Hallazgos histopatológicos pulmonares asociados a COVID-19. Una revisión sistemática y meta-análisis / Histopathological findings in lungs of COVID-19 infected subjects. A systematic review and meta-analysis

El COVID-19 es una nueva enfermedad que requería resultados prontos provenientes de la investigación. Un abordaje para la comprensión de su fisiopatología es conocer el daño a nivel histopatológico que genera en los pulmones de los afectados. Objetivo. Proveer un resumen riguroso de la evidencia disponible sobre los hallazgos histopatológicos pulmonares en pacientes con COVID-19. Se desarrolló una revisión sistemática con metaanálisis de proporciones. Se incluyeron estudios primarios de cualquier diseño que tuvieran datos primarios de hallazgos histopatológicos de pulmones en pacientes COVID-19. Se excluyeron revisiones y guías. Las fuentes de información fueron el repositorio centralizado Living OVerview of Evidence, PubMed/Medline, LitCovid, la base de datos COVID-19 de la Organización Mundial de la Salud, y medRxiv hasta el 3 de abril 2021. La evaluación del riesgo de sesgos se realizó utilizando las herramientas del Instituto Joanna Briggs para series de casos y reportes de casos. Se extrajo cada dato de hallazgo pulmonar histopatológico. Se calcularon las frecuencias encontradas y los datos de los hallazgos más frecuentes fueron resumidas en metaanálisis usando el método de efectos aleatorios de Der Simmonian-Liard. Se midió la heterogeneidad. Los criterios de inclusión fueron cumplidos por 69 artículos sumando 594 sujetos. Presentaron bajo riesgo de sesgos 35 artículos. El metaanálisis de proporciones mostro daño alveolar difuso en 0,62 (IC 95 % 0,51-0,72), I2 59 % (p < 0,01), en su fase temprana (85,14 %). Conclusión. El daño alveolar difuso temprano fue el hallazgo histopatológico más frecuente en muestras pulmonares de pacientes con COVID-19

COVID-19 is a new disease that required prompt results from research. An approach to understanding its pathophysiology is to know the damage at the histopathological level that it generates in the lungs of those affected. Aim. To provide a rigorous summary of the available evidence on pulmonary histopathological findings in patients with COVID-19. A systematic review with meta-analysis of proportions was developed. Primary studies of any design that had primary data on lung histopathology findings in COVID-19 patients were included. Reviews and guidelines were excluded. The sources of information were the Living OVerview of Evidence centralized repository, PubMed/Medline, LitCovid, the World Health Organization COVID-19 database, and medRxiv up to April 3, 2021. The risk of bias assessment was performed using the Joanna Briggs Institute tools for case series and case reports. Each histopathological pulmonary finding data was extracted. The frequencies found were calculated and the data of the most frequent findings were summarized in meta-analyses using the Der Simmonian-Liard random effects method. Heterogeneity was measured. The inclusion criteria were met by 69 articles totaling 594 subjects. Thirty-five articles presented low risk of bias. The meta-analysis of proportions showed diffuse alveolar damage in 0.62 (95% CI 0.51-0.72), I2 59% (p < 0.01), in its early phase (85.14%). Conclution. Early diffuse alveolar damage was the most frequent histopathological finding in lung samples from patients with COVID-19

Visión de las causas de muerte por la COVID-19 con las experiencias de las autopsias / Vision of the causes of death by COVID-19 with the experiences of autopsies

RESUMEN El 30 de enero de 2020, la Organización Mundial de la Salud declaró a la infección por SARS-CoV-2 una emergencia internacional de salud pública. La autopsia, considerada el mejor método de estudio del enfermo y la enfermedad, corrobora que los pacientes pueden morir por la acción directa del virus (fallecidos por la COVID-19), mientras que otros positivos al SARS-CoV-2, no mostraron cambios morfológicos pulmonares atribuidos a la acción del virus. Se propone establecer los criterios diagnósticos morfológicos en el contexto de la epidemia por el SARS-CoV-2 y la COVID-19 en los fallecidos en Cuba, a partir del estudio sistemático de las autopsias. Se han identificado los patrones morfológicos que se establecen en los pulmones de los pacientes fallecidos bajo el efecto de la COVID-19. El edema pulmonar de permeabilidad con el ensanchamiento de tabique pulmonar, el depósito de la membrana hialina desorganizada en el interior de los alveolos, el desprendimiento de células epiteliales (neumocitos y células bronquiales y bronquiolares), seguida de la hiperplasia epitelial con presencia en ocasiones de cambios metaplásicos y atipias, y finalmente, la fibrosis. Cuando se realizan autopsias, es posible ubicar cada enfermedad en su lugar, en el cronopatograma, lo que permite realizar el reparo de los certificados de defunción, para evaluar el lugar que la COVID-19 ha ocupado como causa de muerte en la población estudiada. En criterio del colectivo, identificar en las alteraciones morfológicas, es imprescindible para elaborar el cronopatograma del fallecido y la adecuada evaluación clínico patológica del paciente.

