Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan

Background@#Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19–positive autopsies performed in Jordan. @*Methods@#The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. @*Results@#Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. @*Conclusions@#The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement

PURPOSE: To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. METHODS: Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. RESULTS: During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). CONCLUSION: This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Aspirin resistance in patients undergoing coronary artery bypass grafting

Aspirin is a very common drug used after coronary artery bypass grafting. Significantly it is known to reduce mortality and the rate of ischemic complications after CABG. Resistance to Aspirin is a well known entity and has a great influence on clinical outcome. Our study will investigate the phenomenon of aspirin resistance in our patients that underwent coronary artery bypass surgery. In a prospective controlled study 100 patients undergoing coronary artery bypass grafting [CABG] were included to investigate their sensitivity to Aspirin using platelets aggregometry study. Patients were followed up after one year to show their clinical outcome. 25 patients [25%] showed normal reaction to Aspirin [sensitive to treatment]. 24 patients [24%] were preoperatively resistance to Aspirin and 51 patients [51%] developed this resistance postoperatively. The use of cardiopulmonary bypass, pump time and type of procedure showed no influence on the resistance rate. The one year follow up showed 5 deaths in the group of patients that developed the resistance preoperatively whereas resistance disappeared completely after one year in the perioperative resistant group. Aspirin resistance occurs in a large portion of patients that undergo open heart surgery for coronary artery bypass grafting. It doesn't appear to last permanently but rather for a brief period. The worse outcome for patients with Aspirin resistance could be assumpted by the increase mortality in this group