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Olds ML, Jones AW. Preanalytical factors influencing the results of ethanol analysis in postmortem specimens. J Anal Toxicol 2024; 48:9-26. [PMID: 37804205 DOI: 10.1093/jat/bkad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023] Open
Abstract
Excessive drinking and drunkenness are underlying factors in many fatal accidents, which make the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons although the interpretation of the results is more complicated in medical examiner cases owing to various preanalytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem ingestion of ethanol from PM synthesis. One approach involves the determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid, vitreous humor and/or urine, and comparison of results with blood alcohol concentration (BAC). Another approach involves the analysis of various alcohol biomarkers, such as ethyl glucuronide, ethyl sulfate and/or phosphatidylethanol or the urinary metabolites of serotonin 5-hydroxytryptophol/5-hydroxyindoleacetic acid (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as an enzyme inhibitor, in all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 to 0.02 g% when PM blood is analyzed. During putrefaction low BACs are more often produced after death than high BACs. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.
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Affiliation(s)
- Maria L Olds
- Fort Worth Police Department, Crime Laboratory, East Lancaster Ave, Fort Worth, TX 3616, United States
| | - Alan W Jones
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, University of Linköping, Linköping 58183, Sweden
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Klaric KA, Parai JL, Kepron CA, Walker AE, Milroy CM. Postmortem survey of haemoglobin A1c, non-alcoholic steatohepatitis and liver fibrosis within a general population. J Clin Pathol 2023; 76:606-611. [PMID: 35534202 DOI: 10.1136/jclinpath-2021-207998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/14/2022] [Indexed: 11/04/2022]
Abstract
AIMS Non-alcoholic steatohepatitis (NASH), fatty liver disease and fibrosis are associated with diabetes mellitus and obesity. Previous autopsy series have reported prevalence of fatty liver disease to be 11%-24%. Recent studies, using imaging and serology, suggest a prevalence of 20%-35%, NASH of 5% and advanced fibrosis of 2%-3%. We examined the prevalence of NASH and liver fibrosis in a general autopsy population. METHODS A cross-sectional study of consecutive, adult, medicolegal autopsies over a 1-year period was conducted. Liver sections were scored for fibrosis, inflammation and steatosis using a modified NASH scoring system. Stepwise logistic regression was used to identify associations between NASH or moderate/severe fibrosis and several clinicopathological parameters, including postmortem haemoglobin A1c (HbA1c). RESULTS Of 376 cases, 86 (22.9%) were classified as NASH. Prevalence of diabetes mellitus, body mass index (BMI) and postmortem HbA1c were significantly higher in NASH cases (39.5%, 32.3 kg/m2 and 6.88%) than non-NASH cases (12.1%, 27.0 kg/m2 and 5.73%). Decedents with moderate/severe fibrosis (6.9%) had higher prevalence of diabetes, BMI and HbA1c (50%, 31.4 kg/m2 and 6.7%) compared with those with no/mild fibrosis (16%, 28 kg/m2 and 5.9%). HbA1c ≥7% was found to be an independent predictor of NASH (OR 5.11, 95% CI 2.61 to 9.98) and advanced fibrosis (OR 3.94, 95% CI 1.63 to 9.53). CONCLUSIONS NASH and advanced fibrosis were higher in our general adult autopsy population compared with previously published estimates. This is a large series with histological evaluation showing that HbA1c >7.0% is independently associated with NASH and advanced fibrosis.