ABSTRACT On January 30, 2020, the World Health Organization (WHO) declared SARS-CoV-2 infection an international public health emergency. The autopsy, considered the best method of studying the patient and the disease, corroborates that patients can die from the direct action of the virus (who died from COVID-19), while others positive for SARS-CoV-2 did not show morphological lung changes attributed to the action of the virus. It is proposed to establish the morphological diagnostic criteria in the context of the SARS-CoV-2 and COVID-19 epidemic in the deceased in Cuba based on the systematic study of autopsies. The morphological patterns that are established in the lungs of patients who died under the effect of COVID-19 have been identified. The pulmonary edema of permeability with the widening of the pulmonary septum, the deposit of the disorganized hyaline membrane inside the alveoli, the detachment of epithelial cells (pneumocytes and bronchial and bronchiolar cells), followed by epithelial hyperplasia with sometimes the presence of metaplastic changes and atypia, and finally, fibrosis. When autopsies are performed, it is possible to locate each disease in its place, in chronopathogram, which allows death certificates repair to be carried out to assess the place that COVID-19 has occupied as a cause of death in the population studied. In the opinion of the group, identifying morphological alterations is essential to prepare the chronopathogram of the deceased and the adequate clinical-pathological evaluation of the patient.

Autopsias en fallecidos de la tercera edad / Autopsies in elderly deceased elderly

Introducción: La Organización Mundial de la Salud promueve un compromiso con el envejecimiento saludable. La autopsia constituye el método más completo para el estudio de las enfermedades, y en los fallecidos de la tercera edad se evidencian sus problemas de salud. Objetivo: Mostrar las particularidades en edad, sexo, enfermedades crónicas, en particular los tumores malignos, la sepsis y causas de muerte que se encuentran en las autopsias de fallecidos de la tercera edad. Método: se realizó un estudio retrospectivo, longitudinal, entre los años 1987-2017 de las autopsias en fallecidos de la tercera edad. Se agrupan por edades: edad avanzada, anciana y grande longeva. Se exploran las variables de edad y sexo, enfermedades crónicas, infección y causas de muerte. Resultados: Los fallecidos de la tercera edad constituyen más de las tres cuartas partes de las autopsias en la institución. El sexo femenino muestra mayor longevidad. La hipertensión arterial, diabetes y el cáncer decrecen con la edad, mientras la sepsis se incrementa. Aumentan progresivamente en las causas de muerte directa, la sepsis y el tromboembolismo, mientras disminuyen el choque, edema pulmonar e infarto cardiaco. Aumenta en las causas básicas la aterosclerosis cerebral y generalizada, disminuye la coronaria, la enfermedad hipertensiva y los tumores malignos. La no coincidencia clínico patológica aumenta con la edad, discretamente. Conclusiones: Existen particularidades en el estudio de los pacientes de la tercera edad, evidenciado por los resultados de autopsia, por lo que se recomienda la geriatrización de los servicios(AU)

Introduction: The World Health Organization promotes a commitment to healthy aging. The autopsy is the most complete method for the study of the diseases and in the elderly deceased their health problems are evidenced. Objective: To show the particularities in ages, sex, chronic diseases, in particular malignant tumors, sepsis and causes of death found in the autopsies of the deceased elderly people. Method: A retrospective, longitudinal study was carried out between the years 1987-2017 of autopsies in elderly deceased. They were grouped by age: advanced age, elderly and long-lived. The variables age, sex, chronic diseases, infection and causes of death were explored. Results: The elderly deceased were more than three quarters of the autopsies in the institution. The female sex showed greater longevity. Hypertension, diabetes and cancer decreased with age, while sepsis increased. Sepsis and thromboembolism were progressively increasing in the direct causes of death, while shock, pulmonary edema and cardiac infarction decreased. In basic causes, cerebral and generalized atherosclerosis increased and coronary atherosclerosis, hypertensive disease and malignant tumors decreased. The clinical - pathology no coincidence, increased slightly with age. Conclusions: There are particularities in the studies of elderly patients evidenced by the results of autopsy, so that geriatrification of services is necessary(AU)

A Comprehensive Study of Deaths due to Railway Accidents Reported at a Tertiary Care Hospital Mortuary during the Period of January to December 2015

Introduction: Cities are locations having a high level ofaccumulation and concentration of economic activities andare complex spatial structures that are supported by transportsystems. The evolution of mass rapid transport system in theform of sub-urban railway network has increased railwaycasualties in the cities as the railroads pass through residentialand commercial zones. Hence, the aim of the present studywas to assess the analysis of death due to railway accidents ina tertiary care hospital.Material and Methods: During the study period, total 5240autopsies were conducted in Osmania General HospitalMortuary, out of which 474 were due to railway accidents.All the findings of autopsy report were noted and relevantphotos at the time of autopsy were taken. In relevant cases,wherever necessary the organ were collected and was sent forhistopathological examination. Autopsy on all cases of deathsdue to railway accidents conducted at Mortuary, OsmaniaGeneral Hospital in 2015 were included in the present study.Results: Maximum fatalities were reported among thirddecade of life i.e. 31-40 years followed by second and fourthdecade i.e. 21-30 years. Lowest number of fatalities wasreported from eighth and first decade of life i.e. 81-90 years. Inaccidental cases cause of death in most of the cases is multipleinjuries, followed by head injury and head injury associatedwith other injuries.Conclusion: Highest number of accidents happened whilecrossing the railway track, followed by people lying on thetrack or jumping in front of a moving train. In suicidal deathsmost of the cases were due to decapitation, followed by crushinjuries. About 7 cases of traumatic transection were reportedduring the period of study.

