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Campos MAG, Cutrim ÉAM, Cutrim ÉMM, de Oliveira JVP, de Oliveira EJSG, Pontes DDB, de Figueiredo JA, Silva GEB. Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital. Rev Inst Med Trop Sao Paulo 2024; 66:e33. [PMID: 38747854 PMCID: PMC11095245 DOI: 10.1590/s1678-9946202466033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.
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Affiliation(s)
- Marcos Adriano Garcia Campos
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | - Érico Murilo Monteiro Cutrim
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gyl Eanes Barros Silva
- Universidade Federal do Maranhão, Faculdade de Medicina, São Luís, Maranhão, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia e Medicina Legal, Ribeirão Preto, São Paulo, Brazil
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Das S, Roy A, Das R. New autopsy technique in COVID-19 positive dead bodies: opening the thoracic cavity with an outlook to reduce aerosol spread. J Clin Pathol 2023; 76:664-670. [PMID: 35701143 PMCID: PMC9240445 DOI: 10.1136/jclinpath-2022-208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
AIMS After the advent of the COVID-19 pandemic, most countries have modified some of their health-related regulations. However, this has not been in the case of the postmortem of deceased because it has a legal aspect. Thus, the healthcare providers knowingly or unknowingly faced the threat of COVID-19 exposure from those dead bodies. To introduce an autopsy technique that reduces the droplet spreads, especially in those mortuaries where the biosafety mechanism is not highly equipped. METHODS The validity of the new incision was achieved through the calculation of the Scale Content Validity Index (SCVI) taking inputs from 17 forensic specialists. The subjects for the new technique were selected from the patients who were RTPCR positive for COVID-19 or clinically or radiologically showing features of COVID-19. RESULTS The dissection procedure was finalised by achieving the SCVI at 0.92. The chest cavity was approached through the abdominal cavity by opening the diaphragm and dissecting out the contents of the chest using a long blade knife. CONCLUSIONS The advantage of this approach is that the autopsy surgeon and pathologists do not have to open the chest cavity by dissecting the Sternum, and hence the chance of droplet infection becomes almost nil. This technique is complete, simple, less time-consuming and conducive for sample collection, and even reduces the possibility of body fluid seepage following a postmortem examination.
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Affiliation(s)
- Somnath Das
- Forensic Medicine and Toxicology, RG Kar Medical College, Kolkata, West Bengal, India
| | - Anshuman Roy
- Anatomy, Raiganj Government Medical College, Raiganj, West Bengal, India
| | - Rina Das
- Forensic Medicine and Toxicology, NRS Medical College, Kolkata, West Bengal, India
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Bailo P, Gibelli F, Ricci G, Sirignano A. Verbal Autopsy as a Tool for Defining Causes of Death in Specific Healthcare Contexts: Study of Applicability through a Traditional Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11749. [PMID: 36142022 PMCID: PMC9517079 DOI: 10.3390/ijerph191811749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Autopsy examination, the gold standard for defining causes of death, is often difficult to apply in certain health care settings, especially in developing countries. The COVID-19 pandemic and its associated difficulties in terms of implementing autopsy examinations have made the need for alternative means of determining causes of death even more evident. One of the most interesting alternatives to the conventional autopsy is the verbal autopsy, a tool that originated in Africa and Asia in the 1950s and consists of a structured interview with the deceased's family members concerning the symptoms manifested by the person and the circumstances of death. In the early 1990s, the first doubts emerged about the validity of verbal autopsies, especially about the real reliability of the cause of death identified through this tool. The objective of the review was to identify studies that had assayed the validity of verbal autopsies through a rigorous comparison of the results that emerged from it with the results of conventional autopsies. When starting from an initial pool of 256 articles, only 2 articles were selected for final review. These are the only two original research articles in which a verbal autopsy validation process was performed by employing the full diagnostic autopsy as the gold standard. The two papers reached opposite conclusions, one suggesting adequate validity of verbal autopsy in defining the cause of death and the other casting serious doubts on the real applicability of this tool. Verbal autopsy undoubtedly has extraordinary potential, especially in the area of health and demographic surveillance, even considering the implementation that could result from the use of artificial intelligence and deep learning. However, at present, there appears to be a lack of solid data to support the robust reliability of this tool in defining causes of death.
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Affiliation(s)
- Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, Piazza Cavour, 19, 62032 Camerino, Italy
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Melo DN, Lima GRP, Fernandes CG, Teixeira AC, Filho JB, Araújo FMC, Araújo LC, Siqueira AM, Farias LABG, Monteiro RAA, Ordi J, Martinez MJ, Saldiva PHN, Cavalcanti LPG. Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil. Trop Med Infect Dis 2022; 7:tropicalmed7070123. [PMID: 35878135 PMCID: PMC9316822 DOI: 10.3390/tropicalmed7070123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.
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Affiliation(s)
- Deborah N. Melo
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
| | - Giovanna R. P. Lima
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
| | - Carolina G. Fernandes
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
| | - André C. Teixeira
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
- Argos Laboratory, Fortaleza 60175-047, Brazil
| | - Joel B. Filho
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
| | | | - Lia C. Araújo
- Programa de Residencia Medica em Patologia pela Universidade Federal do Ceará, 60, Fortaleza 60020-181, Brazil;
| | | | | | - Renata A. A. Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (R.A.A.M.); (P.H.N.S.)
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
- ISGlobal, Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Miguel J. Martinez
- ISGlobal, Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Paulo H. N. Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (R.A.A.M.); (P.H.N.S.)
| | - Luciano P. G. Cavalcanti
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
- Correspondence: ; Tel.: +55-85-999878969
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Esposito M, Salerno M, Scoto E, Di Nunno N, Sessa F. The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview. Healthcare (Basel) 2022; 10:healthcare10020319. [PMID: 35206933 PMCID: PMC8871677 DOI: 10.3390/healthcare10020319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 12/12/2022] Open
Abstract
During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.
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Affiliation(s)
- Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.); (E.S.)
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.); (E.S.)
| | - Edmondo Scoto
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.); (E.S.)
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-881-736926
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