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Affiliation(s)
- Kristina-Ana Klaric
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jacqueline Louise Parai
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Pathology and Laboratory Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Charis Anthea Kepron
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Pathology and Laboratory Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Alfredo Eugene Walker
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Pathology and Laboratory Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Christopher Mark Milroy
- Department of Pathology and Laboratory Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Pathology and Laboratory Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
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Lafci B, Hadjihambi A, Determann M, Konstantinou C, Freijo C, Herraiz JL, Blümel S, Pellerin L, Burton NC, Deán-Ben XL, Razansky D. Multimodal assessment of non-alcoholic fatty liver disease with transmission-reflection optoacoustic ultrasound. Theranostics 2023; 13:4217-4228. [PMID: 37554280 PMCID: PMC10405839 DOI: 10.7150/thno.78548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/31/2023] [Indexed: 08/10/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an umbrella term referring to a group of conditions associated to fat deposition and damage of liver tissue. Early detection of fat accumulation is essential to avoid progression of NAFLD to serious pathological stages such as liver cirrhosis and hepatocellular carcinoma. Methods: We exploited the unique capabilities of transmission-reflection optoacoustic ultrasound (TROPUS), which combines the advantages of optical and acoustic contrasts, for an early-stage multi-parametric assessment of NAFLD in mice. Results: The multispectral optoacoustic imaging allowed for spectroscopic differentiation of lipid content, as well as the bio-distributions of oxygenated and deoxygenated hemoglobin in liver tissues in vivo. The pulse-echo (reflection) ultrasound (US) imaging further provided a valuable anatomical reference whilst transmission US facilitated the mapping of speed of sound changes in lipid-rich regions, which was consistent with the presence of macrovesicular hepatic steatosis in the NAFLD livers examined with ex vivo histological staining. Conclusion: The proposed multimodal approach facilitates quantification of liver abnormalities at early stages using a variety of optical and acoustic contrasts, laying the ground for translating the TROPUS approach toward diagnosis and monitoring NAFLD in patients.
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Affiliation(s)
- Berkan Lafci
- Institute of Pharmacology and Toxicology and Institute for Biomedical Engineering, Faculty of Medicine, University of Zurich, Switzerland
- Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Anna Hadjihambi
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King's College London
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Madita Determann
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christos Konstantinou
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King's College London
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Clara Freijo
- Nuclear Physics Group and IPARCOS, Complutense University of Madrid, Madrid, Spain
| | - Joaquin L. Herraiz
- Nuclear Physics Group and IPARCOS, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Sena Blümel
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Luc Pellerin
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
- Inserm U1313, Université et CHU de Poitiers, Poitiers, France
| | | | - Xosé Luís Deán-Ben
- Institute of Pharmacology and Toxicology and Institute for Biomedical Engineering, Faculty of Medicine, University of Zurich, Switzerland
- Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Daniel Razansky
- Institute of Pharmacology and Toxicology and Institute for Biomedical Engineering, Faculty of Medicine, University of Zurich, Switzerland
- Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
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Vishwajeet V, Purohit A, Kumar D, Vijayvergia P, Tripathi S, Kanchan T, Kothari N, Dutt N, Elhence PA, Bhatia PK, Nag VL, Garg MK, Misra S. Evaluation of Liver Histopathological Findings of Coronavirus Disease 2019 by Minimally Invasive Autopsies. J Clin Exp Hepatol 2022; 12:390-397. [PMID: 34312578 PMCID: PMC8294712 DOI: 10.1016/j.jceh.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
AIM The severe acute respiratory syndrome coronavirus 2 outbreak resulted in severe health impact with the loss of many lives across the world. Pulmonary parenchyma suffers the most from the brunt of the infection. However, evidence suggested a systemic involvement during the course of illness. Information on morphological changes of the liver is sparse in the literature. We aimed to evaluate the pathological findings in the liver by minimally invasive autopsies. METHODS Postmortem core biopsies of the liver obtained from patients who succumbed to coronavirus disease 2019 disease were studied. Demographic findings, comorbidities, and relevant laboratory tests were collected. Detailed histopathological changes were assessed. RESULTS Liver function tests were available in 40 cases, and it was deranged in 80% cases. A spectrum of histological changes was observed. Macrovesicular steatosis and nonspecific portal inflammation of mild degree were the common morphological changes. Features suggestive of vascular alteration were noted in more than half of the cases. These included increased portal vein branches, irregular luminal dilation, and herniation of portal veins into the periportal hepatocytes. In addition, we observed morphological changes attributed to terminal shock-related changes. CONCLUSION The present study results highlight that liver parenchyma changes may be related to multiple pathogenic mechanisms. The presence of vascular alteration in portal tracts suggests derangement of hepatic vasculature related to systemic hypercoagulable state induced by the viral infection. It remains to be established if the histological changes are related to direct viral insult or to the systemic response caused by the viral attack.