An assessment of factors responsible for diarrhoea deaths of under five children in rural and urban settings of India

Background: Very little scientifically based information is available on cause-specific mortality rates of diarrhoea among all regions and populations wherein an inequitable proportion exits in low-income households, which have fewer resources and less knowledge to manage burden than high-income households. The strategic purpose of the study is to identify gaps in care seeking in order to make changes in approach to address these gaps either directly by working with the community and by doing area specific advocacy to improve service delivery through government channels.Methods: The study was conducted in nine locations (6 rural and 3 urban) of India. The ethical and confidentiality parameters of conducting verbal autopsies were followed and random sampling methodology was adapted.Results: Respondents of our study attributed 22% deaths to diarrhoea. From the study, it is revealed that children who passed stool for 5 or more number of times in a day are more likely to die 1.5 times than the children who passed stool for 3 times a day. Children having diarrhoea for 5 days or more than 5 days are more likely to die 1.6 times in comparison to the children who have had diarrhoea for 3 days. Approximately seven of the ten children died within five days of treatment.Conclusions: Information on diarrheal diseases, its determinants in India and preventive and control strategies in light of recent developments need to be reviewed for better planning and organization of health services within the community.

Autopsias realizadas por el Dr. Salvador Allende en el Hospital Carlos van Buren de Valparaíso, Chile / Autopsies performed by Dr. Salvador Allende at Carlos van Buren Hospital of Valparaíso, Chile

Introducción: entre los años 1933 y 1937, el Dr. Salvador Allende trabajó con regularidad en el servicio de Anatomía Patológica del Hospital Carlos van Buren de Valparaíso (HCVB), realizando autopsias en los casos de muertes de causa médica. Materiales y método: se revisaron los libros del servicio de Anatomía Patológica del HCVB del año 1937 y se seleccionaron las autopsias realizadas por el Dr. Allende. Los libros y autopsias de los años 1933 a 1936 no pudieron ser encontrados. Los datos demográficos de los pacientes se traspasaron a una planilla Excel. Los resultados se expresaron en números y porcentajes. Resultados: el Dr. Allende realizó 54 autopsias durante un periodo de 5 meses, lo que correspondió al 12,6% de las realizadas ese año. De los 54 pacientes, 48 (88,8%) correspondieron al sexo masculino, con un promedio de edad de 46 (9-97) años. La mayoría tenían nacionalidad chilena y estaban cesantes. El 53,7% de los casos falleció por una causa infecciosa y las más frecuentes fueron la neumonía y la tuberculosis. La concordancia entre los diagnósticos clínicos y de Anatomía Patológica fue de un 70,3%. Conclusiones: se encontró solo una parte de las autopsias realizadas por el Dr. Allende en el HCVB. La mayoría de los pacientes fallecidos fueron jóvenes del sexo masculino y cesantes. Las principales causas de muerte fueron la neumonía y la tuberculosis. (AU)

Introduction: Dr. Salvador Allende often worked between the years 1933 and 1937 for the pathology department in the Carlos van Buren Hospital, performing autopsies in the medical cause death cases. Materials and Methods: the pathology department books from 1937 were reviewed searching for the autopsies performed by Dr. Allende and those were selected. The books and autopsies of the years 1933-1936 could not be found. The demographic data about patients were transfered into an excel spreadsheet. The results were expressed as numbers and percentages. Results: Dr. Allende performed 54 autopsies over a period of 5 months, which corresponded to 12.6% of all the autopsies performed that year. Of the 54 patients, 48 were male (88.8%), with an average age of 46 (9-97) years. Most of them had Chilean nationality and unemployed. 53.7% of studied cases died by an infectious cause being the most common pneumonia and tuberculosis. The concordance between clinical diagnoses and pathology department were 70.3%. Conclusions: Only a small part of the autopsies performed by Dr. Salvador Allende in HCVB was found. Most deceased patients were young men and unemployed. The main causes of death were pneumonia and tuberculosis.(AU)

Experiencias en autopsias del servicio Anatomía Patológica del Hospital Militar Central "Dr. Luis Díaz Soto" / Experiences in autopsies of the Pathological Anatomy Department of the Hospital Militar Central "Dr. Luis Díaz Soto"

Introducción: La autopsia constituye el método más completo para el estudio del enfermo y la enfermedad. Sus resultados muestran los reales problemas de salud de una población. Objetivo: Caracterizar la distribución según edad y sexo de los fallecidos con autopsias realizadas en la institución e identificar las principales causas de muertes en relación al sexo, grupos de edad y frecuencia de años. Métodos: Se realizó un estudio retrospectivo, longitudinal, entre los años 1962-2016 de las autopsias realizadas en el centro. Se organizan grupos de estudio por sexo, grupos de edades y años de trabajo de la institución. Se exploran las variables de causas de muerte y tumores malignos por sexo. Resultados: Las causas de muerte más frecuentes en relación al sexo muestran similitud, con amplia frecuencia de la bronconeumonía en casi la quinta parte de las autopsias. Las causas de muerte según grupos de edades, muestran similitud en los grupos de mayores años. Las enfermedades cardiovasculares, sépticas y tumorales (representado por el tumor maligno del pulmón), ocupan los primeros lugares. Conclusiones: La experiencia alcanzada en el estudio de miles de autopsias, permite establecer bases metodológicas que deben ser analizadas como propuestas para medir la calidad de la asistencia médica que se brinda y los resultados expuestos, valorados como indicadores efectivos de los problemas de salud que deben ser enfrentados(AU)

