Resuscitating the Dying Autopsy

Bassat, Quique; Castillo, Paola; Alonso, Pedro L.; Ordi, Jaume; Menéndez, Clara

doi:10.1371/journal.pmed.1001927

Cited by 34 publications

(43 citation statements)

References 32 publications

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“…Consequently, the fundamental mechanisms leading to death in high-risk patients with COVID-19 need to be discovered and addressed with urgency. Despite a marked drop in frequency, the post-mortem autopsy remains an essential part of both discovering the cause of death in a particular individual, but also in advancing the science and treatment of disease, especially in the case of novel pathogens such as SARS-CoV-2 [2] . The goal of an autopsy is to discover the cause of death (COD) using a macro/microscopic investigation.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Mong

Awkal

Marik

2020

Preprint

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Background To date, more than 161,000 people have died from the coronavirus disease 2019 (COVID-19) yet the fundamental drivers of the morbidity and mortality remain uncertain. Clinicians worldwide appear to be at a loss to know how to prevent and treat the severe respiratory distress in these patients effectively. Consequently, the fundamental mechanisms leading to death in high-risk patients with COVID-19 need to be discovered and addressed with urgency. Despite a marked drop in frequency, the post-mortem autopsy remains an essential part of both discovering the cause of death in a particular individual, but also in advancing the science and treatment of disease, especially in the case of novel pathogens such as SARS-CoV-2[2]. The goal of an autopsy is to discover the cause of death (COD) using a macro/microscopic investigation. Traditionally, the intact organs are carefully removed, inspected, and weighed. Because lung weight is often affected by the cause of death and the last breath occurs very near if not at the moments of death, the evaluation of the lungs is one of the starting points of any COD investigation[3]. Method A comprehensive search was performed to systematically review all reported autopsy findings in COVID-19 patients in order to better understand the underlying disease mechanisms resulting in death. We then compared these findings with the results of a targeted literature review of hyaluronan in relationship to acute respiratory distress syndrome (ARDS). Results In total, data from 181 autopsies were identified. From this group, 6 autopsies of COVID-19 patients were selected for a detailed review and statistical analysis. The average lung weight of those who were determined to have died as a result of SARS-CoV-2 was 2196g-approximately 2.5x normal lung weight. Hyaline membranes were consistently identified on histologic sections. A review of the literature reveals that hyaluronan has been associated with the pathophysiology of ARDS since 1967. However, its key role in driving the morbidity and mortality of the condition has heretofore not been fully recognized. Conclusions We propose that the induced hyaluronan storm syndrome or IHS, is the model that best addresses the heretofore perplexing respiratory failure that is the proximal cause of death in a minority, but ever rising number, of patients. In addition to treating and preventing IHS in currently infected individuals now; an aggressive research effort should be undertaken to discover why the majority of individuals who are exposed to the virus are either minimally or asymptomatic, while a minority of high-risk individuals rapidly progress to respiratory failure and death. Keywords Systematic review; COVID-19; SARS-CoV-2; Hyaline Membrane; Hyaluronan; Acute Respiratory Distress Syndrome; ARDS; Autopsy; IHS; Induced Hyaluronan Storm Syndrome; COD; Cause of Death

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Section: Introductionmentioning

confidence: 99%

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Mong

Awkal

Marik

2020

Preprint

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“…As well, radiologists admit that at present the technology is not yet good enough to provide as much detail as a conventional postmortem examination. accepted among Jewish, Christian and Muslim communities [30,31] and is preferable to no postmortem examination at all [2,17].…”

Section: Discussionmentioning

confidence: 99%

The Final Consultation: The Autopsy

Aljerian¹

2017

FLIS

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Autopsy has long been an important tool for education, maintaining the quality of patient care and the final consultation. In addition to its other benefits, autopsy has been used to provide or modify treatments for future generations of patients; train young physicians; and provide definitive answers about the efficacy of treatments administered [1]. Countries are struggling to keep this rich tool of medicine alive and a revival of autopsy has been called for by many pathologists [2]. However, rates of autopsy have declined over recent years because of changing legislation, challenges with informed consent, and

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“…In contrast, verbal autopsies can be used to investigate any kind of death, but their performance is even more uncertain than that of clinical data, and therefore estimates provided from this source need to be interpreted with skepticism; as they rely on information provided by non-clinicians and can generally only identify broad syndromes rather than specific precise diagnoses. nonethelessNonetheless, while specificity is obviously a problem, given the approach, verbal autopsies are known to provide somewhat credible results at a population -rather than at an individual-level, and often there is no other cause of death information available 12,13 . Quique: Not sure about this.…”

Section: Mozambiquementioning

confidence: 99%

Child Mortality in Mozambique: a Review of Recent Trends and Attributable Causes

2018

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a) Purpose of review:In the last 25 years, child mortality has significantly dropped at a global level.Understanding particularities of child mortality at the national level is useful to tailor health policy to those conditions requiring more attention. In Mozambique, a variety of efforts have been made to better characterize the overall child mortality, and to describe the main contributors for death. In this review, we attempt to contextualize current knowledge on causes of pediatric deaths in Mozambique. b) Recent findings: The available data regarding the principal causes of death in Mozambican children point out to infectious diseases and neonatal causes as the principal causes of preventable deaths, with important variations in recent years in line with the epidemiological changes seen in the country as a result of reductions in malaria transmission and the impact of the nationwide introduction of different conjugate vaccines. c) Summary: Data regarding the main causes of death among children in Mozambique are patchy, outdated, and in many cases based on methodologies with many underlying limitations, which make them unreliable. More robust postmortem methodologies to study the underlying causes of mortality, currently being introduced in a surveillance sentinel site of the country, will surely contribute to improve our understanding of what is really killing children in this country. Keywords: Mozambique, children, mortality, cause of death, verbal autopsy, postmortem methods the year 2016 an estimated population of 28,829,476 inhabitants, 70% of which Comentado [GB(1]: I would modify this term. Comentado [GB(2]:Maybe simplify or re-order the sentence, otherwise the period referred is not very clear. Comentado [GB(3]:Aready mentioned in the sentence above: "have failed to achieve in this period the two thirds reduction in child mortality stipulated by millennium development goal (MDG) 4" Comentado [GB(4]:Some examples? (if poverty and health still faces challenges).

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Resuscitating the Dying Autopsy

Abstract: Clara Menéndez and colleagues consider the importance of conducting autopsies and possible alternative methods for determining cause of death in resource-limited settings.

Cited by 34 publications

References 32 publications

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

Systematic review of COVID-19 autopsies: accelerated hyaluronan concentration as the primary driver of morbidity and mortality in high-risk COVID-19 patients: with therapeutic introduction of an oral hyaluronan inhibitor in the prevention of “Induced Hyaluronan Storm” Syndrome

The Final Consultation: The Autopsy

Child Mortality in Mozambique: a Review of Recent Trends and Attributable Causes

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