italian (N = 15) and Dutch (N = 397) blood expression datasets, for which there was a high assignment probability (80-90%) for each molecular subtype. The ALS and motor cortex specificity of the expression signatures were tested by mapping KCL BrainBank controls (N = 59), and occipital cortex (N = 45) and cerebellum (N = 123) samples from TargetALS to each cluster, before constructing case-control and motor cortex-region logistic regression classifiers. We found that the signatures were not only able to distinguish people with ALS from controls (AUC 0.88 ± 0.10), but also reflect the motor cortex-based disease process, as there was perfect discrimination between motor cortex and the other brain regions. Cell types known to be involved in the biological processes of each molecular phenotype were found in higher proportions, reinforcing their biological interpretation. Phenotype analysis revealed distinct cluster-related outcomes in both motor cortex datasets, relating to disease onset and progression-related measures. Our results support the hypothesis that different mechanisms underpin ALS pathogenesis in subgroups of patients and demonstrate potential for the development of personalised treatment approaches. Our method is available for the scientific and clinical community at https://alsgeclustering.er.kcl.ac.uk .
Topics: Humans; Amyotrophic Lateral Sclerosis; Unsupervised Machine Learning; Motor Cortex; Brain; Autopsy
PubMed: 38129934
DOI: 10.1186/s40478-023-01686-8 -
BMJ Open Sep 2023With socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg,...
OBJECTIVE
With socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg, overweight/obesity, sedentary lifestyle), the majority of adult deaths in Bangladesh in recent years are due to NCDs. This study examines trends in cause-specific mortality risks using data from the Matlab Health and Demographic Surveillance System (HDSS).
DESIGN, SETTINGS AND PARTICIPANTS
We conducted a follow-up study from 2003 to 2017 using data from Matlab HDSS, which covers a rural population of 0.24 million (in 2018) in Chandpur, Bangladesh. HDSS assessed the causes of all deaths using verbal autopsy and classified the causes using the 10th revision of the International Statistical Classification of Diseases. We examined 19 327 deaths involving 2 279 237 person-years.
METHODS
We calculated annual cause-specific mortality rates and estimated adjusted proportional HRs using a Cox proportional hazards model.
RESULTS
All-cause mortality risk declined over the study period among people aged 15 and older, but the risk from stroke increased, and from heart disease and cancers remained unchanged. These causes were more common among middle-aged and older people and thus bore the most burden. Mortality from causes other than NCDs-namely, infectious and respiratory diseases, injuries, endocrine disorders and others-declined yet still constituted over 30% of all deaths. Thus, the overall mortality decline was associated with the decline of causes other than NCDs. Mortality risk sharply increased with age. Men had higher mortality than women from heart disease, cancers and other causes, but not from stroke. Lower household wealth quintile people have higher mortality than higher household wealth quintile people, non-Muslims than Muslims.
CONCLUSION
Deaths from stroke, heart disease and cancers were either on the rise or remained unchanged, but other causes declined continuously from 2003 to 2017. Immediate strengthening of the preventive and curative healthcare systems for NCDs management is a burning need.
Topics: Male; Middle Aged; Humans; Adult; Female; Aged; Bangladesh; Follow-Up Studies; Risk Factors; Autopsy; Heart Diseases; Noncommunicable Diseases
PubMed: 37730396
DOI: 10.1136/bmjopen-2022-065146