Introduction: Autopsy is the most complete method for studying the patient and the disease. Their results show the real health problems of a population. Objective: Characterize the distribution according to age and sex of the deceased with autopsies performed in the institution and identify the main causes of death in relation to sex, age groups and frequency of years. Methods: A retrospective longitudinal study was carried out, between 1962 and 2016, of the autopsies performed at the hospital. Study groups were organized by sex, age groups and institution years of work. The variables of causes of death and malignant tumors are explored by sex. Results: The most frequent causes of death in relation to sex show similarity, with a high frequency of bronchopneumonia in almost a fifth of the autopsies. The causes of death according to age groups show similarity in the groups of older years. Cardiovascular, septic and tumor diseases, represented by the malignant tumor of the lung occupy the first places. Conclusions: The experience gained in the study of thousands of autopsies, allows establishing methodological bases that must be analyzed as proposals to measure the quality of the medical assistance that is provided and the exposed results, valued as effective indicators of the health problems that must be faced(AU)

O suicídio de idosos em Teresina: fragmentos de autópsias psicossociais / The suicide of elderly people in Teresina: fragments of psychosocial autopsies

Este estudo tem como objetivo discutir acerca das principais circunstâncias que envolveram suicídios de idosos ocorridos na cidade de Teresina, PI. Trata-se de um estudo de natureza qualitativa, descritiva, exploratória, viabilizado por meio da utilização de autópsias psicossociais de cinco casos de suicídio de idosos. Para isso, investigou-se retrospectivamente a vida desses sujeitos, a partir de entrevistas aplicadas com familiares que conviviam próximos às vítimas. O método utilizado agrupou três tipos de instrumentos: ficha de identificação pessoal e social do idoso, genograma e entrevista semiestruturada. As histórias reconstituídas foram analisadas qualitativamente, tomando-se como guia os princípios da hermenêutico-dialética. Observou-se a presença marcante de algumas circunstâncias de risco associadas aos suicídios investigados, entre as quais se apontam condições de vida e fatores de risco, a saber, relações afetivas fragilizadas, vida desprovida de sentido, depressão, uso abusivo do álcool, traços de personalidade impulsivo-agressiva e ocorrência de tentativas de suicídio anteriores.

This study aims to discuss about the circumstances that involved the suicide of elderly people that occurred in Teresina city, PI. It is a qualitative, descriptive, exploratory study made through psychosocial autopsies of five suicidal cases of elderly people. Thereunto, it was investigated retrospectively the life of these subjects, by interviews with relatives who lived nearby the victims. The method used has grouped three types of instruments: personal and social identification form of the elder, genogram and semi structured interview. The stories were analyzed qualitatively, reconstructed taking as a guide the principles of hermeneutical-dialectic. It has been observed that the outstanding presence of some risk circumstances associated to the investigated suicides, which there were fragile affective relationships, meaningless life, depression, abuse of alcohol, aggressive impulsive personality traits and occurrence of previous suicide attempts.

Variables demográficas, clínicas y anatomopatológicas en fallecidos del servicio de Nefrología del Hospital "Dr. Luis Díaz Soto" entre 1974-2013 / Demographic, Clinical and Anatomical and Pathological Variables in Deaths of the Nephrology Department of Dr. Luis Díaz Soto Hospital (1974-2013)

Introducción: las enfermedades renales constituyen una causa frecuente de consulta médica, de ingreso hospitalario y de mortalidad. Objetivo: analizar algunas variables demográficas, clínicas y anatomopatológicas en fallecidos por estas enfermedades durante 40 años en un servicio de Nefrología. Métodos: estudio retrospectivo y observacional de variables demográficas, clínicas y anatomopatológicas en 272 fallecidos del servicio de nefrología del hospital Dr. Luis Díaz Soto, a los que se les practicó autopsia, ocurridas de 1974 al 2013. Resultados: predominaron los pacientes masculinos, de piel blanca y con edades de 35 a 64 años. La edad promedio se ha ido incrementando. Los principales diagnósticos clínicos de causa directa de muerte fueron bronconeumonía, infarto agudo de miocardio y shock. Como causa básica se plantearon la insuficiencia renal crónica, la hipertensión arterial y la diabetes mellitus. En los estudios anatomopatológicos fueron señaladas como más frecuentes causas directas de la muerte la bronconeumonía, el edema pulmonar, el shock y el infarto agudo de miocardio; mientras que en los principales diagnósticos de causa básica de muerte fueron registrados el riñón terminal, la cardiopatía hipertensiva, la diabetes mellitus y la aterosclerosis. Conclusiones: los indicadores de mortalidad, necropsia y correspondencia clínico patológica fueron adecuados. Se apreció un incremento, progresivo en el tiempo, de la edad de los pacientes fallecidos estudiados. La bronconeumonía y las cardiopatías fueron las principales causas de muerte. Los signos de aterosclerosis estuvieron presentes en la mayoría de los estudios realizados(AU)