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Key Words
- ACE2, Angiotensin-Converting Enzyme 2
- ALT, Alanine Aminotransferase
- ARDS, Adult Respiratory Distress syndrome
- AST, Aspartate Aminotransferase
- CBC, Complete Blood Count
- CK-MB, Creatine Kinase-MB
- COVID-19
- COVID-19, Coronavirus Disease 2019
- ISH, In situ Hybridization
- LDH, Lactate Dehydrogenase
- LFTs, Liver Function Tests
- PCR, Polymerase Chain Reaction
- RNA, Ribonucleic Acid
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- abnormal liver chemistries
- autopsy
- liver pathology
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Affiliation(s)
- Vikarn Vishwajeet
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Abhishek Purohit
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Parag Vijayvergia
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Swapnil Tripathi
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Nikhil Kothari
- Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Poonam A. Elhence
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Pradeep K. Bhatia
- Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Vijaya L. Nag
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Mahendra K. Garg
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
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Orekhova K, Mazzariol S, Sussan B, Bucci M, Bonsembiante F, Verin R, Centelleghe C. Immunohistochemical Markers of Apoptotic and Hypoxic Damage Facilitate Evidence-Based Assessment in Pups with Neurological Disorders. Vet Sci 2021; 8:vetsci8100203. [PMID: 34679033 PMCID: PMC8537515 DOI: 10.3390/vetsci8100203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Seizures in puppies often present a diagnostic challenge in terms of identifying and treating the underlying cause. Dog breeds with mutations of the MDR1-gene are known to show adverse reactions to certain drugs, yet metabolic imbalance exacerbated by physiologically immature organs and other contributing pathologies require consideration before arriving at a diagnosis. This study analysed the brains of two male, 5-week-old Australian Shepherd siblings that died after displaying severe neurological symptoms upon administration of MilproVet® to treat severe intestinal helminth infection. Despite the initial symptoms being similar, their case histories varied in terms of the symptom duration, access to supportive therapy and post-mortem interval. Histopathology and immunohistochemistry were used to obtain more information about the phase of the pathological processes in the brain, employing protein markers associated with acute hypoxic damage (β-amyloid precursor protein/APP) and apoptosis (diacylglycerolkinase-ζ/DGK-ζ, apoptotic protease activating factor 1/Apaf1, and B-cell lymphoma related protein 2/Bcl-2). The results seem to reflect the course of the animals' clinical deterioration, implicating that the hypoxic damage to the brains was incompatible with life, and suggesting the usefulness of the mentioned immunohistochemical markers in clarifying the cause of death in animals with acute neurological deficits.
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Affiliation(s)
- Ksenia Orekhova
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
- Correspondence:
| | - Sandro Mazzariol
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
| | - Beatrice Sussan
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Massimo Bucci
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Federico Bonsembiante
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
- Department of Animal Medicine, Production and Health, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (B.S.); (M.B.)
| | - Ranieri Verin
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
| | - Cinzia Centelleghe
- Department of Comparative Biomedicine and Food Science, University of Padova AGRIPOLIS, viale dell’Università 16, 35020 Legnaro, Italy; (S.M.); (F.B.); (R.V.); (C.C.)
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Guler E, Unal NG, Cinkooglu A, Savas R, Kose T, Pullukcu H, Harman M, Elmas NZ, Ramaiya NH, Ozutemiz AO. Correlation of liver-to-spleen ratio, lung CT scores, clinical, and laboratory findings of COVID-19 patients with two consecutive CT scans. Abdom Radiol (NY) 2021; 46:1543-1551. [PMID: 33051758 PMCID: PMC7553377 DOI: 10.1007/s00261-020-02805-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Given the lack of information about abdominal imaging findings and correlation with clinical features of COVID-19, we aimed to evaluate the changes in hepatic attenuation during the course of disease. Our aim was to correlate the liver-to-spleen ratio (L/S), clinical, laboratory findings, and lung CT scores of patients with COVID-19 who had two consecutive chest CTs. METHODS A retrospective search was performed between March 1, 2020 and April 26, 2020 to identify patients who had positive RT-PCR tests and two unenhanced chest CTs. Scans that were obtained at hospital admission and follow-up were reviewed to assess L/S and lung CT scores. Patients were divided into two groups based on lung CT scores (non-progressive vs progressive). Patient demographics, laboratory findings, length of hospital stay, and survival were noted from electronic medical records. RESULTS Twenty patients in the progressive group and 7 patients in the non-progressive group were identified. The mean L/S of the progressive group (1.13 ± 0.3) was lower than that of the non-progressive group (1.21 ± 0.29) at hospital admission but there was no significant difference between the two groups (p = 0.547). L/S at follow-up was significantly different between the groups as the mean L/S values of the progressive and non-progressive groups were 1.02 ± 0.23 and 1.25 ± 0.29, respectively (p = 0.009). L/S was negatively correlated with AST and ALT (r = - 0.46, p = 0.016 and r = - 0.534, p = 0.004, respectively). There were significant differences between the two groups in terms of WBC, neutrophil, lymphocyte, monocyte, and platelet counts that were obtained at hospital admission. Length of hospital stay was significantly longer in patients in the progressive group (p = 0.035). CONCLUSIONS Decrease in L/S may be observed in patients with elevated lung CT scores at follow-up. WBC, neutrophil, lymphocyte, monocyte, and platelet counts at hospital admission may predict the progression of COVID-19.