Introduction: Renal diseases are a frequent cause of medical consultation, hospitalization and mortality. Objective: Analyze some demographic, clinical and anatomical and pathological variables in the deaths of renal diseases during 40 years in a Nephrology service. Methods: A retrospective and observational study was conducted of demographic, clinical and anatomical and pathological variables in 272 deaths of the nephrology service at Dr. Luis Díaz Soto hospital, who were autopsied, from 1974 to 2013. Results: There were predominantly male patients, white skin and aged 35 to 64 years. The average age has been increasing. The main clinical diagnoses of direct cause of death were bronchopneumonia, acute myocardial infarction and shock. As a basic cause, chronic renal failure, arterial hypertension and diabetes mellitus were considered. In anatomical and pathological studies, bronchopneumonia, pulmonary edema, shock and acute myocardial infarction were identified as more frequent causes of death; while in the main diagnoses of the basic cause of death, the terminal kidney, hypertensive heart disease, diabetes mellitus, and atherosclerosis were documented. Conclusions: Mortality, necropsy, and clinical pathological correspondence indicators were adequate. There was a progressive increase in the age of the deceased patients studied. Bronchopneumonia and heart disease were the main causes of death. Signs of atherosclerosis were present in most of the studies(AU)

Evolución histórica de las autopsias y situación actual en Costa Rica / historical evolution of the autopsies and current situation in Costa Rica

A continuación se presenta un artículo de revisión en el que se desarrolla la evolución histórica de un acto médico poco valorado: la autopsia. Después de conocer su historia tanto internacional como en Costa Rica se entra a analizar la situación actual de este procedimiento en nuestro país, después de lo cual se concluye que, gracias a la adecuada formación y a la disciplina del personal a cargo, la autopsia médico legal y hospitalaria en Costa Rica están en un nivel de calidad igual al de un país desarrollado, con el mérito de que en nuestras instituciones se trabaja con un presupuesto mucho más limitado, siempre en aras de beneficiar a la sociedad costarricense, tanto en Administración de Justicia como en Salud Pública.

This is a review article about the historical evolution of a medical act poor valued now: the autopsy. After knowing his history both internationally and in Costa Rica, is hard to analyze the current situation of this procedure in our country, after which it is concluded that, with the proper training and discipline of staff in charge, forensic and clinical autopsies in Costa Rica are at a level of quality equal to a developed country, with the merit of our institutions are working with a much more limited economic resources; all this work always in the interest of benefiting the Costa Rican society, across administration of justice and public health.

Abordaje del trauma cráneo encefálico en patología forense / Addressing head trauma in forensic pathology

En el presente artículo se describen los mecanismos de trauma y las principales lesiones que se encuentran en una muerte violenta ocasionada por traumatismo cráneo encefálico con el fin de contribuir a un abordaje práctico de estos casos en Patología Forense, tanto para los médicos de planta como para los que están en formación, con el propósito de homogenizar y unificar criterios y siempre con el objetivo final de contribuir con una adecuada administración de justicia y así cumplir con el objetivo de la especialidad en Medicina Legal.

In this paper we describe the main mechanisms of trauma and major injuries that are founded in a violent death caused by head trauma in order to contribute to a practical approach to these cases in Forensic Pathology for both staff physicians and residents, in order to standardize and unify criteria; and always with the ultimate goal of contributing to the proper administration of justice that is the final purpose in Forensic Medicine.

La autopsia en los 50 años del Hospital Militar Central "Dr. Luis Díaz Soto" / Autopsies in the 50 years of "Dr. Luis Díaz Soto" Central Military Hospital"

Introducción: en 1985 se presentó el Sistema Automatizado de Registro y Control de Anatomía Patológica, objeto de estudio para la docencia y múltiples investigaciones. Objetivo: actualizar las principales causas de muerte en adultos y obtener las experiencias para elevar la calidad de la asistencia médica que se brinda. Métodos: estudio retrospectivo, longitudinal con el referido sistema entre los años 1962 y 2011 de las autopsias realizadas en el Hospital Militar Central "Dr. Luis Díaz Soto". Se analizaron los grupos de edad, sexo, especialidad de egreso, presencia de infección, cáncer, daño múltiple de órganos, causas de muerte y relación clínico-patológica. Resultados: la mitad de los casos fallecidos ocurrió en el área de atención al grave y el daño múltiple de órganos afectó casi el 50 %. La bronconeumonía y el infarto cardiaco constituyeron las principales causas de muerte, mientras que en las básicas resultaron las aterosclerosis. Las discrepancias para ambas causas de muerte fueron de una cada cinco autopsias. Conclusiones: las principales causas de muerte permiten caracterizar los principales problemas de salud. El Sistema Automatizado de Registro y Control de Anatomía Patológica y el daño múltiple de órganos han sido logros importantes de la especialidad obtenidos en 50 años en el Hospital Militar Central "Dr. Luis Díaz Soto". La metodología de trabajo alcanzada en el estudio de la autopsia en dicha institución constituye referencia para otros hospitales y permite elevar la calidad de la asistencia médica que se brinda.

Introduction: the Automated Pathological Anatomy Registration and Control System was first introduced in the year 1985 as an object of study for both teaching and a large number of research tasks. Objective: update the main causes of death among adults and obtain experience useful to improve the quality of the medical care offered. Methods: retrospective longitudinal study, based on the aforementioned system, of the autopsies performed at "Dr. Luis Díaz Soto" Central Military Hospital between the years 1962 and 2011. The variables analyzed were age group, sex, discharge specialty, presence of infection, cancer, multiple organ damage, cause of death and clinico-pathological relationship. Results: half of the deaths occurred in the critical care area, and multiple organ damage affected nearly 50 %. Bronchopneumonia and cardiac infarction were the main causes of death, whereas atherosclerosis were the basic causes of death. Discrepancies for both causes of death were one in every five autopsies. Conclusions: the main causes of death make it possible to characterize the main health problems. The Automated Registration and Control System for Pathological Anatomy and multiple organ damage is an important achievement obtained by the specialty in the 50 years of "Dr. Luis Díaz Soto" Central Military Hospital. The methodology developed for the study of autopsies in the center constitutes a reference for other hospitals, and makes it possible to improve the quality of the medical care offered.

Autópsias psicológicas sobre suicídio de idosos no Rio de Janeiro / Psychogical autopsies into suicide among the elderly in Rio de Janeiro

Esse estudo analisa autópsias psicológicas e contextualiza problemas e fatores que levaram algumas pessoas idosas a acabar com a própria vida na cidade do Rio de Janeiro, entre 2004 e 2007. O estudo parte de 26 laudos periciais de homens e mulheres que cometeram suicídios no centro, na zona norte e na zona sul da cidade. As famílias desses idosos foram contatadas por carta e telefone e depois, pessoalmente. Foram oito autópsias psicológicas, por meio das quais foram coletados dados de identificação, genograma da família e uma entrevista que reconstituiu o modo de vida e as razões da violência autoinfligida. Os entrevistados foram familiares, amigos e conhecidos das vítimas. Os suicídios estão associados a depressão, a enfermidades físicas e mentais graves e a fatores socioculturais como decadência profissional e socioeconômica. Esses eventos ocorreram com e sem apoio familiar, com e sem acompanhamento médico. A fragilização cumulativa de recursos pessoais e sociais no ciclo vital revela que o risco do suicídio em idosos exige cuidados permanentes de saúde pública.

This study analyses psychological autopsies and contextualizes problems and issues that led to elderly people taking their own lives in the city of Rio de Janeiro between 2004 and 2007. The study began with an analysis of 26 expert findings of elderly men and women who committed suicide in the central, northern and southern areas of Rio de Janeiro. The sample was contacted by letter and telephone and after that, by a one-on-one conversation. Eight psychological autopsies were conducted, in which identification data and family genograms were collected followed by an interview to profile the life style and the reasons for the self-inflicted violence. The interviewees were family members, friends and acquaintances of the victims. The suicides are associated with depression, serious physical and mental illness, as well as socio-cultural factors related to professional and socio-economic decline. The suicides occurred with and without family support, with and without medical care. The cumulative fragility of personal and social resources within the life cycle reveals that the risk of suicide among the elderly demands permanent care from the public health authorities.

Valor del diagnóstico de la tuberculosis pulmonar por autopsia en Cuba / Importance of the pulmonary tuberculosis diagnosis by autopsy in Cuba

El diagnóstico de la tuberculosis pulmonar por autopsia mide la calidad de la atención médica y el comportamiento de la enfermedad. Objetivo: Determinar los fallecidos que murieron con y por Tuberculosis pulmonar y la concordancia entre los diagnósticos clínico y anatomopatológico en el período estudiado. Método: Se examinaron 77 341 necropsias del Registro Nacional de Autopsias de Cuba, en adultos, del 1994 -2003. Se realizó un análisis multicausal de la muerte. Resultados: El 0.2 % de los pacientes murió con tuberculosis pulmonar y 0.04 % por tuberculosis pulmonar. El 71 % correspondió al sexo masculino y la edad promedio, 69 años de edad. La causa directa más frecuente de la muerte fue a expensas de la bronconeumonía. La discrepancia diagnóstica entre el diagnóstico clínico y el anatomopatológico señaló 26 % en la causa directa y 53 % en la causa básica de la muerte. Conclusiones: Los pacientes fallecieron en edades avanzadas y un porcentaje importante por Bronconeumonía. El estudio confirma que existe una frecuencia muy baja de tuberculosis pulmonar activa y concordancia diagnóstica en la mitad de los pacientes. También una discrepancia diagnóstica en la tercera parte de los casos como causa directa de la muerte. Quedaría definir por otras investigaciones los factores que influyen en los casos diagnosticados postmortem que mantienen la transmisión oculta de la enfermedad.

The quality of medical care and the behaviour of the illness can be valued through the achievement of the pulmonary tuberculosis diagnosis by autopsy. Objective: To determine the patients who died with pulmonary tuberculosis and because of it and to establish the agreement between the clinical and the pathological diagnoses in the analized period. Method: A total of 77 341 necropsies taken from the Cuban national autopsies register were analized taking as reference a period of ten years (1994-2003).The clinical records were examined in those cases in which active tuberculosis was found. Results: The 0,2 % of the patients died with pulmonary tuberculosis and a 0.04 % died because of it. The average age was 69 years and 71 % of the persons were men. Broncho-pneumonia was the most important cause of death. The diagnostic discrepancy between clinical and pathological diagnosis showed a 26 % as the direct cause of death and a 53 % as the basic cause of death. Conclusion: An important percent of the deaths were by broncho-pneumonia and most of the patients died at an advanced age. It was confirmed a low frecuency of active pulmonary tuberculosis and there was diagnostic agreement in half of the patients. There was also a diagnostic disagreement in a third of the cases with direct cause of death. Other investigations could define the factors of the post-mortem cases diagnosed with pulmonary tuberculosis which keep hidden the transmission of this disease.