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Affiliation(s)
- Ezgi Guler
- Department of Radiology, Faculty of Medicine, Ege University, Bornova, Izmir, 35100, Turkey.
| | - Nalan Gulsen Unal
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Akin Cinkooglu
- Department of Radiology, Faculty of Medicine, Ege University, Bornova, Izmir, 35100, Turkey
| | - Recep Savas
- Department of Radiology, Faculty of Medicine, Ege University, Bornova, Izmir, 35100, Turkey
| | - Timur Kose
- Department of Biostatistics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Husnu Pullukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Faculty of Medicine, Ege University, Bornova, Izmir, 35100, Turkey
| | - Nevra Z Elmas
- Department of Radiology, Faculty of Medicine, Ege University, Bornova, Izmir, 35100, Turkey
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Ahmet Omer Ozutemiz
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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Nontraumatic Multiple-Organ Fat Embolism: An Autopsy Case and Review of Literature. Am J Forensic Med Pathol 2020; 41:131-134. [PMID: 32379096 DOI: 10.1097/paf.0000000000000544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The patient was an 88-year-old woman with a 10-year history of hypertension. She was suspected to have been hit by a car. At the time of the event, she was conscious and able to stand on her own and had no obvious injuries. She was sent home, but she lapsed into unconsciousness and was nonresponsive after 2 hours. She was sent to the hospital, and her heartbeat and breathing stopped. After half an hour of rescue attempts, her heartbeat did not recover, and she was declared dead. During the autopsy, a small subcutaneous hemorrhage was observed below the right knee joint. No obvious internal organ injuries or bone fractures were observed. The deceased also had mild atherosclerosis in the coronary arteries and an old cerebral infarction in the right cerebellum. The tissue histopathological tests showed distinct fat embolism in multiple organs, including the brain, lungs, kidneys, liver, and pancreas. A postmortem blood biochemistry test of the heart blood showed that the levels of low-density lipoprotein, cholesterol, triglycerides, and free fatty acids in the blood were increased, and the level of C-reactive protein was elevated. According to the autopsy results, the direct cause of death was multiorgan fat embolism. This case suggests that aging, hypertension, and hyperlipidemia may be risk factors for nontraumatic fat embolism under stressful conditions.
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Hepatic pathology in patients dying of COVID-19: a series of 40 cases including clinical, histologic, and virologic data. Mod Pathol 2020; 33:2147-2155. [PMID: 32792598 PMCID: PMC7424245 DOI: 10.1038/s41379-020-00649-x] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
The novel coronavirus SARS-CoV-2 (coronavirus disease 19, or COVID-19) primarily causes pulmonary injury, but has been implicated to cause hepatic injury, both by serum markers and histologic evaluation. The histologic pattern of injury has not been completely described. Studies quantifying viral load in the liver are lacking. Here we report the clinical and histologic findings related to the liver in 40 patients who died of complications of COVID-19. A subset of liver tissue blocks were subjected to polymerase chain reaction (PCR) for viral ribonucleic acid (RNA). Peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated; median ALT peak 68 U/l (normal up to 46 U/l) and median AST peak 102 U/l (normal up to 37 U/l). Macrovesicular steatosis was the most common finding, involving 30 patients (75%). Mild lobular necroinflammation and portal inflammation were present in 20 cases each (50%). Vascular pathology, including sinusoidal microthrombi, was infrequent, seen in six cases (15%). PCR of liver tissue was positive in 11 of 20 patients tested (55%). In conclusion, we found patients dying of COVID-19 had biochemical evidence of hepatitis (of variable severity) and demonstrated histologic findings of macrovesicular steatosis and mild acute hepatitis (lobular necroinflammation) and mild portal inflammation. We also identified viral RNA in a sizeable subset of liver tissue samples.
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