Análisis Médico Legal de los homicidios en Costa Rica en el 2008 / Medical legal analysis of the homicides in Costa Rica in 2008

Recientemente se ha comentado mucho en la opinión pública de temas como la seguridad ciudadana, la criminalidad y en general de la violencia social y su aumento en Costa Rica. Con el fin de brindar un panorama actualizado de un indicador objetivo como los homicidios se realizó el presente trabajo, en el cual se revisaron todas las autopsias de 2008 (un total de 3264) efectuadas en el Departamento de Medicina Legal de Costa Rica. Se obtuvo que una sexta parte de las mismas correspondió a homicidios, lo cual generó una tasa de mortalidad de 11,36 por 100000 habitantes, por mucho la más alta en la historia contemporánea de nuestro país. El perfil predominante de las víctimas fue: ser de sexo masculino, en edad económicamente productiva, con fatalidades acaecidas en la noche, los fines de semana, en la capital y las provincias portuarias, con fallecimiento en el sitio del suceso por heridas por proyectil de arma de fuego en cabeza, cuello y tórax, con presencia de alcohol y cocaína en un porcentaje significativo de las víctimas. A pesar de la complejidad de los factores que originan este fenómeno, se insiste en la prevención de la violencia social desde el núcleo familiar.

Recently, in Costa Rica, topics like citizen security, crime rates and social violence have been a topic on public opinion. There are two positions: violence has increased and violence has not increased. We made this investigation for to give an update of the panorama of homicides in Costa Rica, one of the most important and objective indicator of social violence. We have analyzed all autopsies (a total of 3264) occurred during the year 2008 which were made by the Departamento de Medicina Legal de Costa Rica. From these revision, we obtained that one sixth of these autopsies were homicides, which means that the mortality rate was 11.36 per 100000 habitants, the highest of the modern Costa Rican history. The most common profile of the victims was: male, productive age, homicides occurred predominantly during nights, weekends in capital and main harbor provinces, with death at the scene by gunshot in head, neck or chest; a significant percentage were under alcohol and cocaine effects. We insist in the prevention by education fron the family care as a fundamental tool to avoid social violence.

Avaliação dos fatores associados a tromboembolismo pulmonar (TEP), em uma série de autópsias de dez anos / Evaluation on factors associated to pulmonary thromboembolism (PE) in a series of ten years of autopsies

INTRODUÇÃO: A literatura demonstra que tromboembolismo venoso permanece como uma doença subdiagnosticada entre os pacientes hospitalizados, com aproximadamente 25% dos casos associados à internação. OBJETIVOS: Avaliar as doenças associadas ao desenvolvimento de tromboembolismo pulmonar (TEP) diagnosticado em autópsias, e demonstrar a frequência de TEP como causa do óbito ou fator contributivo. MÉTODOS: Estudo caso-controle retrospectivo, realizado no Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1995 a 2004. Revisamos os relatórios diagnósticos das autópsias, identificando TEP fatal, quando TEP foi a causa de morte, e TEP não fatal, quando TEP foi doença associada. RESULTADOS: 1.506 pacientes (502 casos e 1.004 controles), 18.359 óbitos no período, média 2.040; 71,2% desses submetidos a autópsias. Observou-se importante declínio nas taxas de autópsias. De 1995-1999 (87,2%) e 2000-2004 (54,4%); p = 0,016. Dos 502 casos (3,8%), em 328 (2,5%) TEP foi causa de morte e 174 (1,3%), causa contributiva. Gênero: 51,6% homens e 48,4% mulheres. Idade: TEP fatal (328) vs controles (1.004), diferença estatisticamente significativa (p = 0,013). Condições prevalentes: câncer grupo, 31,4%, pós-operatório grupo, 17,2%, infecção grupo, 11,7%, e AVC grupo, 11%. Câncer de pulmão, 3,5%, câncer de cérebro e linfoma, 2,8%. Tempo de internação foi utilizado como indicador de imobilização. Outras doenças: AVCH (7,7%), pós-operatório de abdome (6,7%), pneumonia (5,9%), AVCI (3,1%) e pós-operatório vascular (4%) foram frequentes no grupo controle. Em contrapartida, aterosclerose (1,4%), ITU (1,2%), pós-operatório de ginecologia (0,8%), pós-operatório de obstetrícia (0,6%) e doença falciforme (0,6%) foram frequentes no grupo TEP. Cirrose, média de 14,9 dias de internação dos controles vs TEP com 4,4 dias (p < 0,001). Análise multivariada incluiu as condições com p 0,20 da univariada, idade e tempo de internação...

INTRODUCTION: Literature shows that venous thromboembolism (VTE) remains as a sub-diagnostic disease among hospitalized patients, approximately 25% of all cases are associated to hospitalization. PURPOSE: Evaluate diseases associated to pulmonary thromboembolism (PE) development diagnosed in autopsies, and demonstrate the frequency of PE as cause of death or as a contributive factor. METHOD: The reports performed from 1995 to 2004 in a Brazilian tertiary referral medical school we reviewed for a retrospective study the autopsies diagnosis, identified as fatal PE, when PE was the cause of death and nonfatal PE, when PE was an associated disease. RESULTS: 1,506 patients (502 cases and 1004 controls), 18,359 deaths during the period, average 2,040; 71.2% of these were submitted to autopsies. It was observed an important decline in the autopsies rates. From 1995-1999 (87.2%) and 2000-2004 (54.4%) p = 0.016. From 502 cases (3.8%), 328 (2.5%) PE was the cause of death and 174 (1.3%) PE was contributive cause. Gender: 51.6% males and 48.4% females. AGE: fatal PE (328) vs controls (1,004) significant statistic difference (p = 0.013). Prevalent Conditions: cancer group, 31.4%, postsurgical group, 17.2%, infectious group, 11.7%, and CVA group, 11%. Pulmonary Cancer, 3.5%, Brain cancer and Lymphoma, 2.8%. Hospitalization period was taken as immobilization indicator. Other diseases: HCVA (7.7%), abdomen postsurgical (6.7%), pneumonia (5.9%), ICVA (3.1%) and vascular postsurgical (4%) were frequent in the control group. On the other hand, atherosclerosis (1.4%), UTI (Urinary Tract Infection) (1.2%), gynecology postsurgical (0.8%), obstetrics postsurgical (0.6%) and sickle cell anemia (0.6%) were frequent in the PE group. Cirrhosis, average of 14.9 hospitalization days of the controls vs PE with 4.4 days (p < 0.001). Logistic regression analysis includes the in univariated analysis with p 0.20, age and the hospitalization period. Protector factor for PE: Aortic...

An Analysis of 342 Forensic Autopsies (1987~1989)

The post-mortem investigation (PI) system in a jurisdiction varies greatly with its lagal and social system and culture. Korean PI system considred as "judical autopsy prime" is not well astablished. To develop our own system, it is neccessary to overview the forensic autopsis performed in Korea. Three hundred forty two forensic autopsies were performed prospectively, every 7 to 15 days among the cases of National Institute of Scientific Investigation (NSI), Ministry of Internal Affairs, during the period from October, 1987 to March, 1989. Cases were those registered to NISI on the author's duty day, not selected or rejected. For each case, autopsy protocols, autopsy reports and police's investigation reports were reviewed. The postmortem hours prior to autopsy were about 60 hours in average, mainly due to the defective PI system. The commonest cause of death(COD) among the natural deaths was the circulatory diseases, followed by diseases f the digestive system. As to the manners of death(MOD), the proportion of the natural deaths was now, comparing to those reported in America and Japan, partly because of our PI system where the public prosecutors determine whether autopsy is necessary on the particular area or not. For the proper application of medical knowledge to the practice of law, the independent institute and qualified specialist for the forensic medicine are mandatory.

Systemic fungal infection: A study of 138 autopsies.

A study of 138 autopsy cases with deep fungal infections out of a total of 3328 autopsy cases during the period 1980 to 1985 was carried out when the causal organisms were determined, 160 infections were found: 10 were caused by pathogenic fungi (Crytococcus neoformans) and the other 10 were caused by opportunistic fungi including aspergillus, candida, mucor and penicillium. A combination of more than one fungus was noted in 21 cases. The central nervous system was most likely to be affected by crytococcus, whereas the respiratory and alimentary systems were infected by aspergillus and candida, respectively. In this study, males were somewhat more commonly affected than females. Fungal infections were common in those who had underlying diseases, internal malignancies, diabetes mellitus as well as in patients with a history of prolonged use of antibiotics and corticosteroids. Compared with a previous study in the same hospital, the incidence definitely increased, although the other patterns of the systemic fungal infections showed no significant change.

Identificación de cuerpos ferruginosos en pulmones humanos: estudio retrospectivo de 1975, 1982 y 1988 / Identification of ferruginous bodies in human lung: retrospective study in 1975, 1982 and 1988

Se analizaron 90 casos de autopsia, buscando cuerpos ferruginosos (CF) como indicadores de contaminación ambiental por partículas. Los casos correspondieron a 1975, 1982 y 1988. Se procesaron dos gramos de tejido pulmonar humano con la técnica de digestión en blanqueador comercial. Se observaron las siguientes concentraciones: 4.2 CF/g en 1975, 1982 y 1988 42.5 CF/gramo. Asimismo, los residentes de la Ciudad de México, del sexo masculino, fumadores y en algunos casos con cáncer broncogénico, presentaron mayores concentraciones de CF. Se observó correlación entre ocupación y CF, notándose tres parámetros de distribución: 0-100 límite ambiental, 100.1-1 000 exposiciones ambientales y ocupacionales, y más de 1000 para casos ocupacionales. Del total de CF cuantificados, el centro de asbesto predominó con variaciones del 53 al 75 por ciento. No se encontró correlación con la edad. En conclusión, es patente la exposición no ocupacional al asbesto.

The presence of Ferruginous Bodies (FB) at 90 autopsy cases were analysed. The cases belong to 1975,1982 and 1988. Two grams of lung was digested and observed the following results: 4.2 FB/g in 1975,17.0 FB/g in 1982 and 42.5 FB/g in 1988. Males, Mexico City dowlers, smokers and carcinoma bronchogenic group were exposed to higher FB. The correlation between employment and FB was observed. Three parameters of FB concentration: 0­100 environmental exposure, 100.1-1000 environmental and occupational exposures, and more 1000 to occupa­tional exposure was observed. The asbestos core was predominant in all FB analysed. No correlation between age and FB was observed. Finally there is a non-occupa­tional exposure to asbestos fibres in our